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.
Labels: health care cost, health care delivery, health information technology, telemedicine
posted by Ryan DuBosar at
3:00 PM
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4 Comments:
The main reason physicians have not embraced virtual visits is not because we don't understand the technology or that we have erroneous concerns about HIPAA violations. It's because we can't get paid for it. Insurers, by and large, do not pay for telephone-based visits, and only a few will reimburse virtual web-based visits.
The time I spend when a patient is concerned that they may have sinusitis, for example, but are out of state, is essentially free care. I'm spending 5 minutes reviewing the chart, 10 minutes on the phone with the patient, another 5 putting through the script, and another 5 documenting the encounter. As far as the insurance company is concerned, this 20 minutes of my time is bundled into previous/future office-based care.
I can use the documented phone call to increase the level of service during the follow-up visit that I ask the patient to schedule to ensure that they are responding to treatment, but guess what? If the patient is feeling better, they don't come to the appointment (why pay the copay just to have me tell them that they're looking better?).
If I bill the patient directly for the service, they complain: "What is the bill for? It was just a phone call!"
No matter how you slice it, the physican is the bad guy (or gal). Until the paradigm changes, and insurers/patients accept that medicine is a livelihood as well as a calling, physicians will be reluctant to provide services without guarantee of fair reimbursement for their efforts.
With ACP's focus on evidence-based medical care, I would expect comments posted on this website, supporting "virtual office visits" and other such Googlized medicine initiatives, to at least provide some proof of value.
I am not surprised that "the public is ready and waiting". The same public that chooses virtual sports via big screen TV over going outdoors, and Facebook over a real face-to-face encounter? They already make such good lifestyle decisions.
This article leaves me with one question. Will the use of technology inevitably lead to outsourcing the basic functions physicians perform(e.g. primary care)? We are already outsourcing the interpretation of some tests because its faster and cheaper. Other industries that have adopted the use of technology have ultimately established their operations in other countries. I do believe that the medical field needs to embrace technological advancements. Yet at what point will society say that health care is cheap enough?
If fee-for-service is one of the reasons why medical care has not seen the improvement in service and quality seen in many other sectors, why is it that many/most of those areas , in fact have fee-for-service? The visible quality and service improvements occur in a competitive markets with prices. No such conditions exist in medical care today.Last time I went to Walmart I had to pay with my money, not expecting the government or my insurance to pay.
The commentary did not mention one of the major reasons for where we are in health care:paying for services with what is or is perceived to be as "someone else's money".
What innovations would Mr Jobs be credited with if he found himself in a price controlled,highly regulated environment?
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