Readers Argue Over Obamacare Repeal, Retail Clinics

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month, we excerpt from our Editor's Corner blog, where the managing editor of Physician Practice shared his thoughts on a statement made by the AMA. We also excerpted an article that gave readers an update on the Senate's version of the AHCA. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com. Comments have been edited for style and grammar.

Senate AHCA Bill Draws Sharp Criticism from Medical Groups

The Republican Senate's draft of the American Health Care Act (AHCA), the effort to repeal and replace the Affordable Care Act (ACA), was revealed to the public this week after it was negotiated in secret. There are a number of provisions very similar to the AHCA bill that passed the House by a vote of 217 to 213, with some alterations included.

Like the House bill, the bill eliminates the ACA's individual mandate to purchase healthcare insurance and the employer mandate that requires large employers to offer insurance. Both bills remove cost-sharing subsidies that help insurers pay for low-income customers and enact a one-year funding freeze of Planned Parenthood. They also both end the Medicaid expansion and cut funding to the program.

Janice says: We need to see more physicians and medical people in the news helping to explain to the public what this all means. This will definitely hurt our children and families who are going through hard times. Shame on the White House for allowing and backing such a catastrophe for the American people.

Maria replies: We need to understand that we are responsible for our health, the government should regulate insurance companies and pharmaceutical companies, as they are the real culprits making healthcare very expensive. But each one of us are responsible for our own health.

Kathleen replies: Couldn't agree more. Smoking, drug and alcohol abuse, and obesity (with its co-morbidities) are some of the leading causes of disease in this country. Each comes with inherent struggles, but the first step to health is to choose to live well. Those who have no choice (children, mentally ill, elderly) deserve to be cared for appropriately.

Tim says: NO subsidies for insurance companies at all! All legislators have to participate in the program-no exclusions for the swamp rats! Where is money for preventative care? Subsidize the training of primary-care physicians [who can] make a real impact on American healthcare. Don't subsidize insurance companies and reduce competition in the process. Keep Medicaid intact!! Fund community health centers through the [Federally Qualified Health Center] program or otherwise, [Planned Parenthood] can fend for itself.

Regan says: [The Congressmen] should all be fired! Or at least they should be forced to accept the insurance that the poorest American is forced to take...maybe if it affects them they will try to represent every American and not elitists like themselves.

Scott says: Forget what the American Hospital Association says. I don't care at all what they say, [same goes for] the American Psychiatrists Association and all the rest. I'm sure the American Medical Association is in there as well. They don't have a flippin' clue about the real world...Hold strong Congress! Most of us support you!

AMA Got it Wrong: Inconvenience, Not Retail, is the Enemy

This week, the AMA is holding its annual meeting, announcing its positions and policy on the health issues of the day. For instance, in the past week, it has spoken out against the Medicaid cuts proposed in the American Health Care Act, voted to require pharmaceutical companies to include drug prices in ads, formally opposed discrimination against transgender people, and enacted a resolution that it would be proactive in creating a more diverse physician workforce.

But the one that really stuck out to me was this one aimed at retail clinics. In the resolution, the AMA said that retail clinics "should follow a set of principles designed to ensure continuity of care and support the goal of securing a primary medical home for patients."

David says: Retail clinics ARE the enemy. The [nurse practitioners] in them consistently misdiagnose and provide marginal care. I refuse to "adapt" to substandard care.

Jennifer replies: Wow. How arrogant and ignorant is all I can say to your comment. Perhaps it is time for you to retire?

David says: [I must] have struck a nerve...no apology.

Ron says: Five good visits to five retail clinics equals bad care due to lack of continuity….In the long run, it's not cheaper or more convenient because it doesn't solve the problem, overuses antibiotics, and creates expectations for medicine in patients, even if each visit made the patient happy.

J replies: Very broad generalization. I hear daily how physicians give Z-Pak's for "sinus infection" of three days. We all know it's highly unlikely patient has a sinus infection after three days with clear drainage and no fever.

Leann replies: I would love to see a prescription audit be a part of a physician's board certification process to identify physicians who are prescribing inappropriately. Along those lines, I also think physicians who do not follow best practices should have their board certification pulled (i.e. pediatricians who don't recommend HPV vaccination). When a physician is board certified, patients blindly believe they follow evidence-based, best practices. We all know that there can be a discrepancy between what a physician knows to answer on a test and what he actually does in the exam room.

Wayne says: It is true that there is a get them in get them out mentality in urgent-care, but I do believe that is changing as this type of medicine evolves. I think working relationships should be encouraged. If a dialogue between the office providers and the urgent-care providers takes place, there will be a better continuity to care. Urgent-care centers should be faxing notes daily to the primary's office. We all want to provide the best care and demonizing colleagues is not the way to promote better care.

J replies: Patients are asked if they want a copy of their record sent to their primary-care provider. We cannot send it if they say no.