Amazing.
You can't get a quote or even Ball Park figure for how much your procedure is likely to cost, your Health Insurance (if you have any) with high monthly premium costs will not pay anything until you have reached a deductible that is prohibitive and usually include a co-payment as it does not cover the full costs of many procedures.
But you are also advised to monitor and manage your own treatment whilst in hospital because the hospital often gets it wrong and causes necessary complications, costs or even deaths through wrong drugs, too many drugs as well as other organisational inefficiencies.
I cannot believe that you accept such a substandard, deficient, expensive , non universal and biased system that obviously is putting the Customer who is the last on the list in terms of...anything!
Patients? Customers? Seems to me that most of the people served by the American Health Care system are Victims.
Makes me so relieved I live in a Civilized Society that covers ALL its citizens for all their needs for Free and does so far better and cheaper than is the case in the U.S.
You can't get a quote or even Ball Park figure for how much your procedure is likely to cost, your Health Insurance (if you have any) with high monthly premium costs will not pay anything until you have reached a deductible that is prohibitive and usually include a co-payment as it does not cover the full costs of many procedures.
But you are also advised to monitor and manage your own treatment whilst in hospital because the hospital often gets it wrong and causes necessary complications, costs or even deaths through wrong drugs, too many drugs as well as other organisational inefficiencies.
I cannot believe that you accept such a substandard, deficient, expensive , non universal and biased system that obviously is putting the Customer who is the last on the list in terms of...anything!
Patients? Customers? Seems to me that most of the people served by the American Health Care system are Victims.
Makes me so relieved I live in a Civilized Society that covers ALL its citizens for all their needs for Free and does so far better and cheaper than is the case in the U.S.
2
I know enough about health care to know that I need a doctor to help me coordinate my care. Short of attending medical school myself, there is too much asymmetric information for me to be my own best advocate. I wish I had an independent primary-care provider to be that advocate and coordinator for me. Alas, no such PCPs exist in my community. They all work for and answer to an IDS whose priorities are not always in line with mine own. Only through Medicare-for-All could I truly have an independent PCP who can focus on my needs.
As a physician who has worked in different contexts over the last 15 years - a contracted academic practice, solo practice, as well as an employed physician in a for-profit hospital network - I will say that no system works properly for patients or providers. In the first, endless posturing and negotiating between the hospitals and our practice group led to both parties being unsatisfied with the outcome (not to mention comparisons to the deals other practice groups got). Meanwhile, as employed physicians, we were mere pawns in a corporate enterprise of profit maximization, cost cutting, and market domination by the executives. In neither case was reasonable and moderate demands focused on best practice standards emphasized. Mayo Clinic (where I trained), Geisinger, Intermountain are different in this latter respect, since best practice and amazing care coordination is more often achieved, but financial sustainability is difficult because, as the author states, they require large staffs to support the required services and yet they are rewarded by the same metrics as the worst performers in the system. Little matter then, that patients often love the Mayo Clinic. Short of a total system overhaul, it is difficult to see how anything will change.
2
The system takes physicians and nurses out of the clinical realm, doubles their salaries and makes them administrators. They instantly forget how it used to be and begin to kowtow to insurance programs, the government (CMS/HIPPA) and the regulatory agencies (JCAHO) without giving any constructive push back.
Meanwhile, the EMR has created massive fraud and relegated tasks previously performed by h.s. grads to the most trained and educated people in the system.
This is a recipe for mediocrity, not a recipe for the US health care system to remain at or near the top...
Meanwhile, the EMR has created massive fraud and relegated tasks previously performed by h.s. grads to the most trained and educated people in the system.
This is a recipe for mediocrity, not a recipe for the US health care system to remain at or near the top...
3
I work for a huge health system that calls itself an 'integrated delivery system.' We are all on the same computer, and most of my patients are HMO patients who buy their insurance FROM our system. We should have every incentive to be efficient and help improve discharges. In reality, we are plagued with incompetence. Discharge nurses get the hospital patient an appointment with me, but half the time they don't tell the patient effectively, so they don't come, which keeps other patients from getting in to see me. Discharging hospitalist doctors make med errors on about half my patients, and clearly haven't read my outpatient notes. I have had the discharging hospitalist forget to write a prescription for the main medication needed on a discharge, even though their note says that is the med the patient needs to take at home. It's a mess. There is nothing integrated about an integrated delivery system in our zip code. And we can't go out of business for delivering bad care because we essentially have a monopoly on our region.
5
Our system still pays better for more instead of less. So, more testing, more interventions, more hospitalizations are the result. The lack of a common record results in duplication and mistakes of omission and commission when one doctor does not know want another doctor knows. As a Family Physician who regularly reviews and organizes a patients record and regularly tries to communicate and educate, I know I am giving patients and the system more bang for the buck, but I can only watch while others get much more revenue for more testing, more interventions and more hospitalizations But in the meantime, know thyself patient and if you are a caregiver, know your loved one. Stay organized when you use the current system and have a physician who is also organized and knows you and your loved ones. And advocate for a system more like Europe's and less like ours.
4
I suppose it would help coordination of medical care if there was more coordination of governmental priorities. The ACA wants more coordination and more efficient care. HIPPA, on the other hand, sets up obstacles to sharing any kind of data and encourages treating patients as numbers because that way there is less identifiable patient information floating around. Of course neither is as effective as JCAHO in encouraging pointless waste that frequently does not save money or improve care.
5
Direct pay primary care practices and membership concierge primary care practices run by individual doctors who advocate for and coordinate their patients care are overlooked despite them coordinating and advocating for their patients. CorpMed and other large institutional health care delivery systems encouraged by CMS and the Affordable CarevAct are hoping to bury these small and pop practices that put their patients interests first.
3
"Kaiser Permanente, Intermountain Healthcare, the Mayo Clinic and Geisinger Health System are some of the integrated delivery systems with reputations for high quality and low costs."
Maybe there should be closer study of why integrated care works in some places.
Maybe there should be closer study of why integrated care works in some places.
2
Until insurance companies get a single person to oversee a set of charges , every sub-department will be trying to "game" the system to prove to the CEO that they are saving money.
For example, if I operate on a patient "in-office" and that operation costs net $800 for the insurance company, then the bean-counter responsible for"in-office " procedure costs surgery might be upset that the $800 got charged to her department. Instead, she might be very pleased if I refer the patient to another specialist, who operates "in-hospital" and therefore has a total costs of $3000 (These are real - world numbers). So, it comes down to a battle of how "providers" are audited for usage and how the system is "gamed"
For example, if I operate on a patient "in-office" and that operation costs net $800 for the insurance company, then the bean-counter responsible for"in-office " procedure costs surgery might be upset that the $800 got charged to her department. Instead, she might be very pleased if I refer the patient to another specialist, who operates "in-hospital" and therefore has a total costs of $3000 (These are real - world numbers). So, it comes down to a battle of how "providers" are audited for usage and how the system is "gamed"
6
The entire article assumes that there is a coordination failure without anyone ever presenting systematic evidence of such failures. The typical IOM style count of errors is faulty and not bench marked against a cost-effective standard. Every doctor knows of a problem and a solution. Kaiser, Geisinger and Mayo are PR firms first and foremost. The continued holding them up as some holy grail is misleading. They simply do not do much different than anyone else in terms of the actual care delivered for specific conditions. We can all move to Minnesota, Northern California or central Pennsylvania, but if we did we would replicate the pattern of care we see nationally.
