Posted tagged ‘healthcare’

Uncertainty isn’t good for health, and it isn’t good for healthcare

April 3, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Doctor: “Phil, you have pneumonia.”

Phil: “Oh noes. What shall I do?”

Doctor: “Just take these red pills, here.”

Phil: “Great! I feel better already! When can I go back to work?”

Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills— these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, have some yellow pills.”

Phil: “What? For pneumonia? I think I’m feeling sick again.”

Doctor: “I didn’t say pneumonia. Have some purple pills. And I have to refer you to a specialist, and get an x-ray. Or an ultrasound. That’ll take six weeks to schedule, or maybe you can do it tomorrow.”

What’s worse than being sick? Not knowing what’s wrong, or how to fix it, or when you’ll get well. It’s when everyone disagrees on what your problem is, and when you get different advice, and when the recommendations change. It’s when what your doctor says doesn’t make sense, and makes even less sense when he keeps changing his mind.

Remind you of what’s going on with the US Healthcare system?

We’re in the middle of the implementation of a huge change in healthcare delivery, based on a byzantine law that no one seems to understand. Unexpected provisions and complications seem to crop up daily. The law is just too complicated for anyone to know what’s that’s in there.

The complexity of the law isn’t the only problem. Not only are new rules and provisions continuing to creep above ground into the light, but established, simple rules seem to change daily. Deadlines? We don’t need no stinkin’ deadlines. While some of the changes seem fair, the uncertainty itself is making it impossible for businesses, patients, and health care providers to prepare. We can’t offer good care if we don’t know what to expect.

There’s even more uncertainty. Congress’s addiction to short-term fixes instead of responsible lawmaking has kicked in again, as they’ve just passed another one year “doc fix” for Medicare payments. They’re also about to delay implementation of a whole new coding system for health care delivery called “ICD-10”—just as thousands of hospitals and clinics have already spent millions preparing for that nightmare. And some states seem hell-bent on implementing unworkable technology “solutions”, in some cases as a requirement to hold a medical license.

It’s a tough time to be a doctor, and a tougher time to be a patient. I don’t think anyone can predict the next complication, and I don’t think anyone knows how to address the uncertainties and shortcomings of what’s coming down the road. My best advice: try not to get sick until we figure out what we’re doing. It’s going to be a long wait.

A win for grey hairs! Experienced docs save money

December 3, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

One thing’s clear: we’re spending gobs of money on health care, and we can’t afford to keep doing it.

A provocative RAND Corp study published this month looked at Massachusetts health care spending from 2004-2005, examining the claims data from 1 million residents and 12,000 doctors. They found that the more experienced the doctor, the less health care dollars were spent to diagnose and treat the same health conditions. The differences became larger as more years of experience accumulated. Overall, physicians with 40 or more years of experience had about 13% less costs than those fresh out of residency.

Costs were not associated with other factors—it didn’t matter, for instance, whether the doctors had had a malpractice claim, or were board certified, or whether they practiced in a large or small group. This study didn’t look at outcomes, so it wasn’t designed to see if the increased costs associated with less experienced physicians could mean that there was better health care overall. But other studies have clearly refuted that. Increased costs do not mean better outcomes or better health.

So why does more experience seem to lead to less spending? The authors have some ideas:

  • Younger docs may rely more on the newest, most-expensive technologies. That would be OK, if these devices improved overall health—but there is no evidence that this is true.
  • Less-experienced docs may be less confident, so might order more tests and procedures.
  • Older docs may have patients who trust them more, who might then not push for the latest drugs and tests.

Is 13% a big difference? Considering overall health care expenditures of $2.5 trillion per year in the USA, that 13% is about 325 billion dollars. That could certainly buy a few bottles of Grecian Formula or Clairol for those experienced docs who’ve learned to spend less and still provide good care. And also provide health care for just about every uninsured American – with about 200 billion left over for a tablet computer for every single human on the planet.

(You think I’m kidding? This November, 2012 study puts the cost of healthcare for uninsured Americans at $125 billion per year, leaving 200 billion to spare from the overall 13% cost savings. There are about 6 billion people on the planet, so that 200 billion works out to $30 per person. There are inexpensive computers in development for $25-50 each. The costs of health care are truly staggering, and it’s easy to lose perspective on just how much money we are wasting. Ironically, it’s not even our money—it’s the money our children and grandchildren haven’t even earned yet. Ha ha, suckers, that’s why we don’t let you vote!)

More about health care costs:

Where is the money going?

Who’s wasting the most $?

Bizarro inflated prescription drug expenses

Defensive medicine adds costs for everyone

“Patient satisfaction” may increase costs, and make you less healthy

Counting more beans is sure to help

To improve medical care, we need more beans to count

October 14, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

At a time when our country is nearly bankrupt and medical costs are eating up a huge part of our taxes (and our children’s taxes, and our grandchildren’s taxes), government and insurance-industry officials have come up with a scheme that’s sure to help: more diagnosis codes!

When you visit a doctor, we come up with a bill that includes a “procedure” or “evaluation and management” code, plus a “diagnosis” code. The diagnosis code is picked from a list of about 18,000 numerical codes from a real page-turner of a book called the “ICD-9”. Those 18,000 diagnosis codes include just about anything you could think of.

But not, apparently, anything anyone could think of. Starting soon, your doctor will have to use the new, expanded ICD-10, including 140,000 codes. Included are many new codes that are sure to be useful:

W5631XD  Bitten by other marine mammals, subsequent encounter (This covers manatee attacks, but not sea lion bites. Sea lions have their own code, W5611XD)

Y92253 Injured in an opera house (note that if one were bitten by a sea lion in an opera house, the doc would be required to submit both the Y92253 and W5611XD codes.)

V9027XA Drowning and submersion due to falling or jumping from burning water-skis, initial encounter (The water skis were presumably lit on fire to scare off marauding sea lions. In the opera house.)

(Thanks to the Wall Street Journal for this clever tool to help find ICD-10 codes.)

This is not a joke. Your doctors will be required to use these new codes, which will mean getting our billing systems up-to-date to accept them. For my practice, that requires upgrading our practice management software (to do that, we must also upgrade our server, database, and OS software.) Total cost: $42,000. That could have paid for some well-deserved raises or bonuses for my staff, or even for me to hire an extra nurse. Instead, I will gain the ability to bill for “V9135XA Hit or struck by falling object due to accident to canoe or kayak, initial encounter”.

So: I’ll spend practice money in a way that doesn’t benefit my patients one bit, but rather gives the administrative pygmies more beans to count. This will (predictably) lead to a need for more support staff, more consultants, and even more administrative pygmies to implement this huge new complication. I wonder if there’s an ICD-10 code for “Health care system, destroyed by its own administrative weight and senseless overhead”?