An Unusual Blog Vent

I don't generally blog about anything medical, despite my profession as a PA (physician assistant), and I also don't generally vent on my blog. However, something is happening NOW that really burns me (and pretty much every health care practitioner and senior citizen in the nation)...

The AMA is outraged and rightly so. And in Iowa, the news is even worse. Because of the inequalities in reimbursement, Iowa practitioners will receive a 12.5% pay cut for EVERY Medicare patient they see, starting July 1 (that's TODAY), unless the Senate and our lovely president get their heads out of their you-know-wheres and DO SOMETHING productive for a change! There, can you tell how I feel about this?!

Overtreated
by Shannon Brownlee should IMHO be required reading for EVERYONE in the US, but at the very least, all elected officials at the federal level should be required to read it. This book time and again points out how the federal government's fee structure for reimbursing medical care costs contributes to the problems we have in health care. More care does not necessarily mean better health, yet the government (and all major health insurers follow suit) continues to reimburse fee-for-service, meaning every procedure is well-reimbursed, yet no one pays doctors a red cent for making sure patients are well-educated regarding their diagnoses.

A wonderful case in point: Duke University studied patients with congestive heart failure...several large physician groups participated and educated their patients regarding what to do, how to do it, and had a nurse call the patients EVERY day to check up on their weight (weight gain could mean the patient's heart is backing up with extra fluid and that the patient needs more diuretic/water pills) and other symptoms. They PROVED that they could reduce hospitalizations and complications by some enormous rate. Without reviewing the book again, I think they reduced hospitalizations by 30%, which is astronomical. Why did the experiment fail? No insurer reimburses for such things...the program cost a little bit of money to implement...but the real loss for these physician groups was the loss in income due to the fact that these patients were healthier and were at home rather than in the hospital and clinic all the time with crises and symptoms!!!! The physicians literally came to a point where they could not afford to continue taking such good care of the patients. When I first read this study, I literally cried.

One more example: Iowa is actually a good example of medical efficiency and good results for patients. Jack Wennberg has researched for at least 30 years how different areas of the country have vastly different results as far as quality of care. One of his first studies in the NE showed pockets of Vermont where physicians performed tonsillectomies at rates far exceeding any other physician groups. These doctors were not even aware that they were performing more procedures than anyone else...and their patients were proven to not be sicker, and to not benefit any more so, than the patients in the next town over who were receiving far fewer tonsillectomies. Anyway...Dartmouth Atlas is Dr. Wennberg's research, showing clearly the areas of the country with good versus "bad" care...Miami and Los Angeles are examples of areas where the physicians tend to perform huge numbers of procedures and surgeries to NO benefit of their patients, overall (obviously I am simplifying here...but the bottom line is, 30% more knee replacement surgeries does not mean that population is better off than in Iowa where the ortho doctors use conservative management more often such as injections and medications). Iowa is actually a place where you'll find relatively few unnecessary CT scans, where you will not find a glut of extra cath labs (if you build it, they will come, and the doctors will refer, often unnecessarily). Most of these gross excesses are actually not done on purpose by the physicians. The book points out the doctors just practice as they were taught...so an Iowa taught doctor is less likely to over-order CT scans, just as a LA taught doctor will over-order...they just think that's the norm.

I have dedicated the last 6.5 years of my Thursday evenings to the Free Clinic here in my town. It has been a way to mutually benefit myself and the community. I am mostly a SAHM, but as a PA I need to keep my foot in the door, so to speak, and practice medicine at some level to maintain knowledge and to be ready to work more again as my children get older. As I'm sure you are well aware, 47 million people in the US have no health care insurance, and if doctors have to cut back on the numbers of Medicare patients they see due to 10-12.5% pay cuts, where does that leave those seniors? Effectively also without care! The free clinic cannot absorb all that! Neither can the ER! And who pays for ER visits from patients who cannot pay on their own? That's right, the rest of us...those of us who have health care, either purchased on our own or through our employers, are paying for our own health care, PLUS our taxes go to pay for Medicare, PLUS we subsidize the uninsured. The hospitals cannot afford to just "eat" the costs of those who cannot pay...their fees are higher for everyone, knowing that some won't be able to pay.

The maddening thing to me regarding Congress and the feds is, they continue to give their own employees top-notch medical coverage. Why not reduce the doctor's reimbursements for seeing those patients and see what kind of outcry that produces? I'm guessing Senator So-and-So would be pretty P/Oed if all of a sudden his own doctor refused to see him.

In the few books I've read this past year on health care reform, my favorite "solution" to the problems involves the government "going after" the least efficient, the worst 3% of hospitals in the nation in the first year, then gradually expanding...those few hospitals will be required to implement changes that the best 3% have done to improve care WHILE cutting costs. Ie. don't do a CT scan of the abdomen when you know darned well the patient probably needs exploratory surgery for appendicitis anyway. Implement electronic records and use them to cut down on repeated labs and X-rays...study the data from the records to see if Dr. So-and-So's patients suffer more episodes of hospital acquired pneumonia....does Dr. So-and-So just need to be gently reminded to wash his hands and dry clean his tie more often? Those are pretty cheap solutions to an expensive problem (pneumonia).

I'm telling you, Europe is looking better and better...

Stepping off my soap-box now...I need to finish a scrapbook page so I can blog about something a little less inflammatory next time:)