Here’s the answer to fixing healthcare

September 23, 2017

The United States Congress failed once again to come up with any meaningful changes in Obamacare

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with Kumar Yogesh, MD, a practicing independent physician in Dresden, Tennessee. He is join in this blog by his daughter, Niti Yogesh, PA-S, a physician assistant student at Bethel University. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

 

 

The United States Congress failed once again to come up with any meaningful changes in Obamacare. Honestly, it does not break my heart because I'm very much doubtful that the new law would have made any difference anyway. Basically, what they were trying to do was an insurance reform (not a healthcare reform) which is a quagmire created by politicians themselves.

Dr. Kumar Yogesh

America is the most powerful and free nation in the world. It is a fact that our doctors are the best in the world and our nurses are the most competent and caring group of professionals in the world. The quality of healthcare that every American receives is unmatched anywhere else in the world.

 

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Despite these facts, why is our healthcare system being mismanaged?

There are two answers:

1)    Involvement of the government and insurance companies.

2)    Ourselves. Including the people and physicians.

The three most important groups involved here who have the most to lose or the most to gain are:

  • Patients: This group includes all 325 million of us in America. Democrats, Republicans, independents, moderates, Libertarians and all others.

  • Doctors: Approximately 800,000 or more. Democrats, Republicans, independents, moderates, Libertarians and all others.

  • Nurses: Approximately 2,500,000 or more. Democrats, Republicans, independents, moderates, Libertarians and all others.

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I have been told by senior physicians that in the early 1900s until the mid-1960s, doctors were very well-respected community members and medicine was truly a noble field. Since the mid-60s, with the inception of Medicare and the American Medical Association-created CPT system, things went downhill. Maybe we did allow ourselves to be commercialized and be controlled by the government and insurance companies rather than remaining true custodians of our patients.

Next: "We have failed by being so passive"

 

Yes, we have failed by being so passive and allowing third parties to control this sensitive problem that touches our lives personally. Subsequently, 500 politicians in Washington and 5,000 insurance executives have taken control and put our nation on a path to bankruptcy. If we still expect the same people to fix the system, we may be committing a crime against our own profession.

I think the answer should be coming from us, the physicians, and not from politicians.

 

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Whenever politicians get together and propose "comprehensive reforms,” whether it may be immigration, healthcare or any such topic, I immediately become suspicious. "Comprehensive " appears to be a buzzword in politics and usually it evolves into some type of "dirty scheme" with heavy regulations such as Obamacare, Meaningful Use, MACRA and so on. The only thing it does is create more regulatory burden for the common man and businesses while at the same time becoming very lucrative for lawyers.

Let us start with a simple idea and just address the failing aspects of current healthcare system.

It consists of the following points:

  • Repeal and replace the CPT and RBRVS based current payment system. This system is a setup for corruption and inefficiency since it is not based on free-market principles.

Instead, all of us practicing physicians, regardless of specialty, should demand simple visit, fee-based payments. Such payment should be rendered at the completion of the service. I would be happy to define my visit as a 10-minute face-to-face time with my patients. Current Medicare rate for 99213 payment should be sufficient for this visit. It would easily eliminate 10% of my overhead cost. Tests and procedures can be priced separately.

  • Additional 10% of our overhead cost can be eliminated by transferring the ownership of medical records to the patient. Eliminate all current complex electronic health record (EHR) systems that are based on individual platforms and do not communicate with each other.

EHRs are creating havoc since we're constantly copying and faxing papers all day. Each time the patient goes to the emergency room, another doctor or a hospital, we get hundreds of pages with useless information and nobody knows what to do with these papers. If patients carry their own medical record with a simple universal Word-based format, I would be happy to work into their system, record my office visit and copy it to myself for my records.

 

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All the medical information remains with the patient's device and is easily accessible by any medical person wherever the patient is. Such systems would be infinitely more secure and private and most likely make HIPPA irrelevant. For example, my email system is much more private and under my control than my own medical records in my own office.

This can be just the starting point, and subsequently we can tackle the remaining issues. I wonder how many practicing physicians would agree with such concepts?