2
It seems that the primary measurement of better care is money. What about the quality of care even if it costs more? Having left an "IDS" two years age due to a move, I have found it very frustrating dealing with multiple doctors offices, paper records, not able to access my records, overworked staff, conflicting medication etc. I look forward to a time when I an get back into a good IDS
1
Filming your consultations with your doctors, esp if you have a serious condition or are in the hospital seems very prudent to me. I try to take notes afterwards but I can't remember everything.
1
The vendors and money lenders are back in the "Temple." Where's Jesus when you need him?
5
The patient is no longer the customer, but a commodity. Someone should research that.
8
Live and work in SW Virginia. The two "non-profit systems", Wellmont and Mountain States are merging into one. No competition. The Republican tea -party congressman was down last week telling us how this is a good thing. The monopolization of healthcare will lead to worse patient care, higher costs, and lower wages. The healthcare administration wins; the workers and patients lose. No national news organization following this but they should.
As for me-I can no longer fight the administration. Uncle. I obtained a license in another state and am moving to a health system I have some degree of faith in.
As for me-I can no longer fight the administration. Uncle. I obtained a license in another state and am moving to a health system I have some degree of faith in.
4
Guess what? Employer provided health insurance plans have been providing health care coordination for fifteen years, particularly for people with chronic and complicated health problems, who are the most costly to the system. They also send emails to healthy employees, pointing out that they haven't had their mammogram or that they should have a colonoscopy at age 50.
Why is that? Self insured employers have an incentive to keep their employees and their families healthy. They typically sign contracts with insurers'/administrators for three to five years. The insurer is not encouraged to slight care, because that results in sick or stressed employees who are less able to do their jobs. And because decision making senior employees' and their families are covered by the same plans.
Employers of large companies take the long view on health care costs and health impacts. They pay for travel for the patient and a companion to travel to a distant high quality provider/diagnostic center if that is where specialty care is best offered: aggressive cancer, transplant services, joint replacement.
Having a big medicine provider in charge means their true objective is to maximize profits, and that includes the sacred non profits.
O'Care took a great idea and restructured it to favor their cronies and make it possible for big medicine to increase its profitability. It was always a scam to benefit big med and to get the people to pay more so the rich cold get richer.
Why is that? Self insured employers have an incentive to keep their employees and their families healthy. They typically sign contracts with insurers'/administrators for three to five years. The insurer is not encouraged to slight care, because that results in sick or stressed employees who are less able to do their jobs. And because decision making senior employees' and their families are covered by the same plans.
Employers of large companies take the long view on health care costs and health impacts. They pay for travel for the patient and a companion to travel to a distant high quality provider/diagnostic center if that is where specialty care is best offered: aggressive cancer, transplant services, joint replacement.
Having a big medicine provider in charge means their true objective is to maximize profits, and that includes the sacred non profits.
O'Care took a great idea and restructured it to favor their cronies and make it possible for big medicine to increase its profitability. It was always a scam to benefit big med and to get the people to pay more so the rich cold get richer.
The biggest benefit here is providing big health with big monopolies, and pursuant to the tenor of this article, not necessarily cheaper. Notwithstanding economics, patient care and satisfaction is continuing to be derogated, including choice of physicians. Big health is totally conflicted here economically, and as usual, we are paying the price. Unless we have an HMO, we should not be constrained to be forced to use a specialty physician from the same entity, merely because there is allegedly better data coordination. If that is the criteria, if a patient feels they want to use a physician from another monopoly, whatever the reason including but not limited to competence, demeanor, etc., they should not be precluded from doing so. Professional care from a professional, is just that, and is subjective. A patient in a PPO should have the right to do so, and it shouldn't solely be limited for the purposes of de facto monopolization done under the specious care of patient record efficiency.
3
*Any* patient should have the right to choose their own physician, whether in a PPO or not. See: Medicare.
1
The single best thing the government could do to allow coordination of care would be to mandate a single, fully interoperable platform for EHRs, both in hospitals and in doctor's offices. It amazes me that I can get off a plane in Paris or Japan, go to cash machine and get Euros or yen, yet my EHR cannot communicate with an office or hospital down the street without expensive and time consuming work-arounds. There are hundreds of EHRs, none of which can communicate readily. So when a patient says they had a test elsewhere, it still often takes days to get the report. And FREQUENTLY it is simply faster to do a test again than try to hunt down the report. Why can some bank in Europe immediately communicate with my bank in the US and know how much money I can withdraw, but my office computer cannot communicate with another office? The failure of an interoperability requirement in the mandate to use EHRs is inexcusable.
15
The government designed an EMR for the VA that is superb. Why do we use something else? Crony capitalism. Epic, one of the biggest private EMR's, charges hospitals millions for it and physicians find it cumbersome,loathsome and the developers are fully unresponsive to suggestions from the trenches.
2
This is a good article but concludes with a sorrowful recommendation: "coordinate your own care." When you are sick, stressed out, infirm, or old? Using terminology that brainiacs go to school for years to learn? The article simply assumes a market for healthcare, as many comments here point out. Opportunism is the prime inefficiency in markets. Adopt a single player system. Salary clinicians. Build a unified patient record system with coordination a design feature. Ban profit making health care insurance. No system is perfect, but people live longer in Canada, France, and Great Britain.
15
How are you going to ban profit optimizing hospital chains, including the non-profits?
People live longer in Canada, France and Great Britain as long as thy don't have cancer.
People live longer in Canada, France and Great Britain as long as thy don't have cancer.
1
The forces at work have done just about everything possible to make being a doctor and being a patient two of the most miserable roles in the US.
24
How about making EHRs communicate across all platforms? How about making it mandatory for specialists to send a report to the patient's main physician? What about making sure that physicians and other health care providers can spend more than 7-10 minutes with a patient during a visit? In addition, maybe patients should be automatically provided with a record of their visit with all the pertinent information in it. This way the patient can check the accuracy of the information and try to get it corrected before it's set in stone (or in the computer record).
There are too many places and ways for patient information to be lost, made incorrect, never communicated, or remain inaccurate. The truth is that we shouldn't have to pay someone to coordinate our care; it should be part of the package especially if we are ill, seeing multiple doctors for the illness, do not have a family member available to help us (and many of our relatives and friends work, just like we do when we're well). We have one of the most inconvenient and inaccurate and expensive health care systems in the world. We could improve it with the EHRs if they weren't on separate platforms, we had a single payor universal access system, and if doctors didn't have to worry about seeing a certain number of patients to make enough money to pay for everything. Eliminating the middle man for insurance would go a long way towards decreasing costs. So would price controls on vital meds.
There are too many places and ways for patient information to be lost, made incorrect, never communicated, or remain inaccurate. The truth is that we shouldn't have to pay someone to coordinate our care; it should be part of the package especially if we are ill, seeing multiple doctors for the illness, do not have a family member available to help us (and many of our relatives and friends work, just like we do when we're well). We have one of the most inconvenient and inaccurate and expensive health care systems in the world. We could improve it with the EHRs if they weren't on separate platforms, we had a single payor universal access system, and if doctors didn't have to worry about seeing a certain number of patients to make enough money to pay for everything. Eliminating the middle man for insurance would go a long way towards decreasing costs. So would price controls on vital meds.
