Some of you have berated me for having a negative attitude regarding Obamacare. The truth is that many good things will come out of our new healthcare, but I am alarmed by the negatives which continue to slowly drip out the cracks and insinuate themselves seemingly overnight and unannounced into our experiences with doctors, hospitals, drug companies, etc. I am concerned that the negatives will outweigh the positives and cause damage to our loved ones as they seek care.
So I will have an ongoing project to report on pluses and minuses as they occur. Here are two that appeared on my radar screen this week. Since I am no longer practicing medicine, I go by the experiences of family, friends and myself. Yes it is anecdotal but I also keep watch on the media, especially when clinical trials look at these matters, when doctors speak about the situation, and by watching the AMA reports which I receive regularly. Hopefully some of you will share your observations.
Here are my recent findings. It may not seem like much, but cumulatively, there may be substance, and I do believe that smoke might indicate a fire.
#1. A man approached the front desk at a surgeon’s office. He asked that the surgeon’s report be sent to his doctor. He was told that he would have to pay $15.00 for that service.
Whenever a specialist sees a patient, it is his obligation to send a consultation report to the primary doctor. Ideally he should also call the referring physician. I believe that communication of this type is deteriorating because of the expectation that electronic medical records will fill that void, but they won’t because they are lacking in specificity, and when our society allows time-honored individualized medical practices to fall by the wayside in the interest of time and money, quality will suffer.
Patients should request copies of their consultation notes and they should read those notes carefully. They should find a history, physical exam, test results, a diagnosis and a narrative discussion/analysis, with an individualized plan, regarding the problem; and no one should be charged for those reports.
#2. A doctor orders a blood test for a patient. He orders it, not on a whim, but because it is needed for proper patient care. The patient goes to the lab and is informed that the insurance company may not pay for the test. He is required to sign a form to indicate that he may have to pay personally.
Subsequently he receives a bill for $115.00 from LabCorps for that routine test. Evidently the diagnostic codes supplied by the doctor did not justify the test. The patient complained to the doctor’s office and asked that the bill be resubmitted by the doctor for consideration, using “better” codes. The office tells the patient that this is not the doctor’s problem. Ouch!
Sorry, but this is the doctor’s problem, and he should help so the patient doesn’t get stuck with the bill. This is an example of interference in the practice of medicine by insurance companies and indifference on the part of the doctor.
I’m with Joe – QUALITY of life trumps longevity. To be warehoused in a nursing home for years is not my idea of living, nor is being “slashed, burned & poisoned” to attain a few years or months consumed by Dr appts, hospital visits, scans & drugs while feeling sick. I want to live BETTER, not longer.
Life expectancy isnt a great judge of the quality of a healthcare system. For the longest time the system has strives to beat the diseases and keep people physically alive a along as possible. I think there is a shift as practitioners realize the patient may live to be 96 but what is the QUALITY of that 96 years? Would you rather have 86 quality years and it be over or be kept alive on machines for another 3,4,5 years? So a national life expectancy of 90+seems great, but i would rather have a quality at 80 years than surviving until 90
The biggest problem with ePCR is that it lacks the personal interface between providers. Medical records, or the narratives in them are written a certain way, either to protect from litigation or ensure a bill is approved. Without that direct communication the full picture of the patients condition gets lost. The providers various thoughts about the overall condition dont get shared.
A problem that I see with the Affordable Care Act (ACA) is that it conflates health care with health.
While there seems to be an abundance of health care delivered in the US, at least as measured by spending, US citizens’ health, as measured by life expectancy, is pretty far from the top.
Is the quality of health care service plunging? I think so, and I expect it to get much worse.
The ACA promised more health care for more people without doing much (if anything) to increase the supply of health care, and could actually be decreasing the supply of health care. I don’t see how this can possibly work.
My own doctor (who relies on his clinical acumen more than imaging and laboratory testing) is throwing in the towel and retiring in a few weeks. His office never adopted electronic medical records, and apparently ICD-10 was the final straw.