It Now Affects All of Us…The Final Pearl

October 2nd, 2014 By Steven Knope, MD

It has been a pleasure writing The Pearl for you over the past several years. I have very much enjoyed your feedback on my newsletters. Because the response has been so positive, I have taken several hours every month to write these articles. However, due to some challenging new developments in the Tucson medical community, I will no longer have the time to write The Pearl. So this will be my last newsletter.obamacare In some of my newsletters, I have warned you about the coming crisis in medicine as a result of the sweeping changes of ObamaCare. The impact of this law is now being felt in two specific areas in our community: specialty medical care and hospital care. No one will be immune from the impact of this law. The reason it will affect everyone is that the power of medical decision-making has become concentrated and centralized among a few players. Not only do we have a new government bureaucracy of ObamaCare in Washington, but control in the remaining private sector has shifted from small community hospitals and private doctors to large hospital management corporations. National hospital corporations are now employing doctors and competing with private doctors in the community, in some cases driving private doctors out of business or out of Tucson altogether.

Many specialists and primary care doctors have already left private practice in Tucson. The Affordable Care Act, as it is written, has placed private doctors at a financial disadvantage when competing with hospital-owned clinics. For example, the same procedures done in a hospital owned clinic are reimbursed at a higher rate than they are for a private doctor. As a result, many specialists have left private practice and become employees of hospitals. Others have retired early or moved to cities in which they can survive financially. In certain areas of medicine, I am finding it more difficult to get prompt subspecialty care for my patients. Over the past 2 years, I’ve had to send more patients out-of-state to UCLA, the Cleveland Clinic and other tertiary referral centers to get the subspecialty care that they need.

In addition, for the first time in my life, I have serious concerns about the quality of care in the hospitals in Tucson. I am not prepared to document these concerns in writing, but I will share these issues in person with any of my patients who want to know more about the problem.

Put simply, small community hospitals and private community doctors are disappearing. National corporations, with headquarters outside of Tucson, have taken control of the way that medicine is practiced. Medicine is becoming an assembly line. Doctors are becoming shift workers. Hospital management corporations have installed electronic medical record systems in every hospital in the city, which have been an unmitigated disaster for all of the physicians in these institutions. Multimillion-dollar electronic medical systems are not functioning properly and are interrupting patient care and communication between doctors and nurses.

affordable care actNational corporations now make the rules for local physicians, which often have nothing to do with the practice of good medicine and have everything to do with the bottom line. A well-respected ER physician who has worked at my hospital for 22 years just told me that he is leaving the hospital due to concerns about patient safety. He has decided to leave the city altogether. I’ve heard similar stories from other colleagues at other major hospitals in town, meaning that these problems are systemic and cannot be solved by simply changing hospitals.

Unfortunately, the problems that I predicted as a result of the Affordable Care Act are no longer hypothetical. These problems are now here in Tucson and I am afraid that they are here to stay. For this reason, I have chosen to stop writing. Instead, I will devote my time behind the scenes to finding creative solutions for my patients so that they will have contingency plans when the local medical community can no longer meet their needs. I will do my best to keep you out of the hospital.

Again, I very much appreciate your interest in The Pearl over the years and I thank you for supporting my medical practice. I will end by making one final recommendation: Stay as healthy as you can. Be proactive about your health. See me early for any significant medical problems and don’t wait to become sick. Exercise regularly, stay lean and take care of your body. Your goal should be to maintain optimal health. If you get into a situation where I feel that you would be better off leaving the city for subspecialty or outside hospital care, I will make the recommendation that you do so. In such a case, I will facilitate your transfer so that you will receive the best medical care available.

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