Your Voice: Doctors can be paid to put patient care on back burner

In regards to the JAMA article (“Irresponsible to say physicians can be bought to put patient care second,”June 25, 2016) alleging physicians can be influenced by drug representative incentives/meals, I have to agree with their points. 

I closed my practice about five years ago. During my 25 years in solo practice, I was bombarded with representative offers of meals, golf and early on, even trips. I would accept meals provided only to me, in conjunction with a detail of the product.

I did accept golf, if a conference was included. I found the representatives to be extremely pushy at every visit. When I decided to become a freelance provider, I worked in numerous offices. What I found, in regards to other representative-doctor relationships, shocked me.

I witnessed representatives providing meals to 15 to 20 staff members (nurses, clerks, medical assistants … even bookkeepers!) Sometimes, the doctor(s) didn’t even appear for the meal or details. 

I also was often told by individual representatives (when asked), that they couldn’t even “get in to see the doctor” unless the whole staff was fed, and some said certain days were set apart for each company. 

The most damning statement I heard from one representative, years ago, was that a local clinic even offered employees free meals-if they took a positive position. I’m glad the industry has had to cut back [on incentives] and I am certain as Congress continues to crack down on these so-called doctor-representative “partnerships,” our profession is going to see even stricter rules, mainly because of the abuses of the above mentioned offices.

I do not believe the behavior is rampant, but as physicians, we all have a duty to be “above” this type of behavior. Coincidentally, it also adds to the cost of each medication unfairly.

Craig Freyer MD

Colleyville,Texas

No doubt about it, EHRs are terrible

As a primary care physician, I’m just going to say it, all electronic health records (EHRs) suck. They suck the life out of physicians, they suck the time out of relationships in human interactions and they suck at any utility other than being a glorified digital file cabinet and a clunky digital cash register.

If we remember one thing, medicine is about patients and patients require time to process new diseases, new treatment plans and new ways of having to cope, then we should all come to the requisite conclusion that patients arguably need more time than EHRs need data.  That said, data is important-trying to solve this problem for myself, I built some software in my office years ago that connects doctors and patients, in between visits that took no extra work from doctors and empowered and engaged patients to connect so their doctor knew how they were doing.

It’s a tool that, surprisingly, is now the tool of choice for many large healthcare systems around bundles and value.  If you care about patients and not metrics, you win.

Anonymous 

online comment

We must stay the Obamacare course

In the article, written by Craig Wax, DO (“Healthcare reform is still possible, but Obamacare must go”, Sept. 25, 2016), the following statements are particularly worthy of attention:  “The ACA is perhaps the largest tax ever levied upon the citizens and the most expensive failure in our nation’s history ...Now we are faced with politicians who promise to ‘fix’ it or double down with government single-payer healthcare.  I vote instead for full repeal.”

The following is my reply to this article:  I want my voice to be heard, as another DO, but with a different view from that of Craig Wax, who espouses a free market for health insurance.  

We had a free market prior to Obamacare, but the poor …  did not have any insurance.  Now 20 million people are covered by Obamacare.  Some people might want to return to the former system, but not my patients, who are grateful that they can be treated for their illnesses under Obamacare.  

Obamacare is not a perfect health system, but it is an improvement over what we had before; it can be improved further.  Ditching it completely would be a giant step backwards.  

Yes, we need to continue Obamacare for those 20 million people and more, because the poor will always be with us, and yes, we are our brother’s keeper.  Especially doctors. 

V. Heemstra, DO

White Plains, New York

Concern for Medicare patients grows

I read your article, “Obamacare Report Card (July 25, 2016)” and the editorial by Dr. Chandler “Obamacare hasn’t solved the challenge of uninsured patients (July 25, 2016)” with great interest. 

I am a solo practitioner in California and would like to point out some of our problems with the ACA expansion of Medi-Cal (Medicaid run by the state of California). When the federal government passed the Medicaid-Medicare parity rule, highlighted in the Report Card article, the state of California took them to court saying that since the state runs the program the federal government cannot tell them what to pay doctors. 

The state won and an average office visit still pays a pitiful $16 which does not cover office/billing expenses for most doctors. Currently, California has the highest number of Medicaid (Medi-Cal) patients of any state and 30% of our population is on Medicaid (Medi-Cal). Since 2013, the Medi-Cal enrollment increased by 39% but the number of participating doctors fell from 69% to 63% and continues to decline. 

Only 69% of participation physicians are accepting new patients. 

So, the ACA has increased the number of people with Medi-Cal but reduced the number of doctors treating them. And yes, in order to get care many patients still have to go to the emergency room. As the federal Medicaid subsidies to states decrease and eventually are gone, state governments will have some very tough choices to make. I cannot see how Medicaid patients will be able to get adequate care in the coming years.

Gary Peer, MD

Livermore, California