The axis of medical evil
If you are ever injured or ill, what do you want? Perhaps a caring and knowledgable physician; a hospital that is well equipped, well staffed by dedicated nurses, technicians and other employees, and effective and safe medications and devices to help you heal and relieve suffering. If you give a thought to anything else, it would probably be to have insurance that will pay for what you need, government that will not gum up the works, and honest lawyers that will charge a fair fee and will help you get what you deserve, nothing more and nothing less.
Here are the problems as seen by an insider.
1. The cost of running a medical practice has skyrocketed with no increase in reimbursement to keep up with the costs, and in fact, reductions, including a 10.6% medicare cut that went into effect 7/1/08. In order to stay in business, physicians must see more patients to cover expenses.
2. Government regulations impact everything in health care, from the number of hours a week a physician can work to the words the physician must use in your report in order to get paid.
3. Hospitals are inundated with red tape and regulations. The money to pay to comply with the regulations pales in comparison with the money it costs to document compliance.
4. Managed care organizations have managed to take the focus of concern off the patient and on to the organization. It is no longer what the patient and physician agree upon, but what the managed care organization is willing to pay for. As these behemoths of health care battle for patients, spending huge amounts on advertising, political favors, and the like, their subscribees beg for coverage for the most appropriate medications and procedures for their conditions.
5. If something should go wrong and you need to sue a physician or hospital, at a minimum 1/3 of the settlement will go to your attorney. Plus expenses. If the court agrees that you were harmed 1 million dollars worth, you will be lucky to get $600,000. The doctor who screwed up may have been paid as little as $150. The attorney who helped you point that out will get no less than $333,000.
6. Hospitals are loaded with experienced, well educated nurses who... you thought I was going to say "deliver care to you". No. What they do is sit at the nurses station, extract information from the medical records, and call insurance companies each day to beg for one more day of hospitalization for sick patients. On the other end of the phone are insurance representatives, paid by you, whose main job is to say no.
7. Doctors are graded on how promptly they get patients out of the hospital. Previously, they were graded on how well they did in school; how well they diagnosed patients; and how well they did on exams in medical school. It is hard to break old habits, and doctors still want to get a good grade, so sometimes patients are sent home too soon to please their insurance overseers.
8. Information that may help you is kept secret. In one of the most appalling events in health care, the makers of gabapentin were successfully sued for millions for telling doctors that their product was effective for pain control, based upon scientific studies on patients. A few years later, managed care organizations will not pay for the use of FDA approved medications for pain unless gabapentin is tried first. Yes, the same gabapentin, still without FDA approval for pain control.
9. The concept of medicaid has been largely a failure. What you get for free you don't cherish nearly as much as what you pay for. So, those on medicaid do not seek out health care much more than they previously did when charity care was part of the landscape of health care. Now, however, we have a bureaucracy which adds a layer of expense.
The solution is simple. Return health care to a relationship between physicians and patients. Let the hospitals and pharma companies do their thing without so much red tape, regulations, documentation. Let those in health care work with consultants, IT and others to devise better methods of safety and quality control. Set a fixed reimbursement schedule for harm done and focus on correcting the problem so it won't happen again. Managed care organizations should be in the business of paying for what the patient and doctor decide. They should be a source of information about what does and doesn't work, based on their data. Information that may impact medical decisions should be as available as an internet connection, to assist physicians in their decision making process. And payment for health care providers should reflect the reality of the world, the expenses of running a small business, and the relative value one places on having the brightest and best there 24/7/365 for each of us. And, bring back charity care. Doctors, hospitals and pharma would love it. All we need is a more reasonable reimbursement by those who can pay us.
Here are the problems as seen by an insider.
1. The cost of running a medical practice has skyrocketed with no increase in reimbursement to keep up with the costs, and in fact, reductions, including a 10.6% medicare cut that went into effect 7/1/08. In order to stay in business, physicians must see more patients to cover expenses.
2. Government regulations impact everything in health care, from the number of hours a week a physician can work to the words the physician must use in your report in order to get paid.
3. Hospitals are inundated with red tape and regulations. The money to pay to comply with the regulations pales in comparison with the money it costs to document compliance.
4. Managed care organizations have managed to take the focus of concern off the patient and on to the organization. It is no longer what the patient and physician agree upon, but what the managed care organization is willing to pay for. As these behemoths of health care battle for patients, spending huge amounts on advertising, political favors, and the like, their subscribees beg for coverage for the most appropriate medications and procedures for their conditions.
5. If something should go wrong and you need to sue a physician or hospital, at a minimum 1/3 of the settlement will go to your attorney. Plus expenses. If the court agrees that you were harmed 1 million dollars worth, you will be lucky to get $600,000. The doctor who screwed up may have been paid as little as $150. The attorney who helped you point that out will get no less than $333,000.
6. Hospitals are loaded with experienced, well educated nurses who... you thought I was going to say "deliver care to you". No. What they do is sit at the nurses station, extract information from the medical records, and call insurance companies each day to beg for one more day of hospitalization for sick patients. On the other end of the phone are insurance representatives, paid by you, whose main job is to say no.
7. Doctors are graded on how promptly they get patients out of the hospital. Previously, they were graded on how well they did in school; how well they diagnosed patients; and how well they did on exams in medical school. It is hard to break old habits, and doctors still want to get a good grade, so sometimes patients are sent home too soon to please their insurance overseers.
8. Information that may help you is kept secret. In one of the most appalling events in health care, the makers of gabapentin were successfully sued for millions for telling doctors that their product was effective for pain control, based upon scientific studies on patients. A few years later, managed care organizations will not pay for the use of FDA approved medications for pain unless gabapentin is tried first. Yes, the same gabapentin, still without FDA approval for pain control.
9. The concept of medicaid has been largely a failure. What you get for free you don't cherish nearly as much as what you pay for. So, those on medicaid do not seek out health care much more than they previously did when charity care was part of the landscape of health care. Now, however, we have a bureaucracy which adds a layer of expense.
The solution is simple. Return health care to a relationship between physicians and patients. Let the hospitals and pharma companies do their thing without so much red tape, regulations, documentation. Let those in health care work with consultants, IT and others to devise better methods of safety and quality control. Set a fixed reimbursement schedule for harm done and focus on correcting the problem so it won't happen again. Managed care organizations should be in the business of paying for what the patient and doctor decide. They should be a source of information about what does and doesn't work, based on their data. Information that may impact medical decisions should be as available as an internet connection, to assist physicians in their decision making process. And payment for health care providers should reflect the reality of the world, the expenses of running a small business, and the relative value one places on having the brightest and best there 24/7/365 for each of us. And, bring back charity care. Doctors, hospitals and pharma would love it. All we need is a more reasonable reimbursement by those who can pay us.
posted by DocBrain at
4:40 AM
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