Physicians Feel Reform's Tight Scrutiny

Jacqueline Fellows, for HealthLeaders Media , June 19, 2014

Thanks to healthcare reform, there are now more eyes on how doctors treat their patients and more opinions on how they should be treating them. But one physician leader says the pressure doesn't necessarily mean that doctors have to be on the defensive.

All working professionals, from writers to physicians, have a preference for the way their work gets done, but a doctor's penchant for how he or she cares for a patient is increasingly coming under scrutiny.

First, there are cost and quality pressures from hospitals, health systems, and payers as a result of the value-based healthcare transition that affects how physicians practice, not to mention public pressure on how much physicians get paid with the recent release of Medicare payment data.

Then there are the efforts to standardize patient care among providers in hospitals, group practices, and health systems in an effort to improve quality.

All of it leads to more eyes (and opinions) on how doctors care for patients, which can be uncomfortable.

Kevin Wheelan, MD, chief of staff and co-medical director of cardiology for Baylor Heart and Vascular Hospital, a joint venture hospital within Dallas-based Baylor Scott & White Health, says the pressure doesn't necessarily mean that doctors have to be on the defensive, or have an adversarial relationship with leaders.

Rather, Wheelan looks at the issue through a different lens. Without uniformity of care, quality can suffer, and patients leave confused. "Ten different sets of discharge instructions sets up [the hospital] for inconsistency," he says. "If the patient doesn't leave the hospital with a well-articulated game plan, that could lead to an unscheduled visit to the ER."

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2 comments on "Physicians Feel Reform's Tight Scrutiny"


Arthur Waltuch, M.D. (6/20/2014 at 1:07 PM)
I'm sad that the author misinterprets what we are defensive about. No one would try to defend ten differing lists of medications five different sets of discharge instructions, or ambiguity about setting up follow up visits to see how the patient is doing out in the cold, cruel world. We are all in favor (despite all the extra time we have to spend doing "paperwork" on computers of a single succinct and clear set of orders, and those orders for post discharge should legally and sensibly come from the primary care physician. The pressure comes from committees setting up not uniform methods of making the elements of care more accurately reflective of the inntended care prescribed by the primary care MD, but setting up specific standard management protocols, how each diagnostic code gets treated (don't ever give antibiotics for acute purulent bronchitis, don't do mammograms on a yearly basis, stop doing PSA tests etc. That's what the author should address; that's what we object to about standardized care models (the Cliff Notes approach to medical management of patients). Stay on topic please.

Jay A. Hendrickson, M.D. (6/19/2014 at 1:55 PM)
What a bunch of garbage!!!!! I just love how EVERYBODY, legislators and the author, tells me how to practice medicine. I have new for all of you. YOU ARE NOT A PHYSICIAN!!!! Until you dedicate your life to the study of Medicine and then spend 15 years to receive the proper credentials, I do not what to hear from you!!! I am the physician and will determine what is best for my patients!!! Oh, by the way- I have dropped all insurance, especially Medicare and am now a cash only business. And there are many more to follow!!

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