Top stories in health and medicine, December 18, 2014
Most health care news in the past two years has been about the Affordable Care Act. The new law provides neither care nor affordable health care.
More people are covered by insurance with the down side, it covers less, costs more, has fewer providers, and less access. This at the expense of everyone, except those in the bottom brackets and without previous insurance.. The gain is that previously uninsured must be enrolled no matter what pre-existing condition they have.
This last statement is a black hole for insurers as to what to expect in their new enrollees. Some of these patients are very ill and may be in SNFs for chronic care. In addition hospitals will face shortened stays to reduce cost, and fines if patients return for re-admission 30 days. Shorteing stays will increase re-admission rates.
Doctor ratings generally focus on the patient experience, such as wait times, time spent with the doctor, and physician courtesy. Those are obviously important issues, but they paint an incomplete picture. Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes. High ratings may identify surgeons with great bedside manner, but mask high surgical infection rates.
The quest for ratings perfection influences medical decision making, as patient satisfaction increasingly affects doctors’ salaries. According to the management consulting firm Hay Group, more than two-thirds of physician pay incentives are based on patient satisfaction scores. And Medicare withholds as much as $850 million in payments to hospitals who fail to meet various quality metrics, with patient satisfaction being a significant component. But doing what’s best for patients won’t necessarily make them happy. Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but can anger patients; some vent their frustration by poorly rating their doctors. It’s no wonder that many physicians acquiesce to patient requests. In a survey by Emergency Physicians Monthly, 59% of emergency physicians said patient satisfaction surveys increased the amount of tests they ordered. In another survey by the South Carolina Medical Association, almost half of physicians said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics. In fact, Senators (D-California) and (R-Iowa) wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid & Medicare Services, saying that “there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers (OPRs) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic.”
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Why Hospitals have to change their Mission
These are really difficult times for hospital executives. The system (and I use this term loosely) is rapidly shifting from a volume-based, fee-for-service business model to a population model that puts providers at financial risk. This means that hospitals have to rethink their core business. Instead of filling hospital beds with patients who need complicated treatments and expensive procedures, hospitals must now try to keep patients out of the hospital and do so with low costs.
Some areas of the country are more accustomed to HMOs and managed care models, but they are in the minority. For the rest of the country, this is disruptive stuff, particularly the part about taking on risk
What will the Future of Medicine look like
Excerpts from The Guide to the Future of Medicine.
Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not be washed away. Rather, it should be consciously and purposefully redesigned piece by piece. If we are unprepared for the future, then we lose this opportunity.
Here is the list of the real examples and practical stories demonstrating why we should all be ready for these changes.
These are some additional blogs that offer information on health reform.