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Chief science and health correspondent
NBC News
When it comes to the multiple challenges of health care reform, ideas that look good on paper often do not turn out as planned in the real world. Two excellent examples appear in the latest issue of the prestigious journal Health Affairs.
The first concerns electronic medical records. Most health reform proposals, including the law passed by Congress and signed by President Barack Obama, include strong incentives for computerizing health records. One of the major arguments favoring electronic records is cost savings. Doctors, the argument goes, will see all the tests a patient has undergone and not order duplicates, a well-established cost escalator.
Studies in high-end hospitals and computing groups did find savings. But the latest research looked at 28,741 patient visits to 1187 community physicians. The authors found that the doctors who had access to electronic records were 40 percent to 70 percent MORE likely to order an image such as an X-ray or MRI or a blood test. One reason, the researchers speculate, is that the electronics just makes ordering tests easier by eliminating the paper work. And they conclude “the federal government’s ongoing, multi-billion efforts to promote the adoption of health information technology may not yield the anticipated cost savings from reductions in duplicative diagnostic testing.”
Since 2005 the federal government has been publishing safety ratings data from most hospitals in a system called Hospital Compare, with the hope the information would increase accountability and steer patients to better quality facilities. But the reporting system has led to no reduction in complications beyond existing national trends for heart attack and pneumonia and only a slight reduction in mortality for heart failure, the researchers found after examining Medicare claims forms. The authors conclude that the government’s reporting system “did not result in patients’ shifting toward high quality hospitals.” When it comes to health care -- despite the wishes of reformers -- patients are not consumers who shop for quality but tend to be far more passive, checking into the hospital that is either convenient or recommended by their doctor.
Both reports touch on small parts in the many challenges of health care reform, but show how tough the process is.
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Aren't we really happy that they passed it before they read it to know what was in it. Who would have thought that it just might be reasonable to actually study the impact of such a massive undertaking before throwing money at health care in this country. Perhaps we should require a lobotomy for all legislators who voted for Obama care....then after the fact we can study the effects to see if it was a wise decision.
The law is a disaster & unworkable. With luck perhaps the supremes will knock it down. That's the only hope. Hopefully, they'll pull the whole thing out by the roots, so it won't grow back. That's optimistic, though.
The problem is that doctors rely far too heavily on lab tests, most of which are unnecessary.
Using a shotgun approach, doctors order a whole spectrum of tests hoping that they'll find the diagnosis within the results.
If that's all it takes then we won't be needing doctors at all.
Proper diagnosis requires a clear patient history and basic detective work, not just a barrage of lab tests.
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The need for affordable healthcare has been documented and studied for decades. Implementation has been debated vigoriosly over the last 40 years and has been supported by both sides of our political parties. So to say that "Obamacare" was just devised by "throwing money at health care" without considering the impact of it or anybody having read it is just not true! Furthermore, to judge a piece of the system that has not been fully implemented is ridiculous as well as unfair. It will take time to work out the kinks, but that is true of any new system and even more true when people would rather be part of the problem rather than part of the solution.
TxMom, while your suggestion could be appealing, I might suggest that in November we vote out of office ALL Supporters of the health care Bill. Starting with Barry.
When the Feds straighten out Medicare and Medicaid, then I might consider Obozocare. Until then, I don't want the government involved in my health care decisions.
Janine...OK so could have been over the top with images of Nancy P walking around looking....OK so a lobotomy wouldn't change things too much for Nancy P...
I will certainly do my part to support legislators who wish to eliminate Obama Care. Personally, I don't think our Federal Government has any need to legislate health care until they are a self-insured entity for all Federal Employees....Pres on down....and their system is actually successful.
united:
where do you get your information? Everything you said about making the diagnosis from history and physical is correct...where do you get the idea that drs go on "fishing expidetions" with lab tests?
Some insurance companies refuse to pay some doctors the amount those doctors believe they are entitled to be paid. When that happens, the doctor will stop accepting that form of insurance as reimbursement.Then, of course, once the doctor no longer accepts that insurance company's reimbursement schedule, then doctors no longer accepts patients who use that payer's insurance.Insurance companies jack-up the Premium till nobody can afford.
Each year, doctors and healthcare facilities like testing labs, hospitals, pharmacies and others, negotiate pricing with health insurers and payers. In its simplest form, it goes like this:
Doctor:
When a patient with diabetes visits my office, I charge $100 for the visit, and $75 for the blood work.
Payer: That's too much money. We'll pay you $55 for the visit and $35 for the blood work.
Doctor: I can't pay my staff or keep my lights turned on for that paltry amount! How about $65 for the visit and $45 for the blood work?
Payer:
That's still too much.
