Healthcare Reform Survey: What physicians think

A recent national survey, conducted in September 2010, asked more than 2900 physicians about the future quality of healthcare in the U.S. in light of the Patient Protection and Affordable Care Act (PPACA). The results were released in January. Here are some of the highlights:

• Sixty-five percent of respondents believe the quality of health care in the United States will deteriorate during the next five years, with many respondents blaming insurance companies and the health care reform act.

• Forty-four percent of respondents believe that the 32 million Americans estimated to receive coverage under the health care reform act will be treated mostly by nurse practitioners. Primary care physicians received the same percentage in the survey.

• Seventy-eight percent of respondents believe the overall impact of the health care reform act will be negative, with 74 percent saying physician reimbursement will become "less fair." Write-in comments suggest a growing frustration with non-physician providers being compensated similarly to primary care physicians.

•Fifty-eight percent of respondents believe health care reform will be negative for patients as well. Pediatricians and psychiatrists were the most optimistic on this question, while surgeons and ophthalmologists were the least optimistic.

Check out the full report at:

http://www.hcplexus.com/PDFs/Summary---2011-Thomson-Reuters-HCPlexus-National-P

Obamacare Unconstitutional?

You're kidding, right? Obamacare was declared unconstitutional? That can't be!


Oh, that's right, I forgot... the bill that didn't fix anything in the healthcare system... overconsumption, abuse, fraud, medical liability craziness, and a litany of other problems... it's gone.

Who would have thought that forcing people to buy insurance would backfire?


Time to go back to the drawing board and come up with real solutions. This time, listen to people who know something about healthcare and how it works. Try to create a system that drives costs down, not into the stratosphere. And, make a commitment to the American people that you'll stop wasting their time and money.

http://www.washingtonpost.com/wp-dyn/content/article/2011/01/31/AR2011013103804.html

End of the Road

Today is a sad day for the future of our nation and economy. Historic and appalling healthcare legislation is at the precipice of passage. This sweeping change would impact 1/6 of our economy and create further entitlements. Not to mention the horrendous impacts on hospitals (especially in rural communities) and small businesses. In fact, it's a sad testament to the state of politics in Washington. It's a bill filled with backroom deals, earmarks and every backhanded, slimy maneuver you can think of to get votes. Even more distressing is that the bill itself, on it's merits, is more appalling than the methods used to gain it's passage. Once again, our lawmakers have ignored the will of the American people.

Today, democracy and the American people have lost.

In November, I hope there is a bloodletting like no other in American political history to pay these traitors back for what they are doing to our country.

http://novemberiscoming.com

Are You Kidding Me?

Again, Obama is talking about moving forward on healthcare reform without Republican support on the existing legislation. What he's forgetting is that the American people are strongly against it too! What a joke!

Check out this article:

www.foxnews.com/politics/2010/02/25/dems-gop-set-televised-health-care-showdown

Solution #2

When discussing healthcare reform, any successful plan must combine a strategy that cuts costs and expands coverage. Although this is a difficult task, it is possible. However, as I have stated, government-run healthcare does not necessarily accomplish these goals, as evidenced by the problems in many other countries that have the "government option" as the dominant player. Likewise, a plan that accomplishes one but not both of these goals is a betrayal of the public trust. You cannot truly expand coverage without making healthcare more affordable.

My recent post about medical liability reform has nearly everything to do with eliminating unnecessary costs that are passed on to patients and making the practice of medicine less tedious. Similarly, fraud is a real and constant problem in healthcare, and its costs hurt everyone. Likewise, many patients contribute to the exorbitant cost of care by abusing/overusing the system. Finally, there is rarely a mention of personal responsibility in healthcare. This post will deal with these issues.

Health Insurance Fraud/Waste

The Government Accounting Office (GAO) estimates that fraud amounts to 10% of U.S. healthcare expenditures. With a $2 Trillion price tag per year, this means around $200 Billion is lost to fraud each year. In fact, government-run healthcare is a major culprit when it comes to fraud, waste and abuse. Approximately $60 Billion per year is lost to Medicare and Medicaid fraud. Here are some examples. In 2007, Medicare and Medicaid made an estimated $23.7 Billion in improper payments. From 2000 to 2007, Medicare paid dead physicians 478,500 claims totaling up to $92 Million. Finally, in 2006, nearly 1 in every 3 claims (29%) Medicare paid for durable medical equipment (nebulizers, CPAP machines, wheelchairs, etc.) was erroneous.

The countless examples of fraud and waste in the healthcare system should be enough spur lawmakers to eliminate such wasteful spending. It shouldn't take "comprehensive healthcare reform" to accomplish such a simple goal. In fact, studies have shown that for every dollar spent on fraud prevention, 10 dollars is saved.

Abuse/Overuse of the Healthcare System

Most rational people agree the cost of healthcare in our country is too high. However, very few people ask the obvious question of why. The answer is simple. We deliver too much healthcare because Americans demand too much. And, sadly, most of the time, healthcare is demanded for reasons that are not legitimate.

Aside from being a regular family physician with an office and hospital patients, I also work in the emergency room of several hospitals throughout the state. From personal experience, through residency and since finishing, I would estimate that at least 75% of the visits I see on a given day are not emergencies and thus have no place in the emergency room. In fact, here are some of the complaints I saw last weekend while working in my favorite county hospital:

1. I got drunk last night (Jager bombs), am nauseous and have a headache

2. My throat hurts. It started about 2 hours ago

3. I need a medication refill

4. My knee hurts. It's been going on for five years

5. I was sick last week and need a work note. My runny nose is almost gone.

This is just a smattering of the ridiculous complaints ER doctors across the country see on a daily basis. Because patients cannot be turned away and because there are no deterrants, such abuse goes unchecked. Likewise, patients with real medical problems who do not take care of themselves have a tendency to overuse the emergency system. And, it typically has nothing to do with education level or access to a primary care physician.

