D4PC responds to Aetna CEO Declaring Obamacare is in a Death Spiral


“Aetna CEO Mark Bertolini made headlines by declaring that Obamacare is in a death spiral. It is difficult to understand how this is a news worthy comment. The Obamacare death spiral began 2 years ago when state-operated healthcare exchanges began shutting down. It got worse last year when insurers began pulling out of many states, leaving some with a single insurer under Obamacare. Instead of reporting the obvious, the media should ask how Mr. Bertolini earned $27.9 million in 2015 in total compensation if Aetna was doing so badly as a result of Obamacare, or how his company posted $2.3 billion in earnings on $63 billion in revenues.” Hal Scherz MD, Founder- Docs 4 Patient Care.

This was posted in response to Aetna CEO Mark Bertolini recent comments in the Washington Post.


Reflections on the CNN Healthcare Debate


The CNN healthcare debate between Senators Ted Cruz & Bernie Sanders on February 7 was dubbed a success by the network, ranking first in its cable time slot. With healthcare once again thrust into the headlines, and with two big personalities squaring off, this was certainly the marquee event, as was advertised. It turned out to be what one would have expected; a clash of ideologies, but a deeper look into what was said, and specifically what wasn’t, turned out to be most revealing.

Senator Sanders’ positions contained very little substance as he clung to his talking points which reflected his belief that healthcare was a right and that the government needed to provide it for everyone. Senator Cruz countered with several lines of attack, first giving an explanation regarding his interpretation of the definition of rights, maintaining that government giving something to individuals, in this case healthcare, did not constitute a right. He asked “why would we want to give the government MORE control over Americans’ healthcare, when they have done such a miserable job managing things up to this point?” Cruz concluded with the point that individuals are better at making healthcare decisions for themselves than the government. When the government does so, as in socialized countries, it leads to rationing- the government deciding what kind of care a patient may receive.

It was interesting that both men agreed that a big part of the problem stemmed from greed and excessive influence of special interests. Insurance and pharmaceutical companies were specifically singled out. Where they differed was their approach to solving this problem, retreating to their respective corners of the ring, with government control on one side versus a free market solution on the other.

The Senators missed the biggest problem in healthcare however, which is not surprising because everyone else has as well – the high cost of care. The healthcare reform debate has focused exclusively on insurance coverage and access. What plan will the GOP create to replace Obamacare? Although a market-based approach to healthcare insurance as is being offered by the GOP will result in substantial savings, the current cost of healthcare is unnecessarily high and will continue to be a strain on the American economy. There is a way out of this, but it does not appear to be on anyone’s radar.

The third major special interest, which went unmentioned in this debate is the hospital industry. Obamacare accelerated a trend which was to drive healthcare into the hospitals- the costliest place of delivery. It is folly to believe that taking an approach which focuses only on making insurance more affordable without doing something about the high costs of the healthcare itself, will have a significant impact on overall costs. Why should services be 5-10 times as expensive in the hospital as they would in free standing facilities? It defies logic.

There are many other factors that contribute to the high cost of healthcare that also need to be addressed. The third party payer system hides the true cost of healthcare, which really is not expensive when all of the overhead created by government and insurance bureaucracy is removed. Medical malpractice and frivolous lawsuits has created an adversarial relationship between doctors and patients giving rise to the practice of defensive medicine- performing an extra test or procedure, “just in case something rare could have been missed.” This practice results in annual costs between $200- $600 billion of mostly unnecessary spending that could be returned to patients.

The other major disappointment with this debate were the questions from the audience. CNN undoubtedly had an agenda in the selection of the questions and those chosen to ask them. It appeared that they wished to showcase typical “victims” – the ones who would lose their coverage if Obamacare is repealed. While this is understandably a concern for millions, and people are nervous, it might have been more illuminating to hear questions about other problems that are damaging our healthcare system and how Washington plans to deal with these issues. CNN squandered an opportunity to bring a doctor into the debate; one who was sitting in the first row and happens to be an expert in healthcare information technology and its problems. He was prepared with an important and insightful question but CNN thought otherwise.