Doctor: Sorry I can't help you.
Payer : I'll join Obama care then
Doctor :
Its all Your call.
President Obama : Doctor, how many patients that you got and treated each month ?
Doctor :
Roughly about 30 patients a month,Mr President.
President Obama : So Mathematically 30p x $105 =$3150
Doctor :
Yes ,I think so.
President Obama: Ok then ,let me offers You.You must leave everything else the same volume of procedures as what you're attending now no less. Obama care give you 300 patients a month,as before they all can't afford your bill, But with conditions, your price must be standardize How about $25 for the visit and $15 for the blood work? That will be 300 x 40 $12,000.
Doctor :
That great Mr President,Its a DEAL,but how about the increase of patients,I'm afraid I'll be sue for negligent,since I'll be attending extra patients and how can I manages ?
President : I believes,with that kind of money you got there,its about time you start to think and expand you business ,and you can start hiring few more unemployed Americans to assists you.Don't worry about the patients suing you,they're now well protected by me,they don't need anymore BS attorney,they got the Director of Consumers protection, that complaints and to watch your back,as what they're watching closely with the greedy banking procedures and practices .
Doctor :
Thanks You,Mr President,You are the smartest President we ever have!
President Obama : You most Welcome,I'm done with you,doctor. After this I'll talks to reduce the Insurance healthcare premium, facilities like testing labs, hospitals, pharmacies and others, negotiate pricing with health insurers as what I did give to you and for the payers,benefits ."We are the People"From the People To the People.
this is the dumbest post...why do you keep reposting it????
Healthcare should be a basic human right. Right? Everywhere but America it seems. Is America the land of the free and home of the brave and oh yea your on your own if you get sick.
@terry: I've often argued this point with people before -- the only "rights" are liberties, that is, negative rights, e.g. you have the right to be free of others intruding into your home, you have the right to choose a religion without interference. Rights are that which your autonomy is dependent upon. Health care is not a right, but rather a privilege, and while everyone should have access to such services, they must also be complicit with the rights of that business. This is emphatically not corporatism, but rather, the idea that the lives of others are not at one's disposal. It is not my right to demand the labors of others without reasonable compensation. That's why we pay for goods and services. It is not my right to have free housing, though it is my right to own a house, which I pay for, and be free of intruders.
No, I do not agree. Health care isn't a right. It's a service provided by individuals with special aptitudes/training. When you call it a "right", you hence turn others into slaves. That isn't right.
Moreover, since I'm one of those "others" I have definite opinions on the matter.
Nothing is a basic right if others have to work to provide it. You do not have the right to groceries or water and they are less expensive to produce than is quality health care.
EMRs are time consuming, paper consuming, verbose and confusing. Only about 2 or 3 paragraphs in most 5 page EMRs are relevant. The rest is junk created to slow doctors down and allow insurance and medicare employees with a high school education, or less, to check boxes to decided how much to reimburse medical providers. It would be simpler just to electronically load the information on the paper records to the computers but that would eliminate jobs for the bureaucrats.
Terry, you have a right to have healthcare. When YOU PAY FOR IT. I pay enough enough taxes as it is. I see no reason why I should be supporting another group of people who don't work or provide anything to our economy other than sucking it dry.
I agree with the aspect that health care providers get rid of the "Pre-existing condition" exclusion, and that they shouldn't be allowed to drop someone simply because they are ill.
Now I am not talking about SS or those who are disabled and can't work. I'm talking about those who won't work.
Democracy ceases to exist when you take from those willing to work, to support those who won't. TJ
Food is essential to survival. Yet, it is not a given "right". It is something you have to either work to provide yourself, or beg from others in a soup line.
Same with health care. Why should doctors go through school for 9+ years and end up with 6-figure debt so you can go and use their services on taxpayer's dollars for minimum wage returns? Want to see the fastest mass exodous from a profession in history? Try forcing that on the doctors and nurses in this country! Ya, might be "free" (READ: TAXES pay for it!!!), but you won't be able to find a doctor as they will all be in different professions where they can either pay off school loans or pay their own bills. Maybe older drs might hang around for a while, but somehow I doubt it. Why else would every doctor be so happy to take Medicaid/Medicare? Oh, that's right: MANY DO *NOT* accept it, because the gov't is so horrible at actually paying their incurred bills. And there is a tiny fraction of the population is on medicare/medicaid, the fun would really start when the entire population of the US was forced into a pool. Oh, that would be such fun......
Well, I guess we should get rid of universal primary and secondary education, too, by the reasoning of many of these posters.