11
Go to work for a large. self-insured employer. They figured this out 15-20 years ago.
This article focuses on financial issues, but another downside of merging doctors and hospitals is that currently, 1/6 of the hospitals in this country are religiously-oriented and increasingly they prevent associated doctors from performing procedures relating to women's health. Often, these restrictions are not revealed up front, yet, they can put a woman's life in jeopardy. As mergers increase, these facilities are more often the only health care systems in a given geographical area.
9
You would have to provide some evidence that religiously oriented health systems put women's lives in jeopardy. If that were the case, state regulators would have put them out of business. Try to take a somewhat less narrow minded view of healthcare.
Nearly 20 years ago my dad was treated at the Mayo Clinic in MN. It was my understanding at the time that the doctors were on salary there. I know my mom did not receive individual bills for my dad's surgery for every doctor that was in the OR. We were shocked by how inexpensive his brain surgery was: roughly the same cost as a laparoscopy I had recently undergone at my local hospital. We kept thinking there would be more bills from the anaesthesiologist, radiologist and so forth but there weren't.
Perhaps the real reason I.D.S. hospitals are more costly is because without having the doctors on salary it's really a system that instills perverse incentives.
Perhaps the real reason I.D.S. hospitals are more costly is because without having the doctors on salary it's really a system that instills perverse incentives.
11
Dollars to donuts your father had insurance from a large, self insured employer who put your father into a special care coordination program for complex conditions and covered his care, along with travel costs for him and a companion for a reduced co-pay. It had nothing to do with whether or not the doctors were on salary. And it also had nothing to do with whether or not the Mayo Clinic was offering the lowest price for the care.
The insurance company that was administering the employer's health plan knew that Mayo was the location that would provide the best care with the fewest complications.
If your father had an ObamaCare policy from the individual market, he would not have the option of going to the Mayo Clinic because the major diagnostic centers are not in-network for anyone. He would have to use a local provider, even if they only performed two brain surgeries per year.
The insurance company that was administering the employer's health plan knew that Mayo was the location that would provide the best care with the fewest complications.
If your father had an ObamaCare policy from the individual market, he would not have the option of going to the Mayo Clinic because the major diagnostic centers are not in-network for anyone. He would have to use a local provider, even if they only performed two brain surgeries per year.
1
"your father had insurance from a large, self insured employer who put your father into a special care coordination program for complex conditions and covered his care, along with travel costs for him and a companion for a reduced co-pay." What??? How do you know this? And--why do you seem to believe all patients at Mayo have employer insurance, or that their travel costs and those of a companion are paid by someone else? Certainly not true for any Mayo patients that I know.
2
The commenter related an anecdote regarding her father's care at Mayo 20 years ago. I do not know the specifics of her father's insurance 20 years go, obviously. That is why I began my comment with "Dollars to donuts." Jeesh, I was simply pointing out that there has been coordination of care offered by large self insured employers for a long time. Obama managed to attempt a copy that raises profits for the big hospital chains and also increases overhead.
Since my comment refers to a single instance, you jumped to a conclusion that I thought that all Mayo clinic patients had employer provided coverage from large self-insured companies, which I never said or implied.
There are no patients at the Mayo clinics that are paying for their care using an ObamaCare individual policy purchased through the government exchanges.
Since my comment refers to a single instance, you jumped to a conclusion that I thought that all Mayo clinic patients had employer provided coverage from large self-insured companies, which I never said or implied.
There are no patients at the Mayo clinics that are paying for their care using an ObamaCare individual policy purchased through the government exchanges.
The author omits a significant source of extra costs in the system of healthcare under discussion: that physicians are paid on a procedural basis and not employed by salary . This plus tort reform will enable the providers to render significant cost controls, if the CEO doesn't take home $10 million /year.
12
It depends upon the insurance. Insurance provided by self-insured employers frequently has package payment terms at specialty centers for high quality complex care. It's typically not the cheapest provider of the care, but it is the most cost effective if you include the fact that the patient is more likely to have fewer complications and to survive.
1
One item the article didn't mention are the electronic medical records vendors. The Medicare Meaningful Use criteria should have required that EMRs be able to quickly and easily exchange information in order to qualify for the special EMR bonuses. This was fought tooth and nail by the EMR vendors, because it makes it too easy to switch software. As it stands, if an EMR platform isn't meeting a practice's needs, the practice has to pay hefty exit fees to switch EMR platforms. If you could simply transfer all of your patient records to the new software, switching EMR programs would be as easy as switching cell phones. It came down to a choice between financial interests of EMR companies and patient care. Patient care lost.
23
A federal government that could not write specifications for a platform to sell insurance in three years is hardly the organization that cold be expected to write a standard communication protocol for EMR. And the IT cronies had no incentive to standardize for the reasons you mention.
ObamaCare was designed to increase profits for those who are favored.
Drug companies, big hospital chains have increased the amounts they charge. Part of the practice consolidation in hospital chains was driven by the high cost for small practices to implement EMR, the other being the big chains were able to negotiate higher billing rates from insurers if they had a near monopoly in a market. And all of the higher charges resulted in higher insurance premiums along with higher deductible and co-pays.
It seemed to the central control technocrats that if all of the information was contained in EMRs, that it would be able to be utilized. But none of them knew anything about actually implementing EMR. The central bureaucrats couldn't even put together a software platform to sell insurance, that Amazon.com could have certainly accomplished with three years to plan it. The Obama administration didn't even have the specifications written for the federal or state exchanges written until the summer of 2013.
Obama thinks that if you write a law, it will magically be effective, even if you spend the next few years changing the rules.
ObamaCare was designed to increase profits for those who are favored.
Drug companies, big hospital chains have increased the amounts they charge. Part of the practice consolidation in hospital chains was driven by the high cost for small practices to implement EMR, the other being the big chains were able to negotiate higher billing rates from insurers if they had a near monopoly in a market. And all of the higher charges resulted in higher insurance premiums along with higher deductible and co-pays.
It seemed to the central control technocrats that if all of the information was contained in EMRs, that it would be able to be utilized. But none of them knew anything about actually implementing EMR. The central bureaucrats couldn't even put together a software platform to sell insurance, that Amazon.com could have certainly accomplished with three years to plan it. The Obama administration didn't even have the specifications written for the federal or state exchanges written until the summer of 2013.
Obama thinks that if you write a law, it will magically be effective, even if you spend the next few years changing the rules.
1
Patients can have the benefits of IDS without necessarily being in a system that identifies as IDS. All my care is through the Unviersity of Colorado Hospital doctors. Whenever I go, each of my doctors have read through integrated electronic records and is aware of what has happened to me medically. Though actual intentional coordination does not take place, because my doctors are competent and attentive, my care never has the pitfalls of having doctors who do not have access to other doctors notes and the tests that have been conducted.
5
Forty years ago, I was a member of an HMO where all primary care (5,000 participants) was conducted at a single clinic. When you made an appointment they pulled your paper file and delivered it to the physician you were seeing. people typically selected a "regular doctor" who they saw routinely, but if they needed urgent care, the available physicians had access to their records.
There's nothing magical about the record being on a computer.
