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Message: <blockquote data-quote="tRidiot" data-source="post: 2330918" data-attributes="member: 9374">Side with whomever you like... the fact is, they can, do and WILL continue to tell doctors how to treat patients. This monstrosity allows them futher lattitude to do exactly that, on a grander, more comprehensive scale. They are already talking about cutting pay for priamry care physicians who work in clinics even more (you know, those lowest-paid amongst the supposedly "super-elite"?).Try this scenario on for size:You are a primary care physician operating a clinic in a rural area (or an inner-city, whichever you choose). You have a large population of poorly-controlled diabetics and hypertensives who smoke, eat terrible fast-food diets or "comfort food", are morbidly obese and poorly-motivated.You counsel them every time they come to the office (which is less than you'd like to see them because you just can't get them interested in cokming). They just want you to prescribe them another pill to "fix it". They have no motivation in their own care, no incentive to fix themselves or comply with treatment, and you watch them die off one by one from heart attacks and strokes, or have limbs cut off one by one from diabetes.You used to see your patients in the local hospital, but now you no longer have time. Since you're required to see 40-50 patients per day in the clinic just to make ends meet - this takes usually 9-10 hours, having a quick "lunch" at your desk (meaning grabbing a bite of your sandwich while running in and out of rooms, as it gets colder and soggier) while seeing patients, filling out insurance authorizations, prior-auths for medications and calling specialists who ignore your messages trying to get procedures or consults for those of your patients who need something extra you can't provide. Spending an extra hour or two rounding on patients at the hospital (which means getting up at 5AM every day and taking call every single night) just got to be too much, since you'd also frequently have to go back after clinic to see them if they were in the ICU or something, then spend several hours a night working on computerized charts from home trying to finish all your clinic notes and other assorted paperwork.16-hour days are the norm.Now... the .gov says to you, "Sorry, Dr. X, we've been examining the computerized documentation of your patients provided in our national database, and we see that not only do they not have their labwork performed on a 'routine-enough'" basis, but when they do, their cholesterol is on average too high, and their blood sugars are also out of optimal range. Therefore, we're going to start reimbursing you less money for each visit by 10% this quarter and 15% next quarter, unless you get your patients' blood sugars and cholesterol levels under control and get them to do their labs more frequently. In fact, this reduction in reimbursement will continue until your patients' health improves." Meanwhile, Dr. Y, up in a fancy-ritzy area of the big city, whose patients are all upper-income, privately-insured up-and-coming businesspeople who work out regularly, avoid poor diets, don't smoke and are more motivated and concientious people, will be receiving an increase in his reimbursement, because he has better outcomes.Sounds like a great plan, doesn't it?Get ready... it's coming. In fact, they've already TOLD us they're going to do this, as soon as they get a national database for monitoring people's health. It's coming.What do you think your doctor is going to do, when you've had 6 months'-worth of poor labwork and you are beginning to affect her bottom line, all the while requiring more time and effort?That's right... sayonara. You're gonna get cut like an overweight wide receiver.Bury your heads in the sand and lsay it can't happen. Go ahead.</blockquote>

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