In this latest round of the healthcare fight in America, a prudent person would realize that the so-called “experts” on healthcare- the policy wonks, the politicians, the healthcare economists, didn’t do so well the last time. To go back to what Senator Cruz said in this debate- why would we want to give them another chance at it? It is time to hear from the real experts in healthcare; those who have had to deal with the misery created by these “faux experts.” It is astounding how once again, the medical community has been excluded from this debate. CNN had a chance to begin to change the conversation by bringing a doctor into the discussion, but chose not to. They simply blew it.

This was originally posted on


Doctors Disappointed at Debate


A fitting metaphor from a Doc who was there

m-koriwchakThanks to some undeserved serendipity I had the good fortune of being invited to last week’s live broadcast town hall debate on CNN between Senator Bernie Sanders and Senator Ted Cruz regarding the future of Obamacare. I was offered the opportunity to appear in person to ask a question to the congressmen and spent many hours in communication with CNN producers to formulate a question acceptable to them.  Sadly the event ended in disappointment.  As the congressmen got long-winded and Senator Cruz had already spontaneously addressed the topic of my question, time ran out with my question unasked.  I have no ill feelings towards CNN over this.  Such is the nature of live events. 

Yet such an outcome is a fitting metaphor regarding the main problem with the narrative on health care reform.  My wife Amy said it first:  “This debate was no different from the ones we heard almost 10 years ago when Obamacare was first offered.”  She is absolutely right.  For decades we have heard – from both sides of the aisle – the same tired arguments from people who have never touched a patient and have no understanding of how health care should work.  There was nothing new offered Tuesday night.  On the Democratic side we heard that because health care is a right the government should provide “Medicare for all.”  On the Republican side we heard there is no way to finance such a big plan and that the government needs to get out of health care.  Familiar scapegoats – pharmaceutical companies and insurers – were dragged out with torches and pitchforks.  Both sides fight the war from the same trenches that were dug ages ago.  On Tuesday night no new hearts and minds were won for either side.

It is also fitting that the one opportunity to bring new life to the discussion – to bring physicians into the conversation – was turned away.  The one group who lives and breathes health care every day was ignored – as it has been for decades.  To be fair, some of the blame lies with us physicians – in the past we have as a general rule been averse to carrying our Hippocratic Oath beyond the clinic and the operating room.  But over the last several years that has changed.

Tuesday night’s debate may not have been the right time to engage.  We did not have as much time to prepare as we would have liked, and the exact rules of engagement were not clear.  But even with such apparent misfires we gain knowledge and wisdom.

The right moment to engage will come.  And we will be ready.


The Doctor’s Computer Will See You Now


By Sally C. Pipes and Michael Koriwchak

If you have visited the doctor recently, you probably noticed a new instrument in the examination room. It is a computer running an electronic medical records system, or EMR, that has been lauded by federal agencies as bringing a revolution to health care. But to patients, the computer has proven to be a nuisance rather than a blessing. It is hard to get quality health care when a patient must compete with the computer for his or her doctor’s attention.

Rest assured, most doctors do not like the computer coming between them and their patient either. Multiple studies demonstrate that roughly two-thirds of physicians are dissatisfied with their EMRs and do not think that they improve quality of care.1, 2, 3, 4

For physicians, the computer has become the instrument of obedience to a senseless body of regulations that directs not only the technology itself but also its use as a vehicle to “improve quality of care.” If your doctor pays attention to you instead of entering data, he or she will be penalized by Medicare regulations that reduce physicians to data-entry clerks.

The use of information technology as a Trojan horse for government-driven health care began with a part of the 2009 federal Stimulus Bill called Meaningful Use, or MU. Through a system of incentives and penalties, the architects of MU masterminded a major digital revolution of our health care infrastructure within five short years.

The developers of this system also force-fed physicians the unproven practice of using information technology to improve quality. Despite the mandated implementation of EMRs under MU, they have failed to deliver on any of the promises made in 2009, including a higher quality of care.5 By the end of the five-year program, doctors’ support for MU was waning.

MU would have disappeared quietly had it not been for a unique set of circumstances and timing related to Medicare, the federal healthcare program for seniors. The formula used to calculate Medicare payments to physicians — called SGR, or the Sustainable Growth Rate — had for several years dictated payment cuts of 20-30 percent.

