Sunday, August 23, 2009

Physician, heal thyself

One of the things that has been rattling around in my head is the prospect of savings in the healthcare field. I'm not a professional policy wonk, but I have had more than the usual amount of exposure to medical professionals, and how the healthcare field actually works. Here are a few of the things that I hope are addressed:
  • Electronic records can and should be the norm. Electronic records allow for more efficient storage of greater amounts of information (not just patient notes, but digital X-rays, scans, etc.), provide greater assurance that the various bits of data will stay together (no more physically lost X-rays that wouldn't fit in the regular patient folder, for example), and make for easier transfer and sharing between various providers.
  • Standardized documentation -- not so much for the actual medical documents (which seem to be pretty much geared toward the people that need them, anyway), but the support paperwork. I've seen, with my own two beady little eyes, the claim forms for three different insurance companies. All three of them asked for the exact same information, but used completely different forms to do it. This is a clear and compelling example of how and why electronic record-keeping would save money: using something called XML, insurance companies could have their own "unique" individual paperwork, but still make available a common base that would dramatically reduce the time and effort (and expense) of filing claims. It doesn't matter if you call a blank on a form "Home", "Residence", "Address" or whatever -- it's the place where I live, and I should have to provide it only ONCE for everybody treating me or paying for the care I receive.
  • Defensive medicine is something that a lot of physicians feel the need to practice; it's the "policy" of ordering tests that aren't necessarily needed to establish a diagnosis, simply to ensure that they've covered ALL the bases in an effort to insulate themselves against a malpractice suit. This, of course, leads us to:
  • Malpractice reform is something else that needs to be addressed. There are entirely too many people and lawyers willing to sue for any damn thing, and juries willing to slap heavy-duty lawsuit awards against doctors and other healthcare professionals for things that weren't the result of actual negligence. I mean, let's face it: no matter how much schooling they've had, or how long they've been in practice, doctors aren't immune to making mistakes. Sure, they should be making a hell of a lot fewer of them, but they aren't the life-giving Gods that people want to think they are (despite how some Doctors act). That being said...
  • Physicians (as a community) need to be a HELL of a lot more open about their profession, and the people in it. By that, I mean that patients (consumers!) should be able to find out if a particular physician has a history of bad judgement, ineptitude, substance-abuse problems, or other factors a potential patient should be aware of. Similarly, it should be possible to get some idea of how experienced and proficient a physician is: if, for example, I'm looking at getting a knee replacement, I should be able to look up the names of doctors that do the procedure and see how many they've done, and how successful they were (including long-term results). Yes, some doctors take on "riskier" patients than others, and that can be noted and factored in; it doesn't change the underlying need for accountability and public awareness. I've heard of a lot of physicians saying that they can police their own; I say it's time they do just that -- police themselves, with the corresponding punishments and public accountability, just as the legal system provides.
  • Individuals need to be a lot more active in their healthcare, too. As noted above, the title "Doctor" doesn't equate to "Divine Entity"; folks need to ask a lot more questions, insist on intelligible answers, and not give health care staff an automatic pass on things. By way of illustration, if I ever find myself in a hospital bed again, I fully plan to have a box of gloves and a big bottle of hand sanitizer next to my bed -- and if I don't SEE the staff cleaning their hands (THE most common means of infection transfer in hospitals), I'll insist they use one or the other before touching me so that I reduce my infection risks. Hell, be a pain in the ass, if that's what it takes -- it's your body, life, and health, isn't it?
  • I'm going to suggest something that I think is new, here: a lower level of initial healthcare contact. By that, I mean we should maybe think of having an initial contact level of healthcare that serves as a "triage" point: let doctors and nurses in offices and emergency rooms deal with stuff that really needs people doing doctor stuff, and let this initial contact point serve to tell folks to put an icepack on their sprained wrist (minimal attention needed), they need to make an appointment with a doctor (more important, but not "critical"), or get them to an emergency room. Wouldn't it seem more efficient (and cheaper) to let an LVN/LPN wrap that sprained wrist or give a flu shot than the better-trained and more experienced RN or a doctor -- freeing them up to tend to stuff more appropriate to their knowledge and skills? I'd think that parking a mobile home outfitted as a first-care office in one corner of every schoolyard in the country would dramatically reduce the overloaded emergency rooms and doctors offices, and be cheaper to operate to boot.
  • Insulate doctors (and other health care professionals) from the infrastructure. I can't imagine why a doctor (or nurse, or Physician's Assistant, or...) should even be allowed to have any financial interest in a drug company, medical technology company, or any other kind of product or enterprise that they have direct and immediate contact with. A doctor sending a patient to an MRI facility that he is a part owner of is inexcusable, just as it should be for them to prescribe a drug made by a company that they have stock in (or otherwise stand to receive any kind of tangible income or reward from). Granted that they may not be all THAT many doctors involved in such shenanigans, but I don't think there should be ANY. If doctors want to invest in such things, then it should be done as a "blind" trust -- the doctor(s) involved shouldn't have any idea of who, what, or where.
  • Non-traditional medical "practices" should be subject to rigorous review and evaluation -- there has got to be a way to get rid of the pay-for-pills "pain management" offices, the whiplash-centric chiropractors, and the like. Not only do they give the rest of the medical profession a bad name, they directly and indirectly contribute to the associated costs the rest of us have to pay: increased insurance rates to cover inflated insurance claims, crimes associated with drugged "patients", waste and abuse of the medical infrastructure due to fraudulent claims, and more. I'm not suggesting doing away with pain management or chiropractic practices entirely -- only those that are patently engaged in fraud. If one office accounts for a statistically significant higher number of cases (lawsuits, crimes, etc.) than anyone else, it would seem pretty obvious that something untoward is going on.
No single ONE of these things is going to make a whole hell of a lot of difference by itself. But taken together, I think they'd be a damn good start on reducing the cost of healthcare, and the increasing rate that it's rising at.

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