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    Here’s the answer to fixing healthcare

     

    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.

     

    OPINION: Waiting on Congress to fix healthcare could be hazardous to physicians

     

    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:

    1. 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.

    1. 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.

     

    HOT TOPIC: Wealth shouldn't make health. Ever.

     

    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?

    Kumar Yogesh, MD
    Practicing physician at Dresden Family Clinic for 24 years. Owner of practice, self-employed physician, medical director.
    Niti Yogesh, PA-S
    Physician Assistant student, Bethel University, anticipated graduation May 2018.

    6 Comments

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    • [email protected]
      The fundamental problem to healthcare is three-fold: 1. getting someone who needs healthcare (usually not that difficult), 2. getting someone to provide that healthcare (given schooling, facilities, regulations, etc. a much-more difficult situation, but one we've mastered), and obtaining the medium of exchange (usually money, seemingly the most difficult part). Insufficient money is causing the healthcare problem. Lacking money (disposable income), we get the argument "healthcare is a fundamental right". It is a right in so far as you have a right to be treated for a medical problem; you cannot be refused, a priori, healthcare. But, the patient lacking sufficient money to pay for treatment means compelling someone ELSE has to pay. It's really that simple. Since compulsion has become a common currency in politics and governing today, the logical solution to the delivery of healthcare services is to compel all parties who could potentially provide these services to provide them ... free. Should the people who could provide these services resist, we will need to accompany each patient requesting healthcare services - who can't (or refuses) to pay - with an armed healthcare agent who will see to it that the services are appropriately offered and delivered. This would be a faster, more efficient method than attempting to institute costly, confusing and unreliable insurance systems funded by unwilling and evasive taxpayers way down the revenue chain. You may have a "fundamental right to healthcare", but, you do not have a "fundamental right" to compel ME (or anybody else, or the Government) pay for it. Until healthcare,the ethical problem, is solved, healthcare, the political problem will never be solved. Steve Reade.
    • UBM User
      I definitely agree that insurance companies should NOT dictate what doctors should or should not do. They dictate this by paying the payers. They are getting wealthier and wealthier because they depend on corruption for their business. Definitely, the fee for service is excellent; the problem patient cannot afford it. Insurances should not be the ones to dictate policies, even though they are the payers. Also, there are any business prople, not physicians, involved in the whole medical fields. Their objective is only one thing "to get wealthier and wealthier", on the expense of the poor patients who cannot afford treatment. I still want to have the government involved, specially for those unfortunate and poor civilians who cannot afford treatment. I had a 40-year old in my office (I am an employee), who could not afford the insurance given by the employer. She had breast cancer, and I worked hard to get her assistance from the government. Thus I think the government has a role, but insurances should NEVER have a role or to dictate how physicians should practice medicine. We still can use the ICD and CPT, though.
    • [email protected]
      I agree with Pogo: "I have met the enemy and he is us." I have watched the degradation of the medical profession over the past 35 years. I have always been involved in organized medicine and ongoing contact with my elected representatives over that time span. I believe the third party must be removed from my examination room. If what I do now adds no value to the patient, it needs to go. I agree with the suggestions in this article. I would add direct pay practice, where I work for the patient, not a government or insurance company bureaucrat.
    • [email protected]
      I totally agree. So much of the cost of healthcare is spent on policies not likely to improve healthcare, but rather to enrich insurance companies, government bureaucracy and the pharmaceutical industry. As a result, we have to jump through hoops just to be reimbursed at a ridiculously low "negotiated" rate. The reimbursement idea presented in this article is excellent and simple. It is time we physicians stepped forward and demanded an end to the present highly inefficient system.If we do not help ourselves who will? Also, we must insist on being referred to as physicians as had been the case for centuries and not "providers.
    • [email protected]
      I totally agree. So much of the cost of healthcare is spent on policies not likely to improve healthcare, but rather to enrich insurance companies, government bureaucracy and the pharmaceutical industry. As a result, we have to jump through hoops just to be reimbursed at a ridiculously low "negotiated" rate. The reimbursement idea presented in this article is excellent and simple. It is time we physicians stepped forward and demanded an end to the present highly inefficient system.If we do not help ourselves who will? Also, we must insist on being referred to as physicians as had been the case for centuries and not "providers.
    • UBM User
      My idea is to put control into the hands of those who deserve it: the patients and the doctor of their choice. Services would be priced by free market forces. A single payer system would reimburse services at a cost-based minimum. The physician would then be permitted to charge above that level on case by case basis whatever supplementary fee required to keep up with demand. Physicians can and must have the necessary autonomy to advocate for themselves by providing high quality services to the people they advocate for - the patients. This reasonable arrangement would be driven by freedom of choice. Price discovery would be based on reality, not fantasy. Alconcerned Americans should demand high quality medical services at ther true cost and not arbitrarily determined by the machinations of solely profit driven elite. We can restore fair and affordable health care if we continue to demonstrate why the current system is bad for the health of this country. That there is a health and financial alternative to the current system of wealth stripping that the business and political elite have imposed upon us. Their goals are The usual: wealth and power. The more they take from the people the more they will suffer. They are not interested in anyone's health, their own likely included. These special interests have failed the people si we must continue to press for really meaningful change. Otherwise our nation will be bankrupt- and unhealthy.

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