Every year from 2003 to 2014, Congress had to act under duress to override SGR and pass a temporary “fix.” When Members of Congress became desperate for a permanent solution, the architects of MU seized an opportunity to re-brand their unpopular program by offering the repeal of SGR as part of a bill called MACRA — the Medicare Access and CHIP Reauthorization Act of 2015.

The MU program found a safe haven within MACRA. Its proponents even changed its name to camouflage it. Congress passed MACRA in April 2015, mere hours before another SGR-mandated payment cut was to go into effect.

The implications were not clear until the Centers for Medicare and Medicaid Services issued the MACRA regulations the following year. The centerpiece of the rule is a draconian compliance scoring system that pits small medical practices against large healthcare institutions to compete for a place on the upper half of the MACRA compliance bell curve. Physicians on the lower half of the bell curve who do not meet the requirements must pay penalties to cover the incentives paid to physicians in the upper half who meet more of the requirements.

CMS’s own data predicts that 87 percent of solo practices and 70 percent of practices with 2-10 physicians will receive penalties under MACRA.6

Physicians in independent practices cannot compete, so they are being driven to become employees of large hospitals. It is inevitable that costs will increase as these large institutions gain market share. Quality will suffer as care is depersonalized and unproven “value based reporting” consumes resources formerly directed towards patients.

Physician burnout will continue to increase as doctors must spend more evenings and weekend time on data entry.7,8 And the information technology itself, designed first and foremost to comply with MU certification requirements, will remain useless relative to the needs of individual patients and the doctors who care for them.

The irony is that quality of care was not the original problem. The healthcare reform narrative that began in 2008 was based on legitimate issues regarding cost and access. But the architects soon realized that their agenda would be better served by pivoting the discussion to quality and value.

Cost and access are easy to measure; the latter two are not because they lack well-established definitions. It is impossible within a quality/value paradigm to measure the performance of any program and judge its merits.

The cost of quality reporting alone has been estimated at $15.4 billion per year, according to a March 2016 study published in Health Affairs.9 The total cost of MACRA will significantly exceed that figure.

Reporting quality data to CMS has never been shown to improve outcomes. At a time when cost and access are the real problems facing our healthcare system, our limited resources would be more wisely directed to cost and access problems.

Is there a politician or a bureaucrat that has the chutzpah to face several million Americans and tell them we can’t afford their health care because of our devotion to a program whose benefits are completely unproven?

It is time to make participation in MACRA voluntary. Dropping the penalties and preserving the incentives will allow MACRA devotees to continue their work while unshackling other doctors from unproven quality measures and EMR mandates. Every physician, MACRA supporter or not, will be free to pursue his or her own vision of health information technology — the one that is best for patients.

Understanding exactly how MACRA was passed makes clear that it did not and does not enjoy “bipartisan” support and protection. A new administration should have the incentive to promote and introduce legislation that would make effective changes.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Dr. Michael Koriwchak is an ENT physician in Atlanta, co-host of “The Doctors Lounge” radio show, and Vice President of the Docs4PatientCare Foundation.


1Medical Economics and MPI Group. EHR Survey 2013.  

2Medical Economics. 2016 EHR Report.

3Deloitte Center for Health Solutions. 2016 Survey of U.S. Physicians.

4American EHR Partners and the American Medical Association. Physician Use of EHR Systems 2014.

5Kellermann, AL and Jones, SS. What It Will Take to Achieve the As-Yet-Unfulfilled Promises of Health Information Technology. Health Affairs 32(1) 2013: pp 63-68

6Proposed Rule, The Medicare Access and CHIPS Reauthorization Act of 2015, Table 64, April 2016

7Shanafelt, TD; Dyrbre, LN et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment with Physician Burnout and Professional Satisfaction. Mayo Clinic Proceedings 2016; 91(7) 836-848.

8Shanafelt, TD; Hasan, O et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General U.S. Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12): 1600-1613.

9Casalino, LP; Gans, D et al. U.S. Physician Practices Spend more than $15.4 Billion Annually to Report Quality Measures. Health Affairs 35(3), March 2016.