It may work to rely on paper records in a one-location practice, but today's practitioners often members of a network with multiple locations. It is not practical for me to carry my paperwork from doctor to doctor, even is an organization like Kaiser. Because of computerized records, my primary care doctor, my orthopedist, my cardiologist my surgeon and my hospital can all pull up and see my records, even at the same time, if they need confer among themselves to address a problem. Paper? Too easily lost, especially by me if I'm ill.
Another point added to my comments...Our de facto criminal health care system (where the interests of the billionaire health execs are put above the patient) has started a new cottage industry, ie Americans going to third world countries to get medical work done safely at a fraction of the cost. I know several Americans who have gone to India and several South Americans countries to get work done. At first I thought they were nuts but they told me it was well worth the trip.
Yeah, yeah, I know all the supporters of our criminal system say people come to America too to have this done...yes..RICH, RICH PEOPLE WHO CAN AFFORD IT, not the average person.
Yeah, yeah, I know all the supporters of our criminal system say people come to America too to have this done...yes..RICH, RICH PEOPLE WHO CAN AFFORD IT, not the average person.
9
After a routine office visit to my GP, and after having paid my deductable for same... I received a bill for "outpatient services"...aka a facilities fee, from the local hospital network. A 10 minute office visit justified a $195 bill for outpatient facility use. Same fee as if I'd been in the actual hospital!
5
Of course - health care systems (hospitals) acquire retiring family practices, staff with hired doctors and then use these as "loss leaders." The point is to up the referrels to the money making specialists and hospital facilities. The executives of these systems are quite satisfied to have their family doctors see about ten patients' day and pour reams of often useless detail onto a computer system (because these allow for higher reimbursements), as long as the gravy train of additional, often questionable, care continues.
No sane family doctor opens an office anymore; the compilation of federal regulations, the bias of Medicare, the niggling pf payment by insurance companies, and the ever present financially destroying out of control malpractice courts have destroyed what once was an often intimate doctor-patient relationship. Welcome to the new world of worse care and higher costs - it's just what the government ordered.
No sane family doctor opens an office anymore; the compilation of federal regulations, the bias of Medicare, the niggling pf payment by insurance companies, and the ever present financially destroying out of control malpractice courts have destroyed what once was an often intimate doctor-patient relationship. Welcome to the new world of worse care and higher costs - it's just what the government ordered.
24
And sane doctors retire earlier.
14
I'm sorry to read this but not surprised. My wife is holding on a few more years and retiring early. Maybe the young kids coming out of med school want to be mere employees, but we will live in a van down by the river before she becomes a fungible billing unit for a hospital system.
And if you think we are alone, you have another think coming.
And if you think we are alone, you have another think coming.
8
I currently live in the UK and the NHS is very good at communicating between providers, likely because of a standardized national system and sharing of electronic medical records across that system. Granted I've only needed maternity care, but I have been very impressed at the ability of any health professional I see, from the midwife to the GP to the OB/Gyn to the physical therapist, to be able to pull my file and immediately know what's going on. This is a far cry from having to re-tell my medical history to every doctor I ever saw in the US when I was last living there. Communication is essential for care to function. We need a national system of care delivery.
33
This is crucial- the sharing of electronic medical records. It's like a credit report, any new bank you go to can see all your counts, when you paid your bills etc. Communication will remain inconsistent until we overcome that hurdle.
6
ebmargit, how does the NHS treat mental health records? Are these as easily accessible as other types of medical records to physicians and nurses treating a patient?
2
This is the scariest article with the scariest advice from a so called medical expert or health expert, "Coordinate your own care, or services". Are you kidding me?
Just as I thought the author is a health economist...and this is another article against ACA, and a need to privatize and popularize in the name of shrinking bloated health centers.
In my world one of the doctor's job is to coordinate with other doctors and specialists in the care of their patients. They ask for records, they ask for history, they have medical reports, treatment history, etc. faxed to them from other experts and specialists. while also using the patient and his or her family as verification, clarification and confirmation. My Primary Care Physician in California, who is an angle whom I had for over six years and kept her even when I left the State, even coordinated with alternative health care professionals and programs to make sure herbs, vitamins, supplements did not interfere with whatever she was recommending.
The foundation of medicine is doctors consulting other doctors and medical professionals involved in the care of a patient. When did doctors get so arrogant, haughty, lazy and bubbled?
This article provides terrible advice to a patient, though I certainly support reducing the bloating in structure, function and funds. But some coordination, for the good of the patient, should be done by health professionals and doctors in the system.
Start advising doctors for a change.
Just as I thought the author is a health economist...and this is another article against ACA, and a need to privatize and popularize in the name of shrinking bloated health centers.
In my world one of the doctor's job is to coordinate with other doctors and specialists in the care of their patients. They ask for records, they ask for history, they have medical reports, treatment history, etc. faxed to them from other experts and specialists. while also using the patient and his or her family as verification, clarification and confirmation. My Primary Care Physician in California, who is an angle whom I had for over six years and kept her even when I left the State, even coordinated with alternative health care professionals and programs to make sure herbs, vitamins, supplements did not interfere with whatever she was recommending.
The foundation of medicine is doctors consulting other doctors and medical professionals involved in the care of a patient. When did doctors get so arrogant, haughty, lazy and bubbled?
This article provides terrible advice to a patient, though I certainly support reducing the bloating in structure, function and funds. But some coordination, for the good of the patient, should be done by health professionals and doctors in the system.
Start advising doctors for a change.
10
Employers, who are often purchasers of health care on behalf of employees, and employees who pay for part of their care through premiums and copays, need to vote with their feet and choose health care systems that delivery high quality care at an affordable price. This means saying no to the 800-pound gorilla mega hospital system that's able to charge an arm and a leg by virtue of their sheer size. Prices more often than not do not equate to quality in health care, they only reflect the ability of the biggest health care systems to extract higher prices via increased market power.
9
The author is absolutely right. As these organizations grow in the size, the layers of bureaucracy multiply, and quality control becomes hard, if not impossible, to maintain.
Culture is also important. No matter how impressive an organization is on paper, it cannot deliver consistently high quality patient care unless it has the right culture, which means the right leadership.
The best place to get integrated care, today, in my experience, is a small hospital or group practice with a good reputation, even if they don't have all the latest technological bells and whistles.
Culture is also important. No matter how impressive an organization is on paper, it cannot deliver consistently high quality patient care unless it has the right culture, which means the right leadership.
The best place to get integrated care, today, in my experience, is a small hospital or group practice with a good reputation, even if they don't have all the latest technological bells and whistles.
15
The reason integrated delivery systems, vertically integrated health care systems and cooperative care alliances don't improve the quality of care, or outcomes, is that ologopolies have few incentives to excel. Link: https://en.wikipedia.org/wiki/Oligopoly
More important, so many patients fail to comply with their doctors' orders and to take care of themselves that it is impossible to hold providers or insurers accountable for the quality of care or health care outcomes. Committees and teams are places for people to hide from accountability.
Having published and written numerous articles in the 70s, 80s and 90s about how integrated health care systems would be, I gradually recognized long ago that they were created and are being created to game government-distorted health care markets that are dominated by a few huge insurers.
Insurers also are ologopolies that have few financial incentives to contain premium growth or promote smart decision making by physicians or patients.
Solutions: Reform ObamaCare, Medicare, Medicaid and individual insurance markets.
