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Bruce Bialosky

Losing a Doctor, A Cost to Us All

As you know, President Obama famously promised us that “If you like your doctor, you can keep your doctor.” That myth has been exposed many times over. Then there’s the scenario where your doctor tells you that he is no longer going to practice, and it is largely due to changes from Obamacare. It then becomes personal.

We received a letter in the mail (yes, people still send those) from our infectious disease doctor stating “After an extremely difficult period of thought and soul-searching I have decided to cease practice after almost 47 years.” We were scheduled to see Dr. Ronald Fishbach soon after as we were going on one our annual sojourns after tax season and had to determine whether we needed any shots in a few questionable countries. Hopefully, that will be all for which you need an infectious disease doctor. Unless, of course, you live in Los Angeles where we have an outbreak of typhus due to a runaway homeless problem.

After dealing with the fact we would have to find some other slug who doesn’t have half the knowledge of Fishbach, a quest to discern Fishbach’s rationale ensued. It was quite obvious from his letter that he was taking this step reluctantly.

He stated it was because of the mandate for doctors to institute a policy of maintaining electronic patient records in his office. This mandate was established as part of Obamacare and currently is administered by Medicare. Penalties for noncompliance were originally set at (percentage of Medicare billings) 1% in 2015, 2% in 2016 and 3% in 2017 and thereafter. That means in 2017 you would lose $3,000 for every $100,000 of billings in addition to the usual skimpy reimbursement rates from Medicare. Because of noncompliance by doctors, the penalty rate became 4% in 2018 and will be 5% in 2019 with the threat of going higher.

Add this to insurance company cutbacks and mandates largely dictated by Obamacare and Fishbach threw in the towel.

I had the opportunity to interview the doctor and ask him a series of questions. The most obvious one was regarding his retirement. As you can tell by his statement that he had been practicing 47 years, Dr. Fishbach is not young. He made clear he is perfectly healthy and wanted to continue practicing. He saw himself practicing another 8-10 years and felt his level of knowledge was higher than it has ever been driven by his years of experience. He stated “I am working at the same level as I was 30 years ago. Actually working harder.”

He also stated his retirement was not because of the strain of learning the computer program. He felt perfectly comfortable with the technology. It was the time. He had to make a choice of sitting in his meeting with his patients staring at a computer screen as you may experience with some of your docs or doing the computer work after the patients are gone. He made the choice to be fully interactive with the patient. That meant he was spending two hours each day to properly record the information in his program for the typical dozen patients he saw daily.

Then there is the cost of the program which he estimated as $3,500 upfront and $700 per month. On top of that he had to engage a staff person at $25,000-$50,000 per year to maintain the program. Yet that also would have been fine for him, if the idea as originally proposed was implemented.
The problem is that there are various different programs that are not integrated. For example, in Los Angeles UCLA Medical is on a competing system to the one used by USC. There is the cost, the time and the end product which does not even put all parties on a centralized system where they can access all the medical records of their patients.

It is estimated that next year we will have a shortage of 45,000 primary care physicians and 46,000 surgeons and specialists. Certain states are further straining the existing medical base by providing free medical care to illegal immigrants without defining where the medical resources (doctors, nurses and hospitals) are coming from to service the additional demand.

We spend untold societal assets developing the skills of a doctor like Ron Fishbach. Why would we not maximize the use of that asset for the benefit of us all? Why would we put obstacles in the road for a man like Fishbach to service patients at the height of his skills? That is what happens when government makes arbitrary decisions by omnibus legislation administered by faceless bureaucrats.

The irony of the situation is Fishbach is a fan of Obamacare. He thinks it provides necessary benefits like covering people for pre-existing conditions.
Unfortunately, Dr. Ron Fishbach is not an isolated incident under our current healthcare law known as Obamacare.