Doctors Disappointed After CNN Cruz / Sander Debate


The Health Care Debate is Over and the One Group Ignored – Doctors #Disappointed

Dr. Mike Koriwchak was ready in the front row to engage with a question he was never able to ask:

“I’m Dr. Mike Koriwchak, an ear, nose and throat surgeon from Atlanta.

One of the biggest frustrations physicians face is the paperwork and regulatory burden associated with patient care.  The situation has become so dire that for every hour we spend face-to-face with patients, we must spend 2 hours on paperwork and compliance with regulations  In a world where cost and access are the biggest shortcomings we face in health care, this creates unacceptable levels of inefficiency.

So, Senator Sanders, my question is:  How do we reduce the regulatory and paperwork burden so my colleagues and I can be doctors again?”

The people serving on the front lines of American medicine had no voice in tonight’s debate as answers went long and time drew short.  A doctor’s perspective is key because health care truly begins when the physician begins the exam – not when politicians pick a policy.



CNN Cruz and Sanders Debate will have a Doctor in the House


Michael Koriwchak, M.D. (Vice President of the Docs 4 Patient Care Foundation) is one of six audience questioners participating in tonight’s CNN health care debate.

Dr. Koriwchak has been asked to participate and he will be posing a question that will address the real world experiences of a practicing physician directly delivering care to patients.

Republicans have recently been floating trial balloons testing “repairing ObamaCare” versus “repeal and replace” in the face of the daunting task of dismantling a law with over 1,000 pages of text, over 10,000 pages of additional regulations, and 7 years of implementation.

Dr. Koriwchak’s participation promises to focus the debate on the real world impact of large regulatory systems on the front lines of American medicine.

Tune in to CNN tonight Feb 7, 2017 at 9PM EST

Dr. Koriwchak’s Biography

Dr. Mike

Michael J. Koriwchak, M.D. received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice.

He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.

After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients depend on their voice for their careers. Some are well-known entertainers.

Dr. Koriwchak has performed thousands of thyroid, parathyroid and head and neck cancer operations. He was also one of the first to offer balloon sinuplasty for the treatment of chronic sinusitis.

Dr. Koriwchak has also been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using Visual BASIC script.

In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. He has been writing about health information technology since 2010.

Follow him on Twitter


National Women Physicians Day


From Rolling My Eyes to Being Moved 

EdisonSpecial Commentary – Meg Edison, M.D. – It’s now 10pm and like many working moms, dinner is finished but dishes need to be done, the kids are in bed but I still hear cackles of laughter from my older girls’ room as they are talking before sleep, I’m finally sitting down but I have a lot yet to do. Tomorrow is the 2nd annual “National Women Physicians Day” and I’m thinking about what that means.

I’ll admit it, last year when the 1st National Women Physicians Day was announced, I may have rolled my eyes just a little and wondered why we needed a day to celebrate women only.  Either by luck, sheer optimism, or choice of specialty, I’m fortunate enough to say I’ve never once felt held back by my gender. To the contrary, as a pediatrician, being a woman and a mom is actually an asset rather than a liability.

But when February 3rd arrived, and I watched social media light up with new profile pictures of my fellow women physicians celebrating the day, along with photos at work in scrubs, performing surgery, giving lectures, in rescue helicopters, in military uniforms,  I was moved.  The face of medicine has changed and it is beautiful.  In that moment, I was truly proud to be part of the sisterhood and was thankful for a day to remind each other of all we have in common and all we have accomplished.

Celebrating Women Physicians Day on the birthday of Elizabeth Blackwell, the first woman to receive a medical degree in the United States, puts our careers and successes in context.  We stand on the shoulders of giants. From Elizabeth Blackwell, to Rebecca Lee Crumpler, Mildred Jefferson to Linda Brodsky—countless women physicians not only broke through barriers, they paved the way and mentored others.  They left medicine better than they found it.  This commitment to the future of our profession has never been more pressing.

As it stands, nine out of ten physicians do not recommend medical careers to their children. Those that do, do not recommend primary care.  This is a tragedy.  Our world needs good doctors, and who better than the children of healers to carry on this calling?  There are many things we do for our children to prepare their future, from teaching them to read to saving for college.  We need to take a hard look at the problems in medicine with them in mind. What can we do to make medicine a better career for them, how can we ease their way?