Get employers out of the health insurance business. Breakup big insurers and integrated delivery systems.
Educate and re-educate consumers about healthy living and health care providers beginning in high school.
No one should graduate from high school or college without passing exams that test their decision making skills and knowledge of the health care system.
More important, so many patients fail to comply with their doctors' orders and to take care of themselves that it is impossible to hold providers or insurers accountable for the quality of care or health care outcomes. Committees and teams are places for people to hide from accountability.
Having published and written numerous articles in the 70s, 80s and 90s about how integrated health care systems would be, I gradually recognized long ago that they were created and are being created to game government-distorted health care markets that are dominated by a few huge insurers.
Insurers also are ologopolies that have few financial incentives to contain premium growth or promote smart decision making by physicians or patients.
Solutions: Reform ObamaCare, Medicare, Medicaid and individual insurance markets.
Get employers out of the health insurance business. Breakup big insurers and integrated delivery systems.
Educate and re-educate consumers about healthy living and health care providers beginning in high school.
No one should graduate from high school or college without passing exams that test their decision making skills and knowledge of the health care system.
10
Tossing Obamacare on the trash heap of history will greatly improve the lives of our middle and working class Americans. Government power will be the only casualty.
6
Someone I know has been waiting for several months for the next phase of treatment because the different specialists, who belong to various medical institutions, have not been able to get a common time to confer with each other. The capable primary MD has frequently attempted to help but is continually frustrated - as the patient gets worse.
8
Just merging hospitals and physicians provides no incentives to keep health care costs down -- the only way it works is if they are also a not-for-profit (like Mayo Clinic) or non-profit + insurance provider (like Kaiser).
3
Non-profits behave exactly like for profit hospitals and the "income minus expenses" feeds huge administrative bureaucracies and supplies the capital to buy out physicians so they can increase their power and income. In my area the non- profits are the most aggressive in trying to increase market share and increase prices.
8
No such thing as nonprofit. Nonprofit hospitals are really just tax-exempt, meaning they don't pay tax on profit. A big difference.
19
Alas, most nonprofits have become a complete joke. Had I known in college what would happen to them in the course of my lifetime, I would have gone into the sector because that's where the real money is. Our local ostensibly nonprofit hospital had a "profit" of $50,000,000 over the last two years, and pays by far the highest salaries in the region.
Do you want to reform the nonprofit sector? Cap salaries. Require a spend down of endowments over a certain amount. Make wealthy nonprofits that retain too much earnings pay property taxes and limited income taxes. End the free riding off the backs of the American middle class.
Do you want to reform the nonprofit sector? Cap salaries. Require a spend down of endowments over a certain amount. Make wealthy nonprofits that retain too much earnings pay property taxes and limited income taxes. End the free riding off the backs of the American middle class.
9
The bottom line is that a patient needs to be their own healthcare advocate or have a knowledgable family member or outside professional act on their behalf as the advocate.
While the integrated delivery system (IDS) may seem to offer a better solution for the patient, the IDS has its many faults.
The real problem is that not enough time is alloted for a doctor's examination and consultation appointment and that's a fiscal policy imposed on doctors by Medicare, Medicaid and private insures.
Twenty minute appointments don't give the doctor sufficient time to do all that's required to prepare for, conduct a thorough exam and complete follow up records.
And IDS only really works if all doctors of the patient in complex illnesses actually thoroughly read the patients electronic record and after visit summary from the other treating physicians.
Don't assume the doctor understands anything about you. Be your own advocate for your health. Ask question, be informed.
While the integrated delivery system (IDS) may seem to offer a better solution for the patient, the IDS has its many faults.
The real problem is that not enough time is alloted for a doctor's examination and consultation appointment and that's a fiscal policy imposed on doctors by Medicare, Medicaid and private insures.
Twenty minute appointments don't give the doctor sufficient time to do all that's required to prepare for, conduct a thorough exam and complete follow up records.
And IDS only really works if all doctors of the patient in complex illnesses actually thoroughly read the patients electronic record and after visit summary from the other treating physicians.
Don't assume the doctor understands anything about you. Be your own advocate for your health. Ask question, be informed.
10
Coordinate your own care is good advice and help your loved ones with theirs if you have the capacity. Much better to help care givers link up episodes of care in real time and help prevent mistakes by asking questions. Just don't expect any thanks from nurses, hospital staff or doctors and their staff. Sad that our health care system seems to treat patients and their advocates as nuisances.
9
No, they treat us like adversaries. The patient that most hospitals like best are the ones that ask no questions because they are in a coma, too ill to notice anything, or have no one to advocate for them. And some physicians outside the hospital are the same way: ask them no questions and they'll tell you no lies. Oh, and pay your bills like an obedient child.
2
"Another alternative is a professional patient advocate, who may charge $100 or more an hour to coordinate care."
There used to be another name for such a patient advocate. Doctor.
It used to be the expectation that a individual’s personal physician would guide the patient through his/her hospital course. The physician, not an employee of the hospital, had a duty to his/her patient.
There are interesting arguments both ways as to whether it is good or bad for physicians and hospitals to have the same financial incentives.
For example, a physician might get payment X if he/she does procedure Y to a hospitalized patient. (Let’s assume it is in fact indicated, but there may be room for disagreement about this.) But, while the physician benefits financially, the hospital may be suffer in payment schemes where the hospital benefits by keeping the hospital stay short (as is now often then case). It is not clear if it is better or worse for the patient for these alignments to exist.
The real challenge is to identify: (1) What professional, knowledgeable person, is able to put the patient’s interest first (and has no incentives not to!). (2) What system allows the patient to be placed first?
There used to be another name for such a patient advocate. Doctor.
It used to be the expectation that a individual’s personal physician would guide the patient through his/her hospital course. The physician, not an employee of the hospital, had a duty to his/her patient.
There are interesting arguments both ways as to whether it is good or bad for physicians and hospitals to have the same financial incentives.
For example, a physician might get payment X if he/she does procedure Y to a hospitalized patient. (Let’s assume it is in fact indicated, but there may be room for disagreement about this.) But, while the physician benefits financially, the hospital may be suffer in payment schemes where the hospital benefits by keeping the hospital stay short (as is now often then case). It is not clear if it is better or worse for the patient for these alignments to exist.
The real challenge is to identify: (1) What professional, knowledgeable person, is able to put the patient’s interest first (and has no incentives not to!). (2) What system allows the patient to be placed first?
16
Historically, most physicians have been more interested in their own welfare and in helping their hospitals maximize revenues than in doing what is best for patients.
Our tort system, which forces physicians and hospitals to deliver more services than they would if they weren't so afraid of being sued for malpractice, makes health care 25% to 35% more expensive than it should be.
Human nature is to take care of yourself first regardless of financial incentives. Physicians are human. There isn't any way to get around that.
Our tort system, which forces physicians and hospitals to deliver more services than they would if they weren't so afraid of being sued for malpractice, makes health care 25% to 35% more expensive than it should be.
Human nature is to take care of yourself first regardless of financial incentives. Physicians are human. There isn't any way to get around that.
