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Mahoning Valley doctors say confusion reigns with ACA



Published: Fri, September 27, 2013 @ 12:02 a.m.

By William K. Alcorn

alcorn@vindy.com

YOUNGSTOWN

Doctors just want to take care of their patients.

But, local practitioners say, private insurance carriers have been calling the shots for years as to what health care is appropriate for a patient.

And now, said Dr. James F. Shina, a primary-care physician, the Affordable Care Act has given insurance companies even more power and also added layers of government regulations that even it doesn’t understand.

“The people making the health-care decisions are all wearing three-piece suits and work in an office either for the government or an insurance company. It’s not people wearing the white coats,” said Dr. Shina, a member of the Community Medical Associates group, with offices in Austintown and Struthers.

“In my perfect world ... get out of my way and let me take care of my patients based on my scientific training, intuition and reasoning, not based on bottom line and political motives,” he said.

As it stands now, the general environment is one of chaos, disorganization and uncertainty in which no one knows what’s going on, including the people who are supposed to know, he said.

“In a business where people’s lives are at stake; that is a recipe for disaster,” Dr. Shina said.

The treasurer of the Mahoning County Medical Society, Dr. Michael T. Engle, has dire concerns about the Patient Protection and Affordable Care Act’s effect on private medical practices.

The health-care law “could be the death of the private medical practice” Dr. Engle wrote in an editorial for the Mahoning County Medical Society’s Bulletin.

“The PPAC has many far-reaching and long-term implications to not only the delivery of health care in our country, but also the very fabric of the physician-patient relationship,” he said.

Many aspects of the health-care law, including but not limited to the creation of accountable care organizations, would undoubtedly make it more and more difficult for physicians to remain as independent private practitioners.

“Instead we will be driven into large group settings and employee positions. Further, our ability to advocate on behalf of individual patients will not only be neutered, but actually de-incentivized,” Dr. Engle said.

“I’m not as dismal as a lot of other people are about the Affordable Care Act. I’m not necessarily opposed to it. I see it as leveling of the playing field ... an opportunity to chip in ... all taking care of each other ... each paying what they can,” said Dr. John Venglarcik III, Mahoning County District Board of Health medical director and a pediatrician and infectious-disease specialist at ValleyCare Northside Medical Center.

There are certain things the American Medical Association and the Ohio Medical Association wanted in the Affordable Care Act that we didn’t get, said Dr. Marc S. Saunders, St. Joseph Health Center medical staff president.

“We want an affordable health-care system for everybody,” Dr. Saunders said. “But, we wanted to limit the power of insurance companies to dictate patient care. It should be doctor-patient driven, not driven by profits the insurance companies want to make.

“We wanted the sustainable-growth rate gone and re-formulated with assistance of the AMA. The red tape is horrible. We wanted the whole system of treating patients streamlined. None of these things are included in the ACA,” Dr. Saunders said.

In his editorial, Dr. Engle said a panel of expert physicians concluded that the health-care reform will usher in substantive and lasting changes.

Among the feared changes, Dr. Engle said, are that the independent private-physician practice model will be largely, though not uniformly, replaced with most physicians compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative, and technical resources.

Dr. Shina said that overall he doesn’t know the exact impact the Affordable Care Act could have on his practice because of the confusion surrounding implementation of the system.

From a patient-influx perspective, he said he doesn’t expect an impact because he already has as many patients as he can handle.

But, from a business point of view, it is another story.

“The problem is I don’t know. It’s a moving target. Virtually every day there is something new coming down the pike,” he said.

The ACA is like a gigantic onion with thousands of layers to it, Dr. Shina added.

“The ACA was passed before it was known what was in it. Who does business like that?” Dr. Shina said.

The practicing doctors were left out in the development stage and feel disenfranchised, he said.

Private insurance companies have had the power over physicians for years, he added.

“We have a double shotgun pointed at our left temple: Insurance carriers say don’t order expensive medicines for patients; and malpractice attorneys said you’d better order the expensive medication.

“Now, with the Affordable Care Act, we have a giant cannon in front of us and we don’t know what’s in it,” Dr. Shina said.


Comments

1formerdemliberal(182 comments)posted 12 months ago

"I see it (ACA, aka, Obamacare) as leveling of the playing field ... an opportunity to chip in ... all taking care of each other ... each paying what they can,” said Dr. John Venglarcik III"

What in the world is Dr. Venglarcik talking about?

Leveling what playing field? What does this mean in terms of future doctor/patient relationships? Even Obamacare will have different levels of coverage (Bronze, silver gold, platinum).

Who will chip in under the ACA? Patients, hospitals, administrators, taxpayers? To do what? How will this improve health care quality?

Who will take care of each other? Patients treating doctors? Taxpayers paying doctors? How will this work, Dr.? I naively have always believed that doctors should take care of their patients, period.

