What's ruining medicine for physicians: Government regulations

At the end of every year, Medical Economics publishes a list of the top challenges facing physicians. This list is generated by surveying our physician readers.

For this year’s list, we decided to recast the question. Instead of asking what challenges physicians face, our editorial staff wanted to hone in on what issues annoy and frustrate doctors and get in the way of what’s truly important: Treating patients and running practices.

And so we asked physicians in a poll: “What ruining medicine for physicians?”

In our list of the nine issues ruining medicine for physicians, the goal is not to dwell on the negative aspects of working as a physician. Instead, we wanted to show our readers that they share common challenges when dealing with the vexing issues facing primary care in today’s complex healthcare environment. Each piece also offers practical solutions that physicians can start using in their practices today.

#3 Government regulations 

When it comes to value-based care, government regulations often get in the way of physicians’ best efforts and that’s a challenge that irks many in healthcare. 

Physicians told Medical Economics earlier this year that complying with government regulations was one of the top reasons their practice finances worsened in the last year. Many physicians also cited penalties from pay-for-performance initiatives as a reason. 

Kyle Varner, MD, an internist and the author of White Coat Cartels, says under a value-based care system, physicians and hospitals face a penalty for caring for very sick or very difficult patients, because when reimbursement is tied to outcome, it is really tied to the demographics of the patient population.  

“Low-risk patients will inevitably lead to higher reimbursement, and those who care for the highest-risk patients will end up being penalized,” he says. 

Richard E. Anderson, MD, FACP, chairman and chief executive officer of The Doctors Company, says the U.S. healthcare system isn’t set up to accommodate new payment models, so the transition from where we are to where we are heading will be long and difficult. In fact, The Doctors Company’s recent “Future of Healthcare” survey revealed high levels of resistance and skepticism among physicians when it came to value-based care.

“Healthcare is different from other industries. Human biology is almost infinitely complex and cannot be fixed on assembly lines,” Anderson says. He believes the patient must be at the center of caregiving and there should be less concern of operating as if in a factory. The survey reflects that many believe endless regulations distract from patient care and waste physicians’ valuable time.

Daniel Stock, MD, a family practitioner in Noblesville, Ind., says the problem with value-based care is that it isn’t the patients’ values that get reimbursed for, but rather whatever the accountant and his chosen “experts” value.  

“To make matters worse, governments and insurers think that time spent cutting patients is more valuable than time spent thinking about patients, so they pay a premium for those services, which leads providers to recommend surgery over other treatment,” he says. 

The impact has been felt in the need for additional documentation and justification for services and payment. Moreover, each time another level of documentation is added, it takes time away from the patient encounter and from communicating with the patient or other physicians involved in caring for the patient.

Verner believes the best solution is to get the government out of the doctor-patient relationship.

“Healthcare policy should be laser-focused on giving consumers power and choices,” Varner says. “Health savings accounts, healthcare cost sharing organizations, direct primary care and medical tourism are all viable solutions that can contribute to a revolution.”