Recently I read an article in the NY Times by Elisabeth Rosenthal. She’s the same author of the enlightening article “My doctor charged me $117,000 and all I got was this lousy hospital gown” That may not have been the exact title of the article. Continue reading “Why Doctors Don’t Like to Send You Test Results.”
3 Ways Obamacare is Destroying American Healthcare.
As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.
One patient even complained, “My new health care plan tripled in price, and now, it is like having a third loan to deal with, including my car and home loan.”
The current law and regulations being implemented under Obamacare will ultimately lead to sicker patients and low quality care for three reasons:
1. Older doctors will retire early fed up with the system. These older doctors feel that the loss of a patient-physician relationship and the burdensome regulations (ie. paperwork) will choke off their ability to provide good care. In addition, their expenses are increasing with these new regulations. Add in the projected cuts in reimbursement up to 26%, and their livelihood will be threatened. These cuts could force these doctors out of practice or force them to stop seeing Medicare patients simply because their expenses (which rise yearly) are exceeding their declining reimbursement, which has declined steadily over the past several years already. Continue reading “3 Ways Obamacare is Destroying American Healthcare.”
It’s Time to Move On From ACLS Certification.
I can recall, though it seems quite long ago, my first Basic Life Support (BLS) course as a first year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you ok?” Then hearing no response she showed us how to check for a pulse and spontaneous breathing. “if not present” she said, “call for help and start CPR”. Me, ever the smart-ass, took my own approach. “Sir, are you ok?” Then, grabbing the mannequin tightly to my chest “NOOOO! why? WHY?!”
This didn’t enamor me to the instructor very much and earned me most of the difficult clinical scenarios of the day.
Classes like these are now mandatory for those working in hospitals. Just about all employees have to go through BLS training, and many employees in more advanced clinical settings are also required to take Advanced Cardiac Life Support (ACLS). ACLS is an advanced skill set taught to medical personnel who work in areas of the healthcare field who may have encounters with patients that require interventions beyond the scope of BLS.
Those of us in the medical field who are required to recertify ACLS have long dreaded the process of ACLS recertification. Part of that is because it can be an intense course that makes many feel nervous. Part of it is also because it is expensive and time consuming. But the greatest reason why most who undergo ACLS training object to it is for a different reason entirely: they feel that is simply unnecessary. Continue reading “It’s Time to Move On From ACLS Certification.”
To Reform Healthcare, America Needs to Look to its Doctors.
Our healthcare system is sick and dysfunctional. A vicious cycle of blame is happening between Washington, health insurance companies, and the patients. And it is quickly demoralizing this nation and simply increasing costs with more administrative regulations. It is raising questions regarding the future of healthcare in the United States.
And we need answers.
Surprisingly, in all of this, doctors are rarely mentioned. As if doctors do not know the intricacies of how the health care system works. As if doctors are not there for their patients 24 hours per day, ordering tests or doing procedures that can benefit a patient’s well-being. As if doctors are not dealing with denials from the insurance companies on a daily basis, losing valuable hours to menial paperwork that could be spent caring for our country’s sick.
Doctors have a duty to care for their patients and are the engines that put health care into motion. They yearn to maintain that physician-patient relationship that is important to the care of our patients.
Unfortunately, doctors are not being directly involved in the health care reform debate despite being on the front lines of care. They have an opportunity to provide valuable insight into the day-to-day operations of this health care machine. Continue reading “To Reform Healthcare, America Needs to Look to its Doctors.”
How to Fix Healthcare, From a Doctor on the Frontlines: Part 3.
This is the last of a 3 part series by Dr. Moeller, the infamous Doctor on the Frontlines. In this series he explores ways in which our healthcare system is failing, and how it can be improved from the perspective of those who live and breathe healthcare every day. . . doctors. Click the links to read Part 1 and Part 2.
I want every person in America to have access to quality health care all at a reasonable price because our citizens deserve this. Unfortunately, universal access to care at a reasonable price cannot materialize unless lawmakers look to doctors on the front lines of care for specific input. We as doctors know in many ways why costs are high and why the public is unfortunately misinformed about how it all works. But we need a representative sample of practicing doctors in Congress discussing these issues so that these “insider” insights can be applied to our current laws. In post, I look at the last of three central ideas that would lead to better and more affordable care.
3. Health Savings Accounts.
The third solution highlights increasing patients’ roles in their own health, which would lead to more patient satisfaction, and actually lower costs. This could be accomplished with health savings accounts. These accounts would be funded by patients with pre-tax dollars and contributions made by employers and/or government subsidy stratified based on the individual’s income and job status. With actual money in these accounts, patients would be able to discern costs better and use this money as if they were consuming any other good or service, such as handyman services. This money could grow each year like an investment account and even be passed on to heirs at the time of death, keeping that sense of ownership with loved ones. Continue reading “How to Fix Healthcare, From a Doctor on the Frontlines: Part 3.”
