Deregulation Is the Cure
The recently proposed GOP health-care plan aims to create a health-care system that empowers patients. To build on these efforts — to fuel innovation, lower costs, and expand access — the administration should also scale back onerous regulations in the health-care sector, which have the unique potential to be harmful.
In other industries the costs of regulations are typically passed along to the consumer by increasing the price of goods and services. In health care, by contrast, since there is a third-party payment system, limited price transparency or flexibility exists. This limits the ability of suppliers to raise prices to account for the increased operational costs of regulations. In fact, as costs increase, reimbursements are actually declining. In light of this paradox, the costs of health-care regulations get passed along to patients in the form an inferior product: less face time with doctors.
The time doctors must devote to regulations takes valuable time and effort away from patient care. A minute struggling to navigate the EMR during a visit can mean one minute less with a patient. A minute checking off quality metric boxes can result in one minute less providing a patient with quality care. Such regulations mean that patients have less time to comprehend their diagnosis, understand the treatment course, and have their questions answered. And this can leave patients feeling frustrated. It can also lead to noncompliance and compromised patient care.
At the same time, provider organizations are compelled to devote more resources to the implementation of regulations. This leaves less scarce resources for patient care.
Over the past several years, the health-care industry has been inundated with a spate of new federal programs, regulations, and mandates: HIT, MU, ACO, ACA, ICD-10, PQRS, VBPM, PCMH, MACRA, MIPS, APM. But ultimately, there is no Washington substitute for the education, training, and experience of the physician trying to meet the particular needs of the patient in the exam room.
In short, health-care regulations have become harmful for patients. And the status quo is deleterious for physicians as well. In addition to fostering physician burnout — which is increasingly common — regulations have created a murky practice environment with competing mandates and priorities. For example, some rules emphasize patient satisfaction; others prioritize health-care costs.
Yet, one driver of health care costs is that many patients want the latest, costly technologies, newest drugs, and most specialized care. A driver of patient dissatisfaction is lack of access to these expensive interventions. Research in the Archives of Internal Medicine studied the relationship between patient satisfaction and health-care costs in a nationally representative sample of patients. authors concluded that higher patient satisfaction was associated with higher health-care expenditures (and even a higher risk of death).
Today’s regulatory climate pulls physicians in competing directions and can place them in an untenable predicament where satisfying one mandate can come at the expense of another. The problem is that the one-size-fits-all nature of health-care regulations does not align with the particular individual needs of patients and cannot possibly account for the infinite possibility of scenarios.
We have come to the point where patients and doctors need regulations to protect patients and doctors from regulations. A better approach would be to scale back regulations and encourage choice and flexibility to meet the particular and diverse needs of patients. The GOP health-care plan is a first step towards returning health care to doctors and patients. Broader deregulation will help achieve this goal.
Jason D. Fodeman, MD, MBA is a practicing primary care physician. He specializes in delivery systems and health policy.