Lots of things are happening to medical practices
today, and at an accelerating pace. I remember 40 years ago when my GP quit
medicine, giving up a nice practice in an upscale community because of
Medicare’s onerous reporting burdens. He was
independently wealthy, and had a nice social life, but he was only in his early 40s!
Today, independent private medical practices are
disappearing at an even more alarming rate, being sucked up by hospital conglomerates.
In my area Health Quest and CareMount are cutthroat
competitors. A search on CareMount redirects to “Medical Outsourcing.”
Wikipedia explains: “Some small practices have
outsourced business functions to management services organizations” (MSOs). “Business functions” includes all office staff. My urologist told me
that the benefit to him was that he
can now “just practice medicine.”
Two specialists I have seen in the last year now work for one of these
MSOs. So does my wife’s GP. My internist in NYC is the exception. He resists
the trend and recently, while maintaining a very busy private practice, joined
a boutique medical group where he offers his patients, for a fee, more
personalized attention. I declined. I told him I wanted to see him 3 times a
year for blood work. He suggested I come just once a year.
On a recent final visit to an orthopedic, his receptionist asked me if I
wanted to receive an updated printout of his clinical notes. I told her “no.” After
unexpectedly receiving and reading an earlier version, they upset me. I thought
that they did not fairly reflect what I had told him or his nurse; instead,
they read to me like they were written to be read by the MSO or some clinical
practice reviewer at HHS (Medicare).
I had a similarly eerie experience in Florida several years ago. I had
to fire one physician, who was peddling statins and claimed to be a lipidologist. Another, an endocrinologist, had justly fired
me when I told him he needed to go back to school. They both worked for a large
group that dominated that part of Florida where I spend the winter. Their MSO
is part of HCA Healthcare based in Nashville, Tennessee. The network includes “178
hospitals and 119 independent surgical centers in 20 states and the UK.” The
UK!
The orthopedic – remember, his specialty is skeletal issues, in my case
a torn tendon – asked me if I was eating a “mostly plant-based diet.” Earlier,
his nurse, recapitulating notes from the previous visit, asked me if I was still walking for exercise. I told her I
had NEVER told her that I walked for exercise. I have NEVER walked for
exercise. The only exercise I do is garden work. Where, or more to the point, why was it in their clinical notes that
I walked for exercise? And why would an orthopedic counsel me to eat a “mostly
plant-based diet”?
I protested the counsel to eat a mostly plant-based diet. I replied that
I eat a Very Low Carb diet and would be a carnivore
if my wife would not go apoplectic. I said the body had a zero requirement for
plant-based foods and can make all the glucose it needs via gluconeogenesis
from protein and fat. I also told them that I drink a pint of collagen-filled
bone broth from pasture-raised beef every day to help repair my torn Achilles
tendon (as my brilliant editor had suggested). Tendons are made of collagen. My
ortho appeared to listen attentively and replied simply that he admired a
person who held such passionate beliefs.
My conclusion, I’m afraid, is that to practice
medicine today your MSO MD needs to follow the MSO’s and the government’s “formulary,”
not just with respect to medications, but for lifestyle (“diet and exercise”)
as well. And if those recommendations
are not in your clinical notes, the MD’s
medical practice is penalized by lower reimbursement rates from Medicare and
thus with a lower rating by the bean counters at the MSO….because the MD is not pushing the government’s “lifestyle formulary.”
To not push it risks lower profits for the MSO and even job security for the MD,
based in part on “job performance.” That’s
the price a doctor has to pay today to “just practice medicine.” And that’s what happening to medicine
today.