6
disagree - advocates are far better at knowing the complexities of the social medical system then doctors - let the doctors care for you, work with coordinated care givers, work with family, work with patients, be available to answer questions, and the outcome should be the best. oh... the patient should follow the instructions of the doctor,not the other advocates -
Let's face it, US health care is the only industry that doesn't have set pricing. The fact that a hospital or doctor has a rate for their services, then the insurance company "negotiates" how much they want to pay for those services, and then the patient continually puts money into an insurance plan that may or may not cover treatments is absurd. Because then in order for hospitals and doctors to make up for the lose in income they have to jack up fees on other patients and treatments. It stops becoming a business and turns into a shell game.
That's like a plumber showing up to your house, charging you $7k for work, the insurance company paying the plumber $1k for the job and then the insurance company have you pay the entire $7k because you didn't meet your deductible yet.
The very fact that we put money into an insurance plan that might or might not reimburse for treatment and stops covering us if we don't have money to pay is incredulous. Unlike Social Security and Medicare, the money we put in is ours. As a healthy, middle aged, man, in the course of 30 years I must have put in over $170k into my private health insurance plan, if I was to fall sick, lose my job, can't pay insurance anymore, all of that money is gone. Conversely if we had a single payer system we would at least know that contributions we put in over the years would come back to us.
That's like a plumber showing up to your house, charging you $7k for work, the insurance company paying the plumber $1k for the job and then the insurance company have you pay the entire $7k because you didn't meet your deductible yet.
The very fact that we put money into an insurance plan that might or might not reimburse for treatment and stops covering us if we don't have money to pay is incredulous. Unlike Social Security and Medicare, the money we put in is ours. As a healthy, middle aged, man, in the course of 30 years I must have put in over $170k into my private health insurance plan, if I was to fall sick, lose my job, can't pay insurance anymore, all of that money is gone. Conversely if we had a single payer system we would at least know that contributions we put in over the years would come back to us.
24
This is why HSAs are such an attractive option. If you had invested that $170K in an HSA, you would be able to withdraw the funds (and earnings) tax free to pay for your medical care.
1
The truth is, why does it take ten doctors to screw in a light bulb? While this sounds funny, the real problem is the hospitals, drug companies and insurance companies are all part of the problem.
Primary care now is a 10 minute visit with several in front of a computer.
Insurance changes something every year assuring we pay more.
Drug companies have carte blanche to charge what they want under crony capitalistic pricing policies.
Other types of provlders such as chiropractors are more ideal for evaluating musculoskseletal problems, yet they are often under utilized.
Primary care needs to spend more time, refer less and be able to take the time to properly evaluate people and treat. They also need to either refer better or learn some methods of musculoskeletal diagnosis. This will help them refer more appropriately.
The truth is, if we paid and expanded primary care better, specialists would want to do this type of care.
We need a total reconfiguration of the system. Larger hospitals and the practices they purchased charge more and get more, due to negotiating strengths, yet, this does nothing for care quality.
We need a reboot
Primary care now is a 10 minute visit with several in front of a computer.
Insurance changes something every year assuring we pay more.
Drug companies have carte blanche to charge what they want under crony capitalistic pricing policies.
Other types of provlders such as chiropractors are more ideal for evaluating musculoskseletal problems, yet they are often under utilized.
Primary care needs to spend more time, refer less and be able to take the time to properly evaluate people and treat. They also need to either refer better or learn some methods of musculoskeletal diagnosis. This will help them refer more appropriately.
The truth is, if we paid and expanded primary care better, specialists would want to do this type of care.
We need a total reconfiguration of the system. Larger hospitals and the practices they purchased charge more and get more, due to negotiating strengths, yet, this does nothing for care quality.
We need a reboot
19
We do not have a health care system in the United States. Rather, we have an industry that has evolved to maximize the wealth of executives and shareholders in the various corporations within that industry. And those corporations play a zero-sum game among themselves to maximize their own share of the industry's total wealth. Insurance companies, hospital chains, pharmaceutical companies, pharmaceutical benefit managers, and increasingly consolidated corporate medical practices all play against each other to grab the largest piece of the pie for their shareholders.
In the medical industry, profits come first and patients come last. When a patient actually receives care, it's called a "medical loss." Patients have to contend with the endless complexity of copays, coinsurance, formulary tiers, networks, prior authorization, all of which continually change as the various industry players seek to maximize profits. And even when a patient takes the time to follow the rules and pay ever-increasing premiums and "cost-sharing," the threat of bankruptcy is always looming.
This is all unique to the United States-- American Exceptionalism at its finest! People in other countries don't have to suffer with all the complexity, or risk death or impoverishment when they fall through the cracks, because they have actual health care systems. What we have is an industry in which corporations seek to enrich their executives and shareholders at the expense of patients.
In the medical industry, profits come first and patients come last. When a patient actually receives care, it's called a "medical loss." Patients have to contend with the endless complexity of copays, coinsurance, formulary tiers, networks, prior authorization, all of which continually change as the various industry players seek to maximize profits. And even when a patient takes the time to follow the rules and pay ever-increasing premiums and "cost-sharing," the threat of bankruptcy is always looming.
This is all unique to the United States-- American Exceptionalism at its finest! People in other countries don't have to suffer with all the complexity, or risk death or impoverishment when they fall through the cracks, because they have actual health care systems. What we have is an industry in which corporations seek to enrich their executives and shareholders at the expense of patients.
96
Eisenhower's warning of the military-industrial complex is relevant to what has happened with the medical-industrial complex. The nature of what ails us and the state-of-the-art scientific understanding is such that for a good 80% of all health interactions, less is more. But that is antithetical to a medical-industrial complex. So I ask you "Which industry is seeking decreased revenues?". None. So why would medicine be any different. So mergers are not about patient care they are about good-old mergers and acquisitions. When you cannot make more income by creating value you do it through rent-seeking behaviour. Almost all the complexity in American healthcare is related to parties trying to strip the ball off other parties. The doctor and the patient are rather irrelevant in all of this. We did not necessarily get here because of evil people (maybe it was the invisible hand that did it) but it is shameful that we stay here given what we all now recognize is going on.
1
Large integrated health systems have many advantages such as shared medical information systems and the potential for efficiency in sharing expensive resources. However, non-physician managers in these systems are tempted to think that the answer to every problem in health care is to scale up with all providers and all patients being essentially interchangeable. For individual patient care the opposite is the answer. Patients need and prefer office staff and consistent providers who know them and immediately know who they are when they call and what they are likely to need. This type of care is also more efficient and should ultimately be cheaper- humans are better than computers can ever be at clinical judgment, and at resolving individual problems in the simplest way. My guess is that large health care systems will eventually come to the realization that they will function better when they move away form the industrial model to treat individuals as unique, but we are a long way from there at the moment.
9
Healthcare economists only look at the tail of the elephant, healthcare costs. They don't look at the fact that many integrated healthcare systems have a three-pronged mission - clinical care, education, and research. Or that, yes, outcomes do differ for centers that do lots of complicated procedures, e.g. complicated heart surgeries, in complicated patients with multiple comorbidities.
Take Partners Healthcare in Massachusetts, encompassing Brigham and Women's, MGH, Dana Farber etc. We have an enormous research budget from NIH and elsewhere, dwarfing that of entire med schools. We train hundreds of physician leaders and physician scientists each year, who in turn populate med schools and hospitals throughout the nation and the world.
