The impact of Medicare Reform on Primary Care

Today Medicare reform is all about keeping doctors like me accountable. Quality is defined by having us fill out an abundance of forms to prove that we are following quality indicators, that in fact have no correlation to real quality among the elderly. Cost savings are supposed to be derived by forcing us to use expensive compter systems that do little to improve quality and which cost the doctors a great deal of time, money, and sanity. We are told we have to demonstrate meaningful use of the computers, an act that is not only frustrating, but which can squander tens of hours of time. In addition to the messages, lab results, questions, and refill requests that flood our computer screens as we are attempting to type in Medicare's scripted notes in a fashion that will prevent us from being audited while we try to take care of the patient who sits across from us, we are fed reams of paper to fill out so we can provide our patients with home health care, medical equipment, medicines, handicap plates, VA benefits; the piles of paper grow voluminously every day. The phone rings, patients and families are waiting, nurses need narcotic forms filled out. No wonder I am so disheveled in this picture! Clearly, the current thrust of Medicare reform has missed the point. A great weight has been placed on the backs of primary care doctors, none of which will help increase quality or decrease cost. There has to be a better way! I have explored the wrong direction taken by reformers in my book, and have outlined a better approach. It is time for us to all weigh in and use our ample experience to make our opinions known.