Crisis In Health Care: Vermonters Are Facing Doctor Shortages and Bureaucratic Regulation

By Alice Dubenetsky

Vermont residents may be in for an unpleasant surprise if the Green Mountain Care single payer healthcare system is fully implemented in the coming years, as proposed by Governor Shumlin and Democrat controlled legislature.

H.R. 202, also known as the Green Mountain Care bill, was signed into law amid much fanfare on May 26th of this year. Much was made of the plan’s promise to provide quality health care to all Vermonters, regardless of income or the status of their insurance coverage. On it’s own, the plan has a number or problems, according to Dr. Dan McCauliffe, a Rutland Dermatologist who has done extensive research into the problems associated with the current administration of Medicare and Medicaid. According to McCauliffe, Green Mountain Care, compounded by the national health care law passed last December (The Affordable Care Act), is going to proffer a whole host of new problems to those who provide medical services and to those who need them.

Vermont’s doctors are already feeling the pinch from decreasing Medicare and Medicaid reimbursements, coupled with increasingly onerous regulations. But now many doctors see a perfect storm looming and are concerned that their patients are unaware of the potential shortfalls.

How many physicians will chose to remain in private practice in Vermont? What about future restrictions on services and treatments that are just around the corner with single payer’s cost savings regulations?

Drastic Medicare Cuts Loom

One of the biggest threats to private practice primary care physicians was forecast by the Congressional Office back in 2006 in an Economic and Budget Issue brief about the rapidly rising cost of the Supplemental Insurance Program (Medicare Part B).

Medicare Part B pays for physicians services, outpatient hospital services, durable medical equipment, physical therapy and certain out-patient services. The Sustainable Growth Rate formula called for a reduction in fees by about 4 to 5 percent annually for the next several years unless overridden by congressional legislation, which has been the case for the past several years. Today, with massive federal budget deficits threatening every aspect of government funding, Vermont’s doctors are bracing for a scheduled 30% decrease in Medicare reimbursements in 2012.Donald Berwick, head of the Centers for Medicare and Medicaid Services ((CMS) issued a statement about the cut in which he expressed concern, going so far as to say that the pay cut “would have serious consequences “. Unless there is congressional action on their behalf, a move that may be in doubt in the current climate of economic crisis and the political pressure being put to bear to limit spending and cut costs across the board, the cuts would go into effect in the 2012 calendar year.

“There will be total pandemonium in health care,” said McCauliffe during a recent telephone interview. He said that physicians would likely revolt, possibly by leaving their practices entirely.

Burdensome Regulations

Vermont doctors, like doctors nationally, already face onerous rules and regulations that limit productivity and are acting as an encumbrance to private practices. Dr. McCauliffe used the example of electronic medical records to illustrate his point. Not only is the complexity of the average medical practice out of control, but bureaucrats with no medical knowledge or experience are making decisions about patient care and medical practices. He contends that electronic medical records were rushed into use by regulators before they were fully ready to be implemented. They were embraced by a host of software vendors, who sold their products to doctors and then subsequently went out of business, leaving their customers with no support system for difficult or unworkable programs. The other “fatal flaw” of the electronic medical records system is that it is not currently integrated in a meaningful way that allows data to be easily shared between doctors and hospitals.

Primary Care Physician Shortage Looming

As a result of these factors and more, many of Vermont’s primary care physicians are actually losing money, and some are considering leaving private practice. “It’s hard to find someone taking new patients,” said McCauliffe, who counsels his patients to find a primary care physician immediately if they do not already have one. He said many of the doctors he knows are considering leaving the state or retiring early because of Green Mountain Care’s looming threat to private practice.

McCauliffe said it’s important for physicians to let their patients know how the new health care laws are going to affect them personally. Many patients are not aware that in a single payer, top down medical system, the patient-doctor partnership will be superseded by bureaucratic regulation and cost controls. Decisions will be made on that basis and not necessarily in consideration of what is best for the patient. They will be dropped into a newly created bureaucracy where administrators will have a final say in deciding what is right for individual patients.