Big pressures mount for the new ICD-10 coding system starting October 1 that will be a disaster for patient care. Concurrent is the realignment of Medicare reimbursement with new systems of care called Accountable Care Organizations. Most ACO's are unsuccessful.
More onerous initiatives driven by IT are flooding our office every day. If you are "late" filling your prescriptions by a few days, we get a letter about your "non-compliance". If you are not prescribed specific meds with certain diagnoses, such as ACE inhibitors and statins for people with diabetes, we get a letter about the "gap in your care"- repeatedly, even if we send in something saying that you are allergic or have other reasons not to take the medication.
Primary Care is folding under the pressures. Dr's are moving around, quitting or leaving in preparation for the coming mess. Med students see the piles of useless drivel and shift their specialty selection to specialties that have less hassle and more money. About 3,000 new Family Physicians are produced annually while there are more than 17,000 job openings for Family Physicians, and getting worse.
Both Dayton flagship hospitals don't train primary care physicians since there's not enough profit in it. The new health plans initiated by the Exchanges from the Affordable Care Act have lots of enrollees, but don't have enough physicians to care for their primary care needs. We see many of these insured patients in the free clinic I work with in Bellbrook.
We have to consider walking away from all insurances to survive. Yes. All independents have to get survival plans ready for the next wave of initiatives- none of which helps health. You should think of what happens if you have no primary care access in the next few years. We have to find a survival strategy for the short haul.
We may be shifting our practice style in October.