Tuesday, January 19, 2010
Pay More, Get Less - The Certain Future Of Healthcare
This blog post was originally published at Saving Money and Surviving the Health care Crisis. It appeared January 18 at Better Health.
Even with health care reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the health care system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of health care providers and the fee-for-service reimbursement system.
Doctors and patients haven't altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time-saving devices, patients still get care through face-to-face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed any time soon.
Yet, patients come to doctors for our medical expertise and insight in order to stay well or get better. They don't care if it is done via the web or in person. If doctors think their problems are safe to handle via technology then they are for it. If doctors feel a particular condition must be handled in the office, then they are willing to do it. After all, aren't we the ones who can make that assessment? They trust us to make the right determination. We must be willing to challenge tradition and training in the face of a rapidly evolving world.
If this country is going to make health care more affordable and more accessible, then doctors need to collaborate better. Only doctors can stop the increasing march of medical expenses.
If we as a profession are unwilling to use technology to get the information and expertise at the point of care to get people better sooner, then our country has only two options left to make health care affordable. The first is the government to force pricing down, as it is done in other countries. Based on the agenda of Medicare, the government is already squeezing costs by dictating pricing that may not be realistic. The second is to force patients to try and figure out which tests, procedures, doctors are best to help them. Research shows they don't want that responsibility and when they do have that burden they skip care. Nevertheless, employers are increasingly moving their employees to less comprehensive consumer driven health plans (CDHP) and high deductible health plans (HDHP) to save money.
It's doctors who aren't willing to do virtual visits. The public is ready and waiting. If we as a profession won't consider using the same technology we use to communicate with family and friends as well as use these very same tools to provide "second opinions" to our loved ones who value our medical expertise to our patients, then how can we say that we are committed to making health care accessible and affordable to all Americans?
While there is a small group of enthusiastic entrepreneurial doctors and leading-edge health care organizations trying to move American medicine into the 21st century, the health care system really needs Steve Jobs and Apple to transform health care. As it currently exists, the majority of doctors are either unwilling or unable to make the change.
This post originally appeared on Better Health , a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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