How a Journal Club and a Blog Challenged the Mighty NEJM
Much has been written about how Web 2.0 tools can change the healthcare landscape. It would appear a recent set of circumstances has upped the ante.
This story begins with a recent study that attempted to tackle the problem of ICU infections. ICU infections are a challenging problem, patients who are admitted to the ICU are at risk of worsening illness and death from infections such as MRSA which can be acquired while in the ICU setting. To counteract this risk, current practice is the performance of surveillance cultures on people who are admitted to intensive care. If the person tests positive for certain infections they are placed in isolation (and health care providers are asked to wear silly gowns and share a useless stethoscope).
The success of this strategy is dubious, ranging from successful in some studies to nearly useless in others. Based upon my personal observations of my own hospital’s isolation practices, my only conclusion has been that yellow is not a good look for me.
But I digress. In this study, patients underwent “universal decontamination” with chlorhexidine, a commonly used antiseptic. The study found a dramatic drop in the numbers of MRSA infections and bloodstream infections. The study was peer reviewed and published in the flagship of medical publishing, the New England Journal of Medicine (sorry JAMA). Continue reading “How a Journal Club and a Blog Challenged the Mighty NEJM”
How to Fix Healthcare, From a Doctor on the Frontlines: Part 2.
This is the second of a 3 part series by Dr. Moeller, the infamous Doctor on the Frontlines. In this series he explores ways in which our healthcare system is failing, and how it can be improved from the perspective of those who live and breathe healthcare every day. . . doctors. Click the links to read Part 1 and Part 3.
I want every person in America to have access to quality health care all at a reasonable price because our citizens deserve this. Unfortunately, universal access to care at a reasonable price cannot materialize unless lawmakers look to doctors on the front lines of care for specific input. We as doctors know in many ways why costs are high and why the public is unfortunately misinformed about how it all works. But we need a representative sample of practicing doctors in Congress discussing these issues so that these “insider” insights can be applied to our current laws. In this post, I look at the second of three central ideas that would lead to better and more affordable care.
2. Tort reform.
We as doctors have a calling to help patients. But, as we all are human, mistakes can happen. It is very important that patients who are injured by mistakes be compensated in a way that the law is supposed to provide. However, the point of law is to provide reliable decision-making that can sort good health care from bad health care. Instead, currently, it is run ad hoc jury by jury with no set standards. The system currently favors a doctor if in fact something was done wrongly or it may favor a patient even if no mistake was made. This unreliability leads to defensive medicine, ordering tests and procedures just to prove that you did something, or excessively documenting trivial facts to prove you looked at everything. The estimates for defensive medicine has been estimated up to $200 billion per year. The current laws neglect both the patient and the doctor and drives up costs with administrative and attorney fees.
Here is an example of the evolution of defensive medicine. If a family physician determines a patient’s headache is likely due to tension and there are no warning signs for something serious, the doctor may choose not to order a CT scan and have the patient follow up if symptoms do not improve. Rarely, a tumor or bleeding in the brain could present in such a way despite a normal clinical evaluation by the doctor. If that patient ends up having a tumor or bleeding, they can sue the doctor for not ordering the CT scan earlier. In turn, that doctor doesn’t want that to ever happen again, even though he did everything right by using his clinical knowledge to determine nothing serious was likely going on. Continue reading “How to Fix Healthcare, From a Doctor on the Frontlines: Part 2.”
How to Fix Healthcare, From a Doctor on the Frontlines: Part 1.
This is the first of a 3 part series by Dr. Moeller, the infamous Doctor on the Frontlines. In this series he explores ways in which our healthcare system is failing, and how it can be improved from the perspective of those who live and breathe healthcare every day. . . doctors. Click the links to read Part 2 and Part 3.
I want every person in America to have access to quality health care all at a reasonable price because our citizens deserve this. Unfortunately, universal access to care at a reasonable price cannot materialize unless lawmakers look to doctors on the front lines of care for specific input. We as doctors know in many ways why costs are high and why the public is unfortunately misinformed about how it all works. But we need a representative sample of practicing doctors in Congress discussing these issues so that these “insider” insights can be applied to our current laws.
In this series of posts I will outline 3 central ideas that would lead to better and more affordable care.
