Part of the reason health care software is so horrible is because docs are clearly on the wrong side of the “digital divide”. I’ve watched many a little health care software start up with good ideas crash and burn from complete lack of interest from the technophobic health care industry. Heck, I even worked at such a company.

I’m with you, PostalMed. To me, that looked like a symptom of Stockholm Syndrome.

And you are absolutely right about electronic prescribing and the IRS recoupment scheme.

All of these bad ideas emanate from a single source: the notion that government can “manage” the health care market.

Because every attempt to “manage” it creates 5 new problems, our D.C. masters must create 5 new boondoggles, which create 25 new problems, ad infinitum.

I am a physician, and I was opposed to the veto override of the Medicare payment cut bill. I was also put out by organized medicines fawning and grandstanding for a measly 1.1% fix. But my opposition was not for the reasons you might imagine.

Whether or not the Medicare Advantage plans got cut was not an issue for me; I have always assumed that the life of this program was limited, just like the preceding Medicare HMO program (which MA so closely resembles), and that it would be killed eventually, just like Medicare HMO, by forcing it to cover more and more services for less and less money until it became financially unfeasible for the insurance companies to continue to operate the plans, and the companies would then all “voluntarily” bail out of the program. It’s not a matter of if but rather just when this would happen; if Obama wins in November, this will start in early 2009, right after the insurance companies are cut out of the Medicare Part D program, which I expect will be the second or third bill to be passed by that new Congress.

My opposition to the bill that was passed by veto override was two-fold. The first part was the carrot-stick “bonus-reward” provision to try to force physicians into implementing electronic prescribing. To begin with, the technology is not yet ready-for-primetime, and the legal restrictions (e-prescribing across state lines and e-prescribing controlled substances for starters) have not been lifted to make it more useful; these things needed to be corrected BEFORE any required use is mandated. Forcing doctors to use e-Rx without also forcing pharmacies to accept it makes little sense as well, especially in small towns and rural areas. Furthermore, the bonus does not provide enough funds to adequately pay for the implementation and then ongoing support of the e-Rx software — even before the bonus phases out, leaving physicians with the full brunt of paying for the continued costs of using these systems from that point onward and from which the majority of the financial benefit goes mainly to the PAYORS.

My second major issue with the bill was the provision allowing the IRS to recoup back or unpaid taxes from the physician’s Medicare payments. Not that I am in this boat, but for those who are, it will wreak havoc on trying to keep the financial records straight, and will likely result in more illegal balance billing as some physicians will bill the “unpaid” charges on to patients. (Not to start a new argument, but there are a lot more physicians that balance bill Medicare patients than most people realize, and, as long as it remains illegal, someone should be enforcing that provision, yet no one does, as it recoups nothing for the government except some measly fines.)

Organized medicine has been telling Congress for over 10 years to correct the seriously flawed Medicare payment update formula, but all we have managed to get are a series of stop-gap corrections that do not come anywhere close to the rate of medical inflation. I for one was ready to take to the streets, to take my 10.6% pay cut and join many of my fellow physicians in walking out on Medicare, thus creating such an access problem that Congress would be forced to finally address the issue. Guess that will now have to wait until the 20+% cut of 2010. It’s not going to be pretty.

Ultimately, the only ones who are really going to feel any pain are our patients. It is so sad that we physicians have to use our patients as pawns to get any payor, not just Medicare, to take our complaints seriously. but in my experience so far, that’s been the only strategy that has any impact.

The cuts are coming with the grim inevitability of Greek tragedy. Like your decrepit NHS, Medicare is financially unsustainable.

So, the docs will (along with the patients) be screwed in the end (so to speak).