Yes, Partners is the "big gorilla" in Massachusetts healthcare, accused of dictating terms to Blue Cross et al. But with the adoption of Epic we are starting to realize the benefits of a completely shared EMR. I do expect that we can start to prove the benefits of integrated care. Indeed, in my specialty we have already proven the benefits of a truly integrated center, reducing morbidity, mortality, and yes, costs.
I would love to see a case study done of the Faulkner Hospital in Jamaica Plain. Anecdotally, I attend there a few days/year and have seen steady, clear improvements in the quality of care at what used to be a community hospital and is now a superb teaching hospital, a fully integrated arm of the Brigham and Partners.
Take Partners Healthcare in Massachusetts, encompassing Brigham and Women's, MGH, Dana Farber etc. We have an enormous research budget from NIH and elsewhere, dwarfing that of entire med schools. We train hundreds of physician leaders and physician scientists each year, who in turn populate med schools and hospitals throughout the nation and the world.
Yes, Partners is the "big gorilla" in Massachusetts healthcare, accused of dictating terms to Blue Cross et al. But with the adoption of Epic we are starting to realize the benefits of a completely shared EMR. I do expect that we can start to prove the benefits of integrated care. Indeed, in my specialty we have already proven the benefits of a truly integrated center, reducing morbidity, mortality, and yes, costs.
I would love to see a case study done of the Faulkner Hospital in Jamaica Plain. Anecdotally, I attend there a few days/year and have seen steady, clear improvements in the quality of care at what used to be a community hospital and is now a superb teaching hospital, a fully integrated arm of the Brigham and Partners.
14
"Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.--The New Yorker, "The Cost Conundrum," June 1, 2009
2
Murray Hill-
That is a complete oversimplification of the situation, and really not true at all
That is a complete oversimplification of the situation, and really not true at all
1
As a health economist I'm not surprised, Dr. Donabedian warned us over 50 years ago about complexity of organization and management and its effects on costs we surprised in 2014-16 he was right. It is perhaps more an issue of economies of scope and not scale. Microeconomic theory tells us monopolies, especially bi-lateral monopolies give society increased prices and reduced output.
I wonder if systems organized by physicians (Kaiser and Mayo) have consistently different cost outcomes than those systems organized by hospitals (Gessinger or Cleveland Clinic) with MD/MHA/MBA trained leaders. But what do you say about an industry where information technology still relies so heavily on the fax machine!
I wonder if systems organized by physicians (Kaiser and Mayo) have consistently different cost outcomes than those systems organized by hospitals (Gessinger or Cleveland Clinic) with MD/MHA/MBA trained leaders. But what do you say about an industry where information technology still relies so heavily on the fax machine!
11
Attention Americans, write this on the black board at least three times.
1-America has a de facto criminal health care system.
Shift to any other system in our peer countries, light yrs better than our system.
Heck even some third world countries like Rwanda have a better system. They have a national health plan for $12.
1-America has a de facto criminal health care system.
Shift to any other system in our peer countries, light yrs better than our system.
Heck even some third world countries like Rwanda have a better system. They have a national health plan for $12.
15
I recommend that you go to Rwanda to get your $12 healthcare. What could go wrong?
7
So does Cuba.
2
Write this on the blackboard at least three times. "The grass is always greener on the other side of the fence" - or, in this case, border.
As a Canadian-trained MD now working in the U.S. I collect examples of how care is compromised in Canada.
Like the hundreds of patients who had to be transferred from metropolitan Toronto in mid-2000s with acute NEUROSURGICAL EMERGENCIES - read subarachnoid hemorrhage, etc. - due to inadequate resources
http://www.theglobeandmail.com/life/critically-ill-patients-rushed-to-us...
Or the fact that Ontario MDs and patients have ~zero access to rituximab for severe autoimmune disease.
Or the fact that eculizumab - a life-saving medication for patients, mostly children, with atypical HUS - is completely unavailable in Ontario.
As a Canadian-trained MD now working in the U.S. I collect examples of how care is compromised in Canada.
Like the hundreds of patients who had to be transferred from metropolitan Toronto in mid-2000s with acute NEUROSURGICAL EMERGENCIES - read subarachnoid hemorrhage, etc. - due to inadequate resources
http://www.theglobeandmail.com/life/critically-ill-patients-rushed-to-us...
Or the fact that Ontario MDs and patients have ~zero access to rituximab for severe autoimmune disease.
Or the fact that eculizumab - a life-saving medication for patients, mostly children, with atypical HUS - is completely unavailable in Ontario.
2
My former physician, now retired, used to give me an my wife a summary of all our medications and lab results from our first visit to the present. These could be presented to other physicians when they were visited. One specialists comment on receiving the information was "I love these things" and they stood me in good stead when I had difficulties in Portugal. Now the information could be put on a thumb drive.
A good reason for carrying your own information is that current privacy rules (HIPAA) make it difficult to get the information between entities; another is that it cuts the time spent in getting the information.
Full disclosure: I am a retired physician.
A good reason for carrying your own information is that current privacy rules (HIPAA) make it difficult to get the information between entities; another is that it cuts the time spent in getting the information.
Full disclosure: I am a retired physician.
32
It is often naive to imagine a tech or organizational solution to a relational ideal. In medical care, a long term relationship between patient and primary care MD is the best way to coordinate & oversee care. This 'old fashioned' foundation for sound care has been eroded - with disruptive incentives - in favor of electronic health record, punitive monitoring, hospitalists, super specialization and - in a system with salaried MDs (to an HMO and/or hospital) who lose true 'proprietary' feelings toward 'their' patients.
While there are certainly cost benefits to bundle service & salary MDs, there are threats to real quality care. Patients need individualized treatment- beyond genomic profiles. It is impossible to quantify the nuances of pain perception, adherence, special fears, denial, private behaviors, patterns over time, etc. An attentive, curious primary care physician (likely to be replaced by physician assistants & nurse practitioners) can provide this individualized perspective, reduce error & coordinate specialist care.
This requires payment for continuity & team management.
While there are certainly cost benefits to bundle service & salary MDs, there are threats to real quality care. Patients need individualized treatment- beyond genomic profiles. It is impossible to quantify the nuances of pain perception, adherence, special fears, denial, private behaviors, patterns over time, etc. An attentive, curious primary care physician (likely to be replaced by physician assistants & nurse practitioners) can provide this individualized perspective, reduce error & coordinate specialist care.
This requires payment for continuity & team management.
15
On the other hand, you might gain, if an incurious, inattentive physician is replaced by a curious, attentive NP, with--ahem--degrees from Brown, Duke, and UNC Chapel Hill. Just saying'.
6
Sad state of affairs when the medical system can't communicate and patients have to coordinate their own care. When you have individual specialists looking at each patient as a source of revenue, they don't care about duplicate or unnecessary tests or procedures. The focus on money overwhelms all other considerations.
22
The integration makes sense in the theory, and perhaps would work in practice as well under a system with radically different incentives. But, unfortunately, that's not our health care system. See: http://kimbellardblog.blogspot.com/2016/03/tell-me-that-good-news-again....
3
This article states that, "A study published in Health Services Research found that as soon as Minneapolis-St. Paul area hospitals acquired physician practices, there was an increase in emergency department use as well as unnecessary hospital admissions".
What I think some people don't realize is, that's the whole point.
The business model is hope for an increased revenue stream based on increased & "incentivized" hospital use.
What I think some people don't realize is, that's the whole point.
