Wednesday, November 11, 2009

Nurse Practitioner's Response to The American Spectator's View Of The New House Health Care Bill

Below is Peter Ferrara's opinion of the Health Care Reform Bill that is being considered. I am offended by two points that he makes while referencing health care providers. Read and then go to below to see what I was having a problem with..

One confusion arising from the House bill is that its provisions are phased in over several years. Over the first 10 years of full operation, the House bill actually cuts Medicare by $800 billion, as scored by CBO. The cuts for Medicare Advantage plans will be close to $200 billion, and despite President Obama's phony shtick that if you like your health plan you can keep it, the Administration itself estimates that 8 million seniors will lose their Medicare Advantage plan as a result, 73% of those with such plans.

This is the beginning of health care rationing for seniors, as the payments to their doctors and hospitals for the care that currently maintains their health will be slashed back. In addition, as Betsy McCaughey explains in the Journal, the House bill moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home." The medical home is this decade's version of HMO restrictions on care. A primary care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary care provider. Medical homes begin with demonstration projects, but… HHS…is authorized to "disseminate this approach rapidly on a national basis."

What this means is that your doctor is paid a flat monthly fee for your care, and referring you to a specialist or for a diagnostic test effectively comes out of his pocket. So if you need an MRI or a CT scan to see if you have cancer, or to check if that pain in your chest is due to clogged arteries, or if you need to see a specialist to treat cancer or heart disease, the doctor has a financial interest to delay or deny it. Financially, if you are actually this sick, he will be better off if you die sooner rather than later. That is the result of the perverted, inverse incentives the House health bill creates for medical providers.

I don't like the inference that one would have to "settle" for a Nurse Practitioner. If you ask my patients, they will tell you that they prefer to see a NP over a physician anyway.

His idea that primary care providers are the gatekeepers is nothing new. It's been that way since I can remember. Most specialists require referrals from a patient's primary.

My biggest gripe is the insinuation that ANY health care provider would EVER not use whatever resources it takes to accurately diagnose a patient. If a doctor or NP or PA ever kept a patient from being diagnosed because it would take money out of their own pockets, they should be run out of health care immediately! True health care professionals are not just in it for the money. They really like helping patients and feel a moral obligation to do so. Of course we all need to pay the bills and I can't afford to do it for free. One day, I will be able to donate my services as so many do. Till then, I will keep on taking care of the patients who prefer me! Carry on..

P.S. This is the response I left on this blog article.

I find it a little insulting that you think that patients "settle" for a NP. My patients prefer me to other physicians and will tell you so. I am a great health care provider with patients who actually come back and do the necessary maintenance to remain as healthy as they can be. I serve in a rural community who is having a very hard time attracting physicians. I find it appalling that you would think that any health care provider would keep a patient from appropriate testing in order to line their own pockets. If they are doing so, they need to be run out of health care. I take care of patients because it's a calling and not just because it pays well. I am curious to see if you have ever seen a nurse practitioner in action before you make snap judgments about the quality of our care.

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