I was reading an article in Contemporary Pediatrics (Oct. 2015 p. 14) where 20 to 50% of mothers (N=1,000) were not receiving advise from the pediatrician about sleep position, sleep location, pacifier use and breast feeding. That’s a high percentage!!
Now the American Academy of Pediatrics, the American Academy of Family Practice, and the federal and state health departments would be very unhappy to hear this. The Academies are organizations to provide data and protocols for care to the federal, state and local health departments, private insurance companies and to the providers of healthcare themselves. The state health departments are responsible for the implementation and monitoring of these policies. If a state is doing poorly following advised national protocol, then someone in the health department is not doing their job well.
So the people that actually deliver the services are the “providers” (i.e. doctors, PA’s and nurse practitioners- we’re not called doctors by the insurance industry anymore). That means that the “providers are the end of the line service group. If they don’t do their job then the local, state agencies fail. If you have been to the doctor lately, you probably have noticed that the doctor is looking more at a computer screen than they are looking at you.
Computers are great but many times there are buffering holdups or problems the doctor has with the software that was recently installed. It seems that the doctor is having an appointment with the machine and not you. Now here is something you may not know unless you are a physician or “provider.”
The requirements for the providers as mandated by the respective state health departments include a list “a mile long.’ In pediatrics there are over 50 questions that the “provider” must somehow get answers to, distribute various forms, perform a physical exam, review the chart, chart vaccine status, give injections or prescriptions, and answer questions in what the insurance industry feels should be done in 10 -15 minutes.
Doctors who work in large groups as an employee are generally expected to see 6 patients in an hour. Now if you do the math you can see there is a major disconnect; in ten minutes you have to perform what would ordinarily take 40-50 minutes. What’s also important is that the insurance company will pay you for just ten minutes of time. So the doctor may bill $100.00 for that ten minute visit and receive $10 from the copay and $34.95 from the insurance company. Now if the “provider” spends 40 minutes with you to achieve all the mandated tasks, the insurance company will still pay you $34.95.
I recently had a heating company come to my house to inspect and clean my furnace for the winter. The technician removed the cover, looked around with his flashlight, replaced the filter (that I purchased) closed the cover and charged me $119.00. With a $200,000.00 tuition bill for medical school, the prospective doctors need to take note.
So this is where computers come in. They can memorize anything we put into them and “spit” gobs of information out at the push of a button. Electronic medical records (EMR) use expensive software that can store all the information that the health agencies require and “spit” it out at a moment’s notice. Now it doesn’t mean that the doctor is going to ask all fifty questions but the computer will automatically assume that these questions have been asked and record them as being satisfied. Your doctor’s visit may have lasted only ten minutes but if an auditor asks to see a report the computer will produce 5 pages of “documentation” that everything has been satisfied, thus allowing the “provider” to move on to the next ten minute encounter.
So there is this chess game between “providers” and auditors. As long as the mandated requirements are documented that’s all the auditors are concerned about and you pass there test with flying colors. The doctor is happy that the audit went well but is concerned about the real quality of the encounter with the patient. “I didn’t go to medical school to pass audit surveillance testing,” one might say. Now if you ignore the mandated requirements and focus on real interaction with your patient, you may feel you are doing the right and just thing, but the reality is that you may not be able to practice medicine very long because of non-compliance with state regulations. So what happens is that the “providers” feel unsatisfied with their purpose and certainly the patient feels unsatisfied with the quality of service. Clearly there is a disconnect here. So patients, if you feel your doctor is not meeting your expectations, it’s not the doctor’s fault; they simply are complying with state mandates so they can keep their job.
So where is the solution? Healthcare may be good on computer hard drives but not in reality. Imagine it is the year 2022. Medical care in the USA is divided into two separate entities, preventive and wellness care and disease care. Providers who choose to deliver preventative and wellness care are nurses, nurse practitioners and those with master’s in public health (MPH). The medical doctors are not at all involved here. In a sense, medical doctors no longer practice “primary care.’ Their job is to fight illness, control or cure disease and to repair trauma. Using insurance terms, they are indemnity “providers” only.
Internal medicine doctors will treat cancer and control your diabetes but things like diet exercise, meditation, yoga, sexuality, happiness and stress will be handled by the preventative and wellness personnel. You are required to visit the health and wellness providers if you desire to have coverage for indemnity care. If you choose not to attend wellness clinics, then indemnity care costs comes out of your pocket.
In this system both sets of providers I feel would do a good, thorough and honest job that is satisfactory for the health providers and patients. If we don’t change the concept doctors will be VERY disinclined to go into “primary care” as we call it today and simply go into fields associated with major disease, trauma and fat paychecks.
The Affordable Health Act has revolutionized the coverage of healthcare from insurance companies; now it is time for the healthcare system to undergo its’s own revolution and deliver the care that people expect and desire.
….just a thought…….