The business model is hope for an increased revenue stream based on increased & "incentivized" hospital use.
42
In our health care system, for each doctor there is a legion of other people who are 'administering' care in one way or other. Apart from doing things that directly involve the care, many of these people are measuring what the doctor does, calculating the costs, preparing the bills, giving legal advice, budgeting, reporting safety parameters and on and on. Each insurance plan has its own army of people involved in these multiple pursuits. Each doctor is spread thin, trying to see too many patients and comply with too many regulations. In the end, such a complex system is simply not sustainable economically.
42
Germany uses the patient to maintain their medical records, all new encounters, test results or consults are added to the record continuously. This would resolve any questions, while maintaining excellent documentation.
15
The studies cited here are meaningless. Too high level to draw any useful conclusions because they mask key underlying systemic issues.
Reimbursement schemes provide incentives to offer more healthcare not less. Value-based payments are still the rare exception mainly because it's impossible to agree on what good looks like in terms of medical practice. Reporting/admin requirements make medical practice massively unaffordable for the average independent Doctor to stay afloat. Last but not least, healthcare is an outrageous laggard in employing technology productively. Not only electronic medical record systems are unaffordable, but the basic idea of monitoring patient outcomes and cost of care is an impossibility because no such technological platforms currently exist that can serve this industry.
In the US, the best we can do is hold on tight and hope we make it to Medicare-qualifying age relatively healthy when we can finally obtain some semblance of meaningful and thoughtful care.
Reimbursement schemes provide incentives to offer more healthcare not less. Value-based payments are still the rare exception mainly because it's impossible to agree on what good looks like in terms of medical practice. Reporting/admin requirements make medical practice massively unaffordable for the average independent Doctor to stay afloat. Last but not least, healthcare is an outrageous laggard in employing technology productively. Not only electronic medical record systems are unaffordable, but the basic idea of monitoring patient outcomes and cost of care is an impossibility because no such technological platforms currently exist that can serve this industry.
In the US, the best we can do is hold on tight and hope we make it to Medicare-qualifying age relatively healthy when we can finally obtain some semblance of meaningful and thoughtful care.
14
As long as the provider(s) are incentivized to provide more care to get more revenue, they will, no matter how the health care delivery business is organized. The only solution that will work is to fix the incentive structure, so they will provide care that leads to a cure in the most cost effective manner. If there's one thing that should be clear by now it is that health insurance companies cannot and will not effectively police health care choices to achieve that end. The providers themselves must have an incentive to do it, and probably the only way to achieve that is to integrate insurance with delivery (the HMO/clinic model) or move to a single-payer model that has real enforcement power combined with a consistent rulebook.
22
Frakt omits a major reason given for a policy supporting integration of hospitals and physicians: only hospitals could afford implementation of electronic medical records. Indeed, the original draft of the ACO regulations required a hospital to be part of the network in order to qualify as an ACO. Of course, hospitals have been acquiring physician practices long before ACA was enacted, especially primary care practices. And where primary care physicians go, specialty care physicians soon follow (for the referrals). Studies have shown that most of the progress in reversing or at least limiting rising health care costs is attributable to the expansion of outpatient services such as outpatient surgery centers, which have much lower reimbursement as compared to hospitals; indeed, the co-pay for inpatient services often exceeds the entire "facility" fee for the same services provided in an outpatient facility. Hospitals prefer the higher reimbursement from inpatient services, and communicate that clearly to their employed physicians.
11
As the CEO of an independent professional advocacy, I can countless stories of errors in the business and treatment of care. We've saved clients thousands by finding medical billing errors (an estimated 50% of all bills contain errors), improper claim denials (those requesting manual appeals 56% of the time have the denial overturned) and balance billing, which occurs when a healthcare provider attempts to charge the balance of the medical bill not paid by the insurer. (Balance billing is often fraudulent, but a patient who is unaware of the practice will bankrupt themselves paying it.) In one case, we retrieved over $2000 because we caught a hospital taking multiple x-rays of a child's wrist, exposing him to unnecessary and potentially dangerous levels of radiation.
With the complexities in today's healthcare system, you must have expertise if you don't want to be taken advantage by it. We offer our service for $60 - $70 per hour. Our service includes expert one on one advisement from an actually human being -- not a call center -- assigned to the client and his/her family.. When a patient pays our company $240 and saves $3400 on medical bills they've been fighting for months, I assure you they think it's a pretty good deal.
As strange as this may seem in a capitalistic society, I wish there were hundreds more companies like ours There are far too few independent advocacies to help patients battle the $3 trillion dollar healthcare industry.
With the complexities in today's healthcare system, you must have expertise if you don't want to be taken advantage by it. We offer our service for $60 - $70 per hour. Our service includes expert one on one advisement from an actually human being -- not a call center -- assigned to the client and his/her family.. When a patient pays our company $240 and saves $3400 on medical bills they've been fighting for months, I assure you they think it's a pretty good deal.
As strange as this may seem in a capitalistic society, I wish there were hundreds more companies like ours There are far too few independent advocacies to help patients battle the $3 trillion dollar healthcare industry.
14
So we add yet another layer of complexity to the system? Why? If we're paying more and more people to deal with our health and the resulting bills, in the end we have to pay more.
"When a patient pays our company $240 and saves $3400 on medical bills" Why not try to design a system that doesn't erroneously bill people on a routine basis. If I pay you $240 to get back $3400, I'm still paying $240 for something that does nothing to improve my health.
"When a patient pays our company $240 and saves $3400 on medical bills" Why not try to design a system that doesn't erroneously bill people on a routine basis. If I pay you $240 to get back $3400, I'm still paying $240 for something that does nothing to improve my health.
18
So all we need to do is search for your name and the city and state you conveniently provided beside it? Awfully nice of NYT to provide free advertizing for you like this! Wonder if they'll be doing that for other service businesses?
6
"In one case, we retrieved over $2000 because we caught a hospital taking multiple x-rays of a child's wrist, exposing him to unnecessary and potentially dangerous levels of radiation."
YOU decided the x-rays were unnecessary and dangerous? You filed a lawsuit? You know how many X-rays are necessary? While you may find some errors the patient may not, I agree with the previous comment about adding another layer of complexity, and expense.
More CEOs in the mix is not the answer to a real problem in health care.
YOU decided the x-rays were unnecessary and dangerous? You filed a lawsuit? You know how many X-rays are necessary? While you may find some errors the patient may not, I agree with the previous comment about adding another layer of complexity, and expense.
More CEOs in the mix is not the answer to a real problem in health care.
3
1)You are more likely to be referred to only doctors in the larger group, even if the "best" one for your particular problem is in another group.
2) If you are fired (as a patient) by anyone in the system you are fired by the entire system - with the continued consolidation of health care this may mean in smaller towns you effectively have no, or very limited, local health care left. This is an especially critical issue that has not been addressed. The practices of fire you from the practice means you can see no one in the practice used to be just a several doctor practice. Now it could be hundreds of doctors who will no longer see you. Considering the varied reasons why doctors fire patients, this is a problem that needs addressed sooner rather than later.
3) As large practice physicians typically only have privileges at one hospital, rather than several, you are now limited in where you can be hospitalized if you want your care to be with your current doctor.
4) The upshot of all of this is that patients can suffer significant problems in obtaining the best care possible in the best hospital possible, and in some cases any care at all.