1. Costs Need to Be Simple and Transparent.
The first idea involves making costs and reimbursement more simplified and transparent. These changes would help clarify misconceptions about doctor’s pay. Leaders need to stop attacking doctors for how much they earn because they do not really know how it works. In all other professions, one gets paid what the bill says. If a handyman comes in to fix your sink and charges $80, you pay him $80. If you seek a lawyer, and he says he charges $250/hour and he works 4 hours for you, you owe him $1000.
Unfortunately, the medical billing is unique, confusing, and wrong. The charges (bills) that patients see in the mail are not what doctors get paid. These are inflated numbers derived from contracts between hospitals or groups and insurance companies. A recent New York Times article headlines read “As Hospital Prices Soar, a Stitch Costs $500.” Sadly, these inflated numbers have nothing to do with what the doctor gets paid. In fact, those bills do not go to the doctor at all, but rather to the hospital.
When a hospital or doctor submits a charge (bill), the insurance companies or Medicare/Medicaid, depending on the patient’s insurance, utilize a fee schedule. This schedule consists of thousands of codes that give dollar amounts for individual procedures or clinic visits. Each code has a dollar figure to determine how much to reimburse that doctor. This is called a “Medicare fee schedule” and insurance companies will pay a certain percentage of the fee based on Medicare. This can range from 80% to 180% of Medicare depending on the insurance carrier. Continue reading “How to Fix Healthcare, From a Doctor on the Frontlines: Part 1.”
Dear Physicians: You Are Far More Wealthy Than You Know.
-By A. Joseph Layon, MD, FACP.
This article was written in response to Doctor Moeller’s Post: An Open Letter to Washington, D.C. From a Physician on the Front Lines
With interest, I read and re-read Matthew Moeller’s Open Letter. My son, a first year medical student at Drexel University in Philadelphia, commented that this missive was being discussed by his colleagues in a tone of moral righteousness. Interesting.
I know, I remember, what it was like to realize that the way to live an authentic life was to engage in providing health care for our people. I remember debt, struggle, and 120 work-weeks. All of this, I remember.
And I remember being a third year medical student at The University of California, Davis – Sacramento Medical Center. My professors, between patients on rounds, arguing how disastrous the health care system was becoming, how it was better in the “old days”, how they / we were suffering, how no one really understood what we had to go through. Well, you get the idea.
While I understand, empathize and remember much of what Doctor Moeller says in his piece, and while he is – in my view on the mark in much of what he writes – I think he misses several points that are worth comment:
1. Medical School Debt: As a member of the Faculty Senate at the University of Florida I once got into a running argument related to the lack of breadth our undergraduates exhibited prior to their entry into professional school; lack of knowledge of history, language, and cultures other than their own. Medical training is expensive. In the not so distant past, a huge portion of this expense – certainly in the State of California where I was both an undergraduate and graduate student – was funded through tax revenue. This was done not to be nice to our medical students, but because education was considered a social investment. Proportionally, the monies in education have decreased (see Christopher Newfield, Unmaking the Public University – The Forty-Year Assault on the Middle Class, 2008, Harvard University Press), resulting in a grand portion of the debt saddling Doctor Moeller. Nowhere in Doctor Moeller’s missive do I find any comment upon this. The very policies that many in our profession cling to – physicians being, oddly to my mind given our work, frequently conservative and in the Republican or Libertarian camps – i.e., anti-taxation policies, put our medical students – and undergraduates, and graduates – at risk. These policies put our future at risk. Doctor Moeller rightly notes his difficulties; but Matt, what about the broader picture ? This isn’t just a medical student issue. Continue reading “Dear Physicians: You Are Far More Wealthy Than You Know.”
5 Ways Healthcare Reform May Impact Medical Education
Guest Post by Ta’Rikah Jones
Unless Congress completely smothers the Affordable Care Act (ACA), its changes will shake healthcare to the foundations as millions of people gain access to insurance and expanded medical care.
The ACA’s goal is to move Americans toward a health insurance umbrella for everyone while striving to control costs and drastically alter the insurance industry. Potentially every facet of healthcare could be affected, from the doctor’s office to research labs. Changes could even reach into healthcare education.
The law will change the number of patients seeking care, how much doctors are paid and may make some med school students even more uneasy about school loans.
These are some ways the ACA may affect medical education:
1. More primary care
The law seeks to foster primary care and boosts Medicare payments to primary and internal medicine physicians significantly while lowering payments for subspecialty doctors. Also, payment and coverage for preventative care would rise along with primary care.
This could slow the drop in students who pursue primary care in medical school. For years students migrated into more lucrative subspecialties, leaving only a small percentage of students interested in general medicine.
The act also calls for expanding some scholarship and repayment programs for primary care doctors and expands nurse and primary care training.
Continue reading “5 Ways Healthcare Reform May Impact Medical Education”