Govt is supposed to PROMOTE the general welfare. That's different than PROVIDING it. When tangible things become rights, the problem is who pays for it. Trying to apply market forces to this is a joke. Its not a market. The people receiving the service dont pay for it and they get it whether or not they're able to pay for it even through a 3rd party. So of course market forces wont work.
Let's be real. The patients still do not have easy access to hospital data, especially costs. And for the Doctors ordering more tests, DUH that's how they get paid. We need to get rid of fee for service. That is the single biggest factor driving unneeded cost in health care.
this is one of the most common misconceptions I see. Doctors are NOT paid for ordering tests.
Just think about it. If an internist orders an xray, the radiologist gets paid, not the ordering physican
If he orders a lab test, then the lab company gets paid--again, not the physician
The only time a dr gets paid for ordering a test is if a)he performs the test himself (rare for most docs aside from cards, GI, pulm, and some surgeons) or b)if he owns the equipment (which is becoming harder to due b/c of government restrictions, and not applicable to your post since you were talking about hospitals)
I agree fee for service probably drives some cost in health care. But I worry about the flip side of asking someone to do a job and NOT paying for it. I think that's what leads to delays in treatment in the socialized medical model.
In addition, I think you're in for a tough argument if you try and tell me fee for services is a bigger cost driver than say the obesity epidemic, for example
Main reason doctors order tests is so they don't get sued if something gets missed. The solutions to the issue include:
1) Tort Reform: Require a medical affidavit by somebody practicing in the same specialty attesting that there has actually been negligence resulting in injury before a suit can even be filed. The emotional toll on a doctor involved in fighting a frivolous suit is huge; it's not too much to ask the plaintiff's attorney to have a case before playing the lawsuit lottery.
2) Practice Guidelines: While this may seem to intrude on the "art" of medicine, it can protect a practitioner who has followed them.
We see a whole bunch of head MRIs where I practice with minimal/no clinical indication. Hyperactivity seems to be an indication commonly used. I would guess the fear is that if there may be something organic causing it the neurologist can get sued for if not discovered. However, the yield I would venture to say is miniscule. And most of those kids wind up with a general anesthetic so the study can be done. Every so often, albeit rarely something catastrophic happens with a general anesthetic. It's safe, but not innocuous.
But the neurologist is off the hook, which I guess is the important thing!
None of this is central to Obamacare, but it's very important.
happens to be that because i have a congenital birth defect and an accident 14 years ago, i have so many hospital bills i cant keep up. if i get it in time to see all the mistakes and inaccuracies then im ok, i still have to call my insurance company to fight the errors for me. i am treated like a third class citizen due to the hospital bills on my credit report, mostly inaccurate, i been trying to clear it up for years to no avail. i need a laywers help, they seem to fix it then. but anyways i have always paid my credit obligations and have never been late on any car payment, paid off 4 or five cars with zero late payments, but i still cant get a credit card, never had one, and i still need to come up with 2000 down and 300 a month for a 6 year old car with 80,000 miles. because i have a low credit score due to inaccurate hospital charges each visit split up into 5 diferent bills just to confuse me more and to drop my score down to a low 480 with two pages of immaculate credit. ten pages of medical bad credit. go figure
We have an electronic record for anesthesia in one of our hospitals. Most of the time, it works without a hitch. I couldn't say that it saves time even when it does work. Its main benefit is that the anesthetic record is in a computer readable format. I secretly suspect the government is viewing it as a tool to control physicians, maybe even not pay us ("the blood pressure was under x for y minutes... we won't pay you!"). Sometimes, however, things get fouled up. The way it usually happens is in printing the record for the paper chart. Those times, I spend more time on the phone with the IS computer geeks than actually taking care of the patient. Other times, the system is completely unusable and we have to fall back on pen & paper. So we wind up with a bastardized system, some electronic, some with the "backup system". On balance it takes us more time & is more prone to problems than pen & paper. The whole thing impresses me as an idea thought up by some academic who has never actually gotten blood under his/her fingernails & taken care of a patient. But then again, all of Obamacare seems that way.
That's paranoia. The system is shifting to one where the doctors are paid for providing quality care rather than for services rendered.
Most of what Healthcare reform is bringing are things that my health provider is already working on and had been working on prior to the legislation passing. The reason being that it's a better way of doing business. Now there are glitches, but the paranoia and anger about the reform is greatly overblown.
And mostly consists of people making outlandish lies about the current and future systems to support their previous beliefs.
You american have to stop sueing all the doctors and hospitals its driving your costs up like crazy. Every time I go to the states on business turn on the tv in motel I am greeted by commercial after commercial of lawyers telling me to sue for malpractice car accidents falling down the stairs someone farting in your general direction I mean come on wtf who needs to play the lottery just sue someone. Americans probably dont notice it because they are used to it but in my country commercials usually are to buy tide or oreos or cars lol.