Before my girls went to bed tonight, I asked if they’d ever consider being doctors. My oldest, who is genetically wired to be an engineer, gamely said she’d think about it only after making a complete list of the pros and cons. I think the engineer mind is strong with that one!  My younger daughter said she’d be interested, but wasn’t sure about “that blue cross stuff”. My heart sank as I realized my frustrations with bureaucracy, MOC, and third party payers were far more transparent than I’d realized. “But if I can fix those things, what would you think about being a doctor, like mom?” Her eyes brightened and she responded, “Spending the day around babies? Sign me up!”

On this 195th anniversary of Elizabeth Blackwell’s birth, it is interesting to note that despite all her hardships and challenges as the only female medical student among 150 men and subsequently the only female doctor in the country, she loved medicine and recommended the career to other women. Just five years after Elizabeth graduated from medical school, her sister Emily became the third woman in the United States to receive a medical degree, one sister paving the way for the other.

This is what being a woman physician means to me now. It’s no longer about passing the next test, proving myself, and advancing in my career. I am happy and fulfilled where I am. Having reached my goals, I can look beyond myself to the next generation of physicians. Within the next 6-8 years, my girls will be making their career choices.  If I do my job and “fix those things”, medicine will be better than I found it.  I truly hope one, or both, of my daughters will look at this wonderful profession with bright eyes and say, “Sign me up”.


Tom Price: Still the Right Choice to Head Health and Human Services


The Democrats and the political Left have been apoplectic over the nomination of Congressman Tom Price by President-elect Trump to be the next Secretary of Health and Human Services. The reason is because there is no person in the country more qualified to oversee the dismantling of Obamacare and the institution of healthcare policy that makes sense, that will succeed and that will benefit everyone. So it was simply a matter of time before the smear merchants tried to create a controversy and drag a good man through the mud.

CNN, which is still stinging from the rebuke that Donald Trump dished out to reporter Jim Acosta over the “fake news” brouhaha, appears determined to get retribution by trying to bring down Dr. Price. They broke a story regarding stock transactions that occurred in Price’s portfolio, alleging that legislation he introduced was tied to this investment. There were facts that CNN allegedly possessed but decided not to report, in an attempt to provide ammunition to the Senate Democrats who hope to derail Price’s confirmation. The fact that this was a broker initiated event, unknown to Dr. Price and done to rebalance his portfolio was conveniently omitted. Once again, fake news.

The double standard and hypocrisy on the part of Democrats and the media is on full display in their failure to apply the same standards to Harry Reid. In 2005, he invested $50,000 to $100,000 in an energy fund (IYE) trading at $29.15 per share. He sold his shares 8 months later at $41.82 per share. One month after this, while Majority Leader and in the most influential position to directly affect legislation, he brought a bill to the Senate floor which cost the oil industry billions in taxes and regulatory fees. One month after the bill passed, the shares fell 42 percent, to $24.41. Shrewd investing to be sure.

Tom Price is an orthopedic surgeon who has a lifetime of real world experiences, taking care of patients in academic and private practice settings. He has years of experience dealing with healthcare policy at the state and the federal level. He has devoted his life addressing the problems in healthcare wherever he has worked. He takes the time to speak with patients and understand their problems, as well as with doctors and empathize with their frustrations. No one is more qualified than Dr. Price to assume the reins of HHS.

The Left is terrified of Dr. Price because there is no one else who will be able to fix healthcare in America. They fear that he will succeed, where they have failed. This begins with the dismantling and eventual repeal of Obamacare. This process requires someone at the helm who understands that patients know better than the government, what is best for themselves and their families. This is a phrase that Dr. Price often uses when discussing healthcare.

He has introduced legislation that puts control of healthcare decisions back where they belong- in the hands of patients with the counsel of their doctors. He supports a system where patients can purchase healthcare insurance in a competitive national market. This market will once again thrive when insurance companies can offer policies that people want and need, and not those that include everything but that no one can afford. He supports patients owning their healthcare insurance so they can change jobs without fear of losing their insurance. He wants patients to be able to have health savings accounts owned separately from their insurance and paid for with pre-tax dollars. He wants Medicare to be protected for those who rely on it, but modified for future recipients so that it will be sustainable. The same for Medicaid, only he wants to see each state determine how they wish to handle the funds through block grants. He wants to see alternative healthcare delivery models that provide value and better care to patients. He supports competition in the marketplace, which will drive healthcare costs down. He believes that the medical liability system is broken and needs to be amended, because it has resulted in billions of dollars of waste in the form of defensive medicine.

