Why Doctors In The US Are Either Depressed Or Retiring

Burned out by bureaucracy.

There is a growing litany of acronyms and alphabet soup organisations and algorithms that are designed to confuse, obfuscate and subordinate the discretionary thinking of a physician. What these achieve is to funnel the physician's thinking into pre-defined and standardized patterns. The notion being that these patterns are always superior, more efficient and more accurate than traditional physician discretionary thought, observation and formulation of diagnosis and treatment plans.

We have entered the era of economic zero sum medicine. Where doctors are simple agents of health insurance reimbursement schemes.

This dizzying array is one of the many reasons why virtually every physician over the age of 65 is retiring. You are losing an entire generation of extremely well educated and experienced physicians. The ones who cared. Who were trained to observe. Who were taught to exhaust all testing means, to use deductive and inductive logic.

We have entered the era of economic zero sum medicine. Where doctors are simple agents of health insurance reimbursement schemes. A world in which medicine becomes thoroughly and inexhaustibly politicised. That is what is being played out in Washington today.

Do you care?

  • ACO = Accountable Care Organization
  • MA = Medicare Advantage, original Medicare + choice
  • ACA (aka PPACA, Patient Protection And Affordable Care Act)--disastrously branded as ObamaCare
  • MSSP = Medicare Shared Savings Programs (built into the ACA)
  • MUHIT = Meaningful Use of Health Information Technology
  • GPRO = Group Practice Reporting Option (CMS provider value modifier, 2010-present
  • MACRA = Medicare Access and CHIP Reauthorization (an acronym within an acronym)
    • MIPS = Merit Incentive Payment Systems (has 4 components)
      • ACI = Advancing Care Information (replaces MUA's IT).
      • CPI = Clinical Practice Improvement Activities
      • TCoC = Total Cost of Care (usually expressed as annual cost per beneficiary)
      • Quality = replaces the PQRS (physician quality reporting system)
    • APM = Alternative payment models
  • SGR = Sustained Growth Rate physician formula (1997 – 2016)
  • RAF = Risk Adjustment Factor (used to adjust capitated payments)
  • HCC = Hierarchical Condition Category (codes that derive the RAF)
  • TIN = Taxpayer identification number
  • CMS = Center for Medicare Services — formerly HCFA (Healthcare Financing Administration)
  • CPC+ = Comprehensive Primary Care + (a CMS- driven advance primary care medical home model)
  • CPT = Current Procedural Terminology (procedure or billing codes)
  • ICD-10 = Diagnosis coding module currently used in the United States (supersedes the ICD-9)
  • VM or PVBM = Value Modifier or Physicians Value-Based Modifier
  • CAHPS = Consumer Assessment of Healthcare Providers And Systems (HCAHPS, CGCAHPS, HHCAHPS, OASCAPS, etc.)
  • HiTECH = Health Information Technology for Economic and Clinical Health Act (HITECH Act)

Makes your head spin. Doesn't it? My mission is and has been the development of a new healthcare paradigm. Health and wellbeing for the next 20 years. Enhancing your health span. Enhancing cognitive function—being smarter, basically. You are going to need it in these times.