I agree with you there Ryan. If it's not them, then it's the drug commercials which spend 30secs telling you how great this or that medication is, and then another 30secs telling you basically that the cure is worse than the disease. When I started menopause my doctor wanted to put me on hormones, which I refused. A few years later that same medication was linked to cancer.
People need to educate themselves regarding healthcare and the medicines they take every day. Find out the side affects and seek out natural alternatives. There are many dangerous drugs on the market that can harm more than they cure. Proper diet and exercise can often bring about the same feeling of wellbeing as the chemicals.
The medications that have always concerned me the most are the mood altering type for things like ADHD and depression. I have seen more side affects in people that I know who used them.
Your doctor is not God. Question what they tell you. Don't be afraid to second guess them, and get another opinion. Do your own reseach. The information is out there.
Ryan, we sue doctors and hospitals because that's the only way of paying for future medical treatment, ensure accountability and get some remuneration for loss of quality of life.
Despite right wing criticisms, the fact is that people don't generally want to take things to trial, it's frustrating, stressful and you never know if you're going to win. Many people wouldn't sue at all if they could just get an apology and somebody to pay for the cost of the mistake.
frank,
yet it still happens all the time...way more often than any other country. It causes untold costs in defensive medicine, unneeded tests and hospitalizations, and of course, court costs and settlements. The only reason more isn't done is that the trial lawyer association is a big supporter of the democratic party.
electronic record has not saved money. Systems don't communicate with each other. So to send a report to another doc or hospital I have to print it out. What was a 2 page hand written report is now 6-14 pages. I don't mind, my family is in the tree business. Put not cost or tree friendly. Electronic record where I work is so cumbersome that I can only see half the people I used to see in an 8 hour shift. This is when it is working properly. The greatest increase in health care cost is due to paperwork that was not required 20-30 years ago. This is due to the government. My family doctor has more than 75 percent of his staff to deal with Medicare and insurance companies that have followed in the steps of medicare. Used to be only 10 percent of his staff. The federal government is the problem not the solution.
Two comments, Thomas: 1) why would you have to print out reports to sent to another doc or hospital? I am not really computer savvy, but why not just send it as an attachment?
2) I have lived in both Canada and Australia. Having a one supplier (a national health system) cuts WAY down on necessary office staff. It isn't the feds that is the problem it is the health insurance companies.
why not send it as an attachment?
Because you need secured servers for that, or its a hippa violation
2)I disagree. Just dealing with medicare is a MOUNTAIN of paperwork
Seems that most people responding on this page are more into trashing "Obamacare" than looking for real solutions to an ever growing problem of providing healthcare that is affordable for everyone. While no system is ever perfect, it is better than no system at all and can be modified as new ways are found to improve it.. A nation that can figure out a way to go to the moon can surely figure out a way to build a system that meets the health needs of its people. Get the "greed" out of the system and replace it with "compassionate" care.
Working in one of those "high end" hospitals in the study I can say the EMR that we use is poorly designed. Being in a specialty practice we are forced to click through a lot of "decision support" designed for primary care that is completely irrelevant for us. Entering basic information can take quite a bit of time. Finding a particular note for reference is a nightmare.
As a result most of the attendings bypass direct entry and dictate notes that are electronically transcribed . As far as the irrelevant "decision support" in diagnostic order entry our attendings avoid it by asking the residents or nurses to enter the exam.
EMRs are important to administrators as they can be targeted to demonstrate "quality" for insurers and Medicare. Unfortunately this does not actually mean that quality care is being delivered. It means that is is documented. This makes this push for "quality" healthcare a complete farce.
Obamacare is a disaster. It was conceived by a group of individuals who apparently have absolutely no idea what the question is. And this is their answer.
For an inside view of the problem of excessive test ordering and how it might be solved see my post above. I give the reason, and two possible solutions. None of this is in Obamacare.
Your opinion that some system is better than none at all, is absolutely idiotic. Hitler had a system of concentration camps. That wasn't good either.
Obamacareotheing but long lines and lack of access. I agree healthcare is a service and not a right. Doctors dont work for free. If thats waht the idiotic liberals want, i recommend you buy stock in the funeral home business because the number of people that will be dieing will be skyrocketing. Please not that the piece of @!$%# Pelosi, Reed and Obama don't participate in this obamacare or medicare or social security I think they need to be treated like the french monarchy during the revolt (guillotine).
The reason reform doesn't work is because the best ideas take money away from Big Pharma and Big Medical and the insurance companies. If they're not soaking the public for every cent they can get, they make sure the idea doesn't work.