Dr. Price’s critics are quick to point out that he supports a system where patients will be forced to fend for themselves. That a repeal of Obamacare will result in millions of people losing their coverage. That children will be thrown off of their parents’ health insurance. That patients with pre-existing conditions will be left without health insurance coverage as they were before Obamacare. These are scare tactics intended to arouse emotion. Each of these issues has been addressed in Dr. Price’s bill, “Empowering Patients First Act,” or in the Speaker Paul Ryan-authored GOP plan “A Better Way.” The final answer will likely come from these 2 plans.

The Democrats need to stop the Tom Price nomination. He is our last best chance to steer the healthcare system back onto the right path. We cannot allow media distractions or theatrics by Senate Democrats to stand in the way of Dr. Price’s confirmation.

This was originally posted at Townhall.


The Health Insurance Companies Are Scamming America


The Obamacare insurance co-ops have collapsed. Of the original 23, only three are expected to survive past 2017. The insurance companies are losing hundreds of millions of dollars on the healthcare insurance exchanges. Their reaction is to pull out of a number of them in order to reduce their exposure; a process they repeatedly employ to shed under-performing products called “purging”. To make up for these losses, insurers are expected to raise 2017 premiums across the board on all policies. The Kaiser Foundation expects an average increase of nine percent for policies on the exchanges, but in the individual market, the increases will vary by state- averaging 14 percent, but may be as much as 25 percent in some markets.

People are outraged because healthcare is going in the wrong direction for most of them. This is not the $2500 reduction in healthcare premiums promised by President Obama. There are fewer insurance options, with narrower physician panels. A McKinsey study reported that there will be only one insurer in up to 1/3 of counties in the US. Patients are responsible for a greater amount of their healthcare costs before insurance pays a penny–often $6000 for individuals and $12,000 for a family. Obamacare is spinning out of control as we approach what the healthcare policy experts predicted would eventually happen: the “death spiral” of this hastily contrived government intrusion into healthcare.

It would appear that the insurance industry is on “thin ice “as the healthcare system, that they helped to turn upside down, begins to unravel. Progressives are now openly saying “we have tried to use the “free market” to fix healthcare but it just doesn’t seem to work”. President Obama is pushing for a “Public Option” to save the healthcare system and patients. This is just the inevitable next step towards a single payer (Federal government controlled) healthcare system. Hillary Clinton tried to take us there in 1993, but failed. She is talking about this again and would be closer to making this a reality in this environment.

The insurance companies are victims too, right? Not even close.

They are co-conspirators. What is taking place in healthcare is a contrivance and the insurance industry is a major player, very pleased with the results. They are reaping record profits due to changes in the healthcare insurance arena created by Obamacare; changes that their representatives helped to negotiate as they sat around the table creating the Affordable Care Act. Yes, they are losing money on the portion of their business tied to the healthcare exchanges, but in every other part of their health insurance portfolio, the profits are staggering.

It is necessary to connect the dots. The truth may be more sinister than anyone even imagines. What if the insurance industry actually wants a single payer system? Is this even possible?

First, consider that the largest purchaser of healthcare insurance is the government- federal and state. When the ACA passed, there was outrage that Medicare Advantage would be scaled back. This is the most popular and well liked part of the Medicare program by seniors because of richer benefits than traditional Medicare. Instead, the program has grown so that 1/3 of Medicare recipients are on this program. Ironically, insurance companies, through provisions under Obamacare, have figured out how to get paid more than before.

Second, the cozy relationship between the federal government and the insurance industry should be cause for concern and investigated. The former director of the Center for Medicare and Medicaid Services (CMS) in the Obama administration, Marilyn Tavenner, is the President and CEO of AHIP, America’s Health Insurance Plans. This is the professional lobbying arm for the insurance industry, and the group that “sat at the table” when the ACA was being conceived. Currently, it is difficult to see any daylight between the federal government and the insurance industry. It is curious how a tax on the insurance industry amounting to $12 Billion; funds which are sorely needed to help pay for this entitlement has been postponed.