A recent report from the Integrated Care Collaboration, a nonprofit group, examined the abuse of emergency rooms in Austin, Texas. Their report showed that 9 people visited Austin's ER's more than 2600 times in a 6-year period. One of the nine, was seen in the ER 145 times last year alone. The total cost for treating these 9 individuals exceeded $3 Million. This is certainly not limited to one city or small group of hospitals. Every ER doc has their top 10 list (or 20 depending on the hospital) of abusers, fondly referred to as frequent fliers. The effects of such abuse are far reaching, both in the medical costs passed on to those who do not abuse the system and by the consumption of resources that should be used for those who really need them.

We can and should educate people on what constitutes an emergency and what does not. But, education alone will not fix this problem. Only when there are consequences to their actions do people change. Healthcare is no different. How patients are dealt with at the emergency room door has to change. Patients should be triaged (possibly by a PA, nurse practitioner or physician) with a determination of their status: emergency or non-emergency. If it is deemed an emergency, the patient should be seen for their complaint. If their visit is not an emergency, they should be directed to the appropriate level of care or be given the option of being seen in the ER but with an up-front cost paid in cash. Other fees/costs would of course be attached to any patient actually seen. This type of triage system would deter and prevent people from abusing the emergency room.

A deterrant should also be put in place to prevent the abuse of ambulance services, which is likewise a huge problem. I once had a patient take an ambulance to the ER because she wanted to have breakfast at the hospital. That might sound like a ridiculous example. But, just as off-base are those who take an ambulance to the ER for an ankle sprain, sore throat, or other non-life threatening problem.

Personal responsibility is clearly lacking, not only from the standpoint of making healthy choices but also with respect to the overutilization of resources. Americans need to be held accountable for their actions. Those who are unwilling to change should be held to a different standard than those who lead healthy, productive lives.

The Real Truth - Part 2 (Solutions)

With the next few posts I'm going to tackle the 5 main issues the current legislation is not addressing that should be an integral part of any legitimate healthcare reform initiative. As most Americans have realized, the current legislation does not address many issues that could be pivotal to reducing healthcare costs and expanding coverage. In fact, it does a poor job of addressing the important issues. So, let's see what's missing...

Medical Liability Reform

Also known as tort reform, medical liability reform is essential to reducing the cost of care. Malpractice costs directly cause higher insurance premiums and medical care costs. As Charles Krauthammer recently wrote, "our crazy system of casino malpractice suits results in massive and random settlements that raise everyone's insurance premiums and creates an epidemic of defensive medicine that does no medical good, yet costs a fortune." I could not possibly say it better. The Pacific Research Institute estimates defensive medicine wastes more than $200 billion per year!

Defensive medicine is a direct result of the suit-happy and settlement driven society we live in, but it could be fixed and to the direct benefit of American consumers. The solution is to eliminate the current medical malpractice system, allow physicians to be judged by a jury of their peers (a board of medical experts) and eliminate non-economic judgments (i.e. pain and suffering awards).

Several states, including Texas, have passed tort reform legislation of one kind or another. A 2001 study published by the Texas Medical Association revealed that 6 out of every 7 medical malpractice claims in Texas were closed with no fault found on the part of the doctor. A recent Department of Justice study evaluating malpractice claims in 7 states showed that the majority of claims were closed without any compensation paid to those claiming a medical injury. The point here is not that doctors are infallible; but that nearly every case regardless of merit has significant legal costs and many are settled at significant expense. These costs are eventually passed on to the consumer in the form higher insurance rates. Most importantly, the constant threat of lawsuits has led to the widespread practice of defensive medicine, which is by far more costly to each of us than the lawsuits themselves.

Of note, other studies have cited the increasing frequency of lawsuits and severity of the awards as reasons for reform. In Texas, medical liability reform was eventually passed in late 2003, including a $250,000 cap on non-economic damages. Since then, malpractice costs have dropped sharply, the amount of malpractice suits filed has decreased and the number of family physicians in the state has increased significantly (10% between 2003 and 2006). Let me remind you, there are not enough family physicians in most states, especially in rural areas.

Similar reforms passed in Pennsylvania in 2002 have led to 5 straight years of reduced medical liability lawsuit filings and a 41% drop in claims in 2008 compared to average numbers in 2000 & 2002. A number of states, including Pennsylvania, have passed laws requiring plaintiff’s lawyers to file a certificate of merit from an expert with each case. Time after time, when such laws are passed, patients benefit by increased access to care, lower costs and expanded services.

The main issues with medical liability reform on a state level are simple. Most laws don't go far enough and too many states have yet to pass any significant reforms. Clearly, this is not limited to individual states. It's a national problem, that should get more attention from those in Congress. Unfortunately, our representatives tend to ignore this as part of the national debate. Defensive medicine practices and medical liability reform are intimately related. If medical liability is reformed, as I suggest, the vast majority of defensive medicine practices could be eliminated.

Great Articles & Video

Check out this article about abuse of the Emergency Room. Having worked at a county hospital where this problem is rampant, I can tell you this easily costs the system a few hundred million dollars per year.

http://www.cbsnews.com/stories/2009/04/02/eveningnews/main4915011.shtml

Great article on personal responsibility in healthcare...

http://www.msnbc.msn.com/id/32306655/ns/health-health_care//

20/20 Clip from John Stossel:

http://www.youtube.com/watch?v=q9GMKK_fWKg

Statement from the American Academy of Orthopaedic Surgeons regarding Obama's recent comment about the reimbursement of surgeons for foot amputations:

http://www.aaos.org/news/whatsnew/ObamaStatement.asp