Each paying what they can. What do you suggest, a barter system for health care? Should someone pay more money for the same blood work simply because they work hard and have achieved a certain level of success? And will you provide your services for free if someone is uninsured?

I knew Dr. Venglarcik when he was when he was wet behind the ears at Struthers High School. He had a typical "baby boomer" hippie attitude back then and apparently still represents those communal beliefs prevalent in those days.

Health care is not a village, Dr. And most of us in the United States do not want your incomprehensible view of socialized health care, including many of your fellow physicians.

Of all the statements I have read about Obamacare both locally and nationally, none can compare to the sheer nonsense and utter incompetence of Dr. Venglarcik's comments. At least comments appearing in the article by other local physicians addressed the actual issue of ACA implementation and its potential effect on future patient care.

As an example, my primary care physician is no longer taking Medicare patients simply because Medicare reimbursements have been cut severely and diverted to pay for Obmacare subsidies. Many of his fellow local practitioners are taking the same approach. These physicians want to help their patients as much as anyone in their field. But unlike your mythical health care village, Dr. Venglarcik, they have bills and thousands of dollars of student loans to pay without having to incur losses due to insufficient Medicare reimbursements. Many older patients do not realize that the quality of their health care and ability to select their own physicians will be severely limited in the future because of Obamacare.

So next time the Vindy comes around and asks you to comment about the ACA,, Dr. Venglarcik, do yourself a favor, stick to advice on medical issues and tend to your village people.

Suggest removal:

2jmagaratz(166 comments)posted 12 months ago

1965--local physician (Dr. J Schrieber) was the voice of professional opposition to Medicare---same tune...."socialism"; to expensive; loss of control by the professional physician; insurance company regulation.....yada yada yada......"

Now--nearly a half century later, Medicare is part of the landscape and people have adjusted....

Today, Dr. Shina appears to have replaced Dr. Schrieber as the opposition voice to the ACA....same tune....probably same result.....it stands a good chance of being implemented and after that it will be accepted....

The best way to pay for a "socialized system of medical services" is to levy a separate tax above and beyond current taxing categories for the military war adventures.....that would free up current tax collections for medical services---might also lead to the elimination of war too.....

Suggest removal:

3formerdemliberal(182 comments)posted 12 months ago

jmagaratz,

"Medicare is part of the landscape and people have adjusted"

Medicare is going broke (contributing billions to the national debt), provider reimbursements have been significantly reduced resulting in reduced service and staffing (my wife is an administrator at a local nursing home) and many doctors, as noted in the article, have adjusted their practices by not accepting Medicare patients, thus reducing (not improving) patient choice and quality of care and causing more people to pay out of their own pockets for adequate medical care, particularly for their elderly parents.

Why don't you make an individual contribution to the federal government to help pay for Obamacare? You have every right to do so. You would help spread the Obama gospel to all of us "unfortunates" who have not seen the light like yourself and save dollars for the rest of us who would rather keep more of our money for our own health care decisions, rather than government bureaucrats.

"(a military tax) might also lead to the elimination of war too"

Better idea. Let's just defund the military, give the money to Obamacare, and tell Iran, Russia, and our other enemies that we give up our freedoms.

Brilliant ideas. Just brilliant. Keep 'em coming. I need a good laugh.

Suggest removal:

4jmagaratz(166 comments)posted 11 months, 4 weeks ago

note to "formerdemliberal".....

Medicare here to stay....may be adjusted for the "younger half" of the baby boomers but the idea of having it available will continue....

the new tripod of the safety net will be Social Security, Medicare and ACA.....

Republicans have had the presidency for 36 of the last 61 years and have not been able to eliminate Social Security and Medicare....

Dream on "formerdemliberal"

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5formerdemliberal(182 comments)posted 11 months, 3 weeks ago

And just who will pay for your safety net of the future, as simple demographics and poor economic conditions reduce tax revenues while payouts increase substantially? Of course, the next generations will pay more for less future "safety". And the ACA will only increase younger people's health care costs to subsidize older, less healthy patients.

Supporters of social security, medicare/medicaid, and the ACA somehow never take into consideration the cost of these programs to society as a whole. Social security will soon be running deficits that will have to be funded by higher taxes on those employed, medicare and medicaid have bled cash for years, and the ACA will steal higher premiums from the young and healthy to fund the more expensive elderly patients.

But as long as you get yours, jmagaratz, who cares about the younger generation, right?

Try reading this article about the current effect of your precious Medicaid and Medicare on doctor availability and quality of care, particularly the elderly, and what likely will continue to happen in the future under ACA.

http://www.heritage.org/research/repo...

However, based on your previous comments totally unrelated to the article subject, I'm betting that you won't take the time to spend the energy to read a different perspective about ACA effects on doctor care and continue in your own dreamworld.

Enjoy your shrinking safety net.

Suggest removal:


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