Equally troubling is the recent discovery that the issue of “risk corridors” is not settled. This was a program that AHIP negotiated to make up for losses sustained in the Obamacare exchanges. In 2014, $8 Billion was collectively paid out- a tax payer bailout of the insurance companies. Congress voted to put a stop to these payments, but the Executive branch is trying to bypass Congress in the waning days of this administration, and get more money back to the insurance companies.

When over 50 percent of the insurance company business comes from government contracts, and with insurance companies making record profits, why would they not want to go 100 percent government contracting? Their downside risk would be eliminated when the federal government is the guarantor. They can’t lose in this scenario. The only losers are patients and taxpayers.

By Dr. Hal Scherz

Originally featured on


The Forgotten Promises of Electronic Medical Records


New Evidence of Continued Failure

Readers of this blog and listeners of The Doctor’s Lounge radio show already know that electronic medical records have failed to fulfill the promise of reduced paperwork, increased practice efficiency and improved patient care. To this point, however, the only hard evidence we had to support our position were physician surveys that document a low physician satisfaction rate for EHRs.   But a recent study published in the Annals of Internal Medicine has given us newer, more objective data to make the case.

A very elegant time/motion study was carried out in which physicians were closely monitored by trained, standardized observers to classify how much time physicians spent with patients versus the amount of time they spent on electronic medical records and other tasks besides direct patient contact. The data were stunning. Physicians only spend about 25% of their clinic time in direct patient contact. For every hour that physicians spent face-to-face with patients, over 90 minutes were spent on administrative tasks including data entry and other activities associated with the EHR. Furthermore, nearly 40% of the time spent with the patient in the exam room was devoted to interacting with the EHR rather than facing the patient. Even that much time with the EHR was not enough – physicians still had to spend an additional hour every night with the EHR to stay “caught up.”

This study confirms what those of us who see patients every day already know: despite the tremendous potential of information technology to improve patient care and practice efficiency, the promise remains forgotten by regulators and electronic medical record vendors who continue to conspire to force physicians to use poorly designed health information technology products.

As with any study, there are limitations on how far one can interpret these findings. The biggest problem is that there is no comparison to how physicians allocated their time in the era of paper records. Older studies done with doctors using paper charts all seem to concur that physicians spend about 50% of their time in the exam room and 50% outside. So it’s difficult to separate how much of the inefficiency is due to the technology versus the inefficiency coming from regulations, insurers and the legitimate needs of patients who are not in the clinic that day.

Nonetheless, the take-home lesson is clear. At best electronic medical records have failed to live up to the promise of improving quality, improving efficiency and reducing paperwork. And most practicing physicians agree that EHRs have actually made the problem worse. The Annals of Internal Medicine agrees. In the most recent issue the study is accompanied by a harshly worded editorial entitled Electronic Health Records: An Unfulfilled Promise and a Call to Action. In this editorial the results of the time/motion study are linked to other studies that demonstrate a higher risk of burnout among physicians who use electronic medical records. Physician burnout has also been linked to higher rates of depression and suicidal ideation. Patient satisfaction scores are also lower when physicians spend more time with the computer and less time with the patient.

Unfortunately, the editorial’s “call to action” is disappointing. The editorial concludes by claiming that it is time to stop complaining about EHRs and make the needed changes to direct the focus away from the computer screen and back towards patients. This noble but rather trite idea fails to recognize that such a paradigm shift is impossible given the current regulatory environment which forces physicians and EMR vendors to maintain the status quo. The editorial recognizes the symptoms but fails to recognize the underlying problem. Under such regulatory pressure the entire combined bandwidth of the healthcare and health information technology communities must be devoted to compliance rather than innovation. Furthermore, the same regulations prohibit innovative ideas from actually being implemented.

A more useful conclusion is obvious. Regardless of the record keeping method (paper or electronic) physicians in clinic function at about 25% efficiency. HIT vendors must devote themselves to improving this metric. This will lead us to technologies that will serve patients and physicians rather than regulators, insurers and other competitive stakeholders in health care.