Editorials from the Executive Medical Director
The physician-patient relationship has long been the cornerstone of the practice of medicine. I would imagine that most allergists would say that it is the connection they have with their patients, parents and caregivers that brings them the most joy in the practice of medicine. The American Medical Association (AMA) Code for Medical Ethics on the patient-physician relationship states, “The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.
Just as we get some good news on the compounding issue from USP, our friends at the Centers for Medicare and Medicaid Services (CMS) may be causing the allergist misery in 2019. First some good news from CMS. Administrator, Seema Verma, announced the contraction of our office-based E&M codes from five to two. This would reduce the amount of documentation and paperwork for physicians and save 51 hours of clinic time per doctor per year. Let’s face it, that sounds terrific. The plan is to keep Level 1, which is primarily used for non-physician services, and Levels 2-5 would be incorporated into one code with one reimbursement rate.
The business of medicine is in flux. Practices are merging, getting bigger, moving into integrated health care delivery systems. With all these changes, is the way physicians are paid also changing? If we are moving away from a fee-for-service to a value-based health care system, should we not see changes in how we are compensated? Over the last eight years, the American Medical Association has analyzed its every other year Physician Practice Benchmark Survey results to assess how physicians are compensated. The latest data, from the 2016 survey, recently released in a paper written by Apoorva Rama, has some interesting insights for the allergist. Compare your compensation sources to the data below.
Are you laughing at the title of this article? Are you confused by it? I think you are looking at the future of medicine in the U.S. – the “Amazoning” or “Walmarting” of medicine. How can I say this is the future? I am sure that “mom and pop” grocery stores, clothing stores and hardware stores never thought they would be out of business 15 years ago. I’m afraid the same thing will happen with the “mom and pop” allergist as we move into the realm of disruptive innovation in health care.
With the conclusion of the Academy/WAO meeting in Orlando last month, there was the passing of the guard in the executive vice president (EVP) position of AAAAI from Tom Casale, MD, FACAAI, to Tom Fleisher, MD, FACAAI. The fraternity (and hopefully one-day sorority) of medical executives of allergy medical societies is small. We all are aware of the terrific job that Bob Lanier, MD, FACAAI, did for the College for seven years as Executive Medical Director (EMD) and Dr. Casale just completed as EVP of the Academy for almost 10 years.
Maybe I lead a boring life, but I do look forward to the Medscape surveys on different aspects of US physicians’ lives. The latest is entitled Medscape Physician Lifestyle & Happiness Report 2018.
This survey queried 15,543 practicing physicians from 29 specialties from July 19 through Oct. 2, 2017. Unlike many other physician surveys, it does include allergists/immunologists, who made up 1% of the physicians surveyed.
The first question was very enlightening, as physicians were asked if they were happy outside of work. Fifty percent were extremely happy or very happy, with another 26% somewhat happy outside of work. Only 10% were very unhappy or extremely unhappy.
Most of you received a “present” from the ABAI in your inbox to start the new year. The Continuous Assessment Program (CAP) has begun. Will this be the savior of MOC? Will the practicing allergist embrace this format of continuous learning or will it lead to the fall of the ABAI? Already, 21 states have passed or considered legislation to protect physicians who choose not to fulfill American Board of Medical Specialties requirements for MOC. My state of Georgia passed the following in March 2017: “maintenance of certification shall not be required as a condition of licensure to practice medicine, staff privileges, employment in certain facilities, reimbursement, or malpractice insurance coverage…”
One of my favorite websites is Bogleheads.org. In case you are not familiar with this site, it is a forum inspired by the investing philosophy of Jack Bogle. You don’t know Jack? Well, you should. Mr. Bogle was the founder of The Vanguard Group, who developed the world’s first index mutual fund in 1975. It was his idea to just mimic the market with an index fund instead of trying to beat the market and, most importantly, do it at a low cost so that more money would stay in the pocket of the investor.
Recently, I had the pleasure of giving a series of lectures on asthma topics in several respiratory hospitals and at the Sichuan Medical Association meeting in China. It was a great opportunity to spend time in a country that is rivaling the U.S. in economic growth and to get an idea about the health care of patients with respiratory conditions in this country. These maladies make up a large percentage of chronic disease in China, especially as related to the high incidence of smoking in the population (believed to be greater than 30%), and the increasing issue of air pollution in the major cities. In a visit to Shanghai Pulmonary Hospital, the largest pulmonary hospital in Asia, with over 1,000 beds, I toured the Laboratory Functions Labs in the outpatient center.
I hope that you saw the Summer 2017 issue of the College Advantage and specifically the article entitled “A Glimpse into the Future.” The article contained predictions on the future of allergy – made by members on the College’s 50th anniversary in 1992. The predictions were sealed in a time capsule, and revealed and commented on for the 75th anniversary. I found some of the insights into our future fascinating, and was lucky enough to read all the submissions from 25 years ago. I’m going to share with you some more of these predictions – and by the way – not all were about advances in the field of allergy.