At MGMA, a glimpse of the (bleak) future

By: David Burda and Andis Robeznieks

A futurist, a physician assistant and a cash-only doctor walk into a convention center. The futurist tells a large audience they are becoming increasingly robotic and speaks of gloom, doom and mosquitoes. Before smaller audiences, the physician assistant talks about making more money and standing up to insurance companies, while the doctor who doesn’t take insurance money talks about how enduring some initial pain can relieve you of your present misery that’s being caused, at least in part, by insurance carriers.

Well, that’s one version of the Medical Group Management Association conference at the Philadelphia Marriott Downtown hotel and Pennsylvania Convention Center. Another is that it was a discussion about the survival of our healthcare system in general and of primary care specifically, and about how more physicians might adopt information technology if the federal government takes advantage of data it paid a lot of money to dig up.

First, MGMA President and Chief Executive Officer William Jessee set the tone for the meeting. In his opening remarks, he evoked the battling imagery of the famed fictional boxer from Philadelphia, Rocky Balboa, and the never-quit attitude of his hometown World Series-losing Colorado Rockies as he implored attendees to never quit fighting to fix the government’s “ill-advised� formula for Medicare payments to doctors.

In a news briefing later that day, he announced that “Medicare physician payment is No. 1 on our advocacy agenda,� and in his closing remarks at the end of the conference he pulled no punches in declaring that affordable healthcare is a basic human right and that it’s a national disgrace that 47 million Americans lack health insurance. (Underscoring the scope of the challenge, later in the week the CMS issued its final rule setting a 2008 Medicare physician payment cut of 9.9%.)

Calls to action were issued, but after hearing keynote speaker James Canton, attendees may have been wondering “What’s the use?�

Canton, a futurist, painted a bleak picture of an aging U.S. population with a decreasing fertility rate, an upsurge in “local pandemics,� and rising temperatures that will help increase the world’s mosquito population. Although he said preventive healthcare will become more of a force by 2015, Canton also predicted that new technologies and scientific discoveries will emerge that will lead to the growing of new organs and humans becoming “increasingly roboticized.�

We think that would strike a blow to preventive care. Human nature being what it is, it’s doubtful people will take better care of their livers, lungs and kidneys if replacement parts are available.

After Canton’s talk, Charleston, S.C., primary-care physician David Albenberg described how he freed himself from corporate healthcare tyranny and set up his independent, mostly cash-only, retainer-based practice known as Access Healthcare, where insurance may cover lab and radiology services.

Albenberg spoke of how he had become dissatisfied with his position as an employed physician, decided to do something different and opened his practice in March 2003. His personal savings dwindled as he didn’t give himself a paycheck until July, and he sunk some $125,000 into practice startup costs, which included about $50,000 for information technology.
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