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    Physicians, patients must unite for major healthcare change

    "I just want to do what’s right for my patients. When I go to bed at night, I don’t worry about my future … I worry about theirs.”

    This was the reaction of an internist recently when I asked how she gets through the day given all the stressors plaguing the profession, from meeting quality metric targets to dealing with technology intended to improve patient care, but that doesn’t deliver on the promise.

     

    Hot topic: To help physicians, EHRs must adapt to value-based care

     

    She didn’t bemoan her own lot in healthcare, but instead how patients are suffering. Many physicians face anxiety about their future reimbursement and the ever-uncertain state of private practice. But many more worry about the individuals who come through their doors for care. 

    In this, our annual “Fighting Back” issue, we look at the latest challenge for physicians affecting patients: value-based care. For physicians, the main concern isn’t deciphering what a payer—government or commercial—feels is “quality” or collecting the data to prove the metrics are being met. The overarching question is whether this is really good for patients.

     

    More: How to measure up for value-based care

     

    But when given a challenge, physicians meet it. And they will with value-based care, just as they have with the myriad mandates they have faced over the years. They will adapt, adjust and get back to improving the lives of those seeking relief and compassion on a daily basis. 

    But the underlying symptoms plaguing healthcare today persist with daily visits from patients battling high-deductible plans, rising prescription prices and fear that a procedure could mean a life spent riddled with debt. 

    Next: Physicians can, and should, advocate for themselves and patients

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    • UBM User
      One thing I find particularly ridiculous is the insurance companies right to deny payment for higher level services. Some of the doctors who work for insurance companies are reasonable and approve inpatient stays for patient's who are legitimately sick, while others are just ridiculous. For example, I dealt with a doctor from Aetna Better Health who would not approve an inpatient level of care for a 91 year-old woman with a sodium of 118 who received hypertonic saline and was hospitalized in the ICU. She required 14 BMP's and also presented with small bilateral pleural effusions and an elevated BNP - a harbinger of intolerance to hypertonic saline. Fortunately the patient did well and was able to be discharged in 48 hours, but the Aetna physician told me "because you appropriately cared for her and she got better observation services are appropriate". They hide behind Milliman's extreme ridiculosity like it is the doctrine for care when actually it is better used as a tool for case managers to do an initial screen. The whole point of a physician peer to peer review is to be able to offer a high analytical perspective on patient care and risk. If hospitals and doctors do not rid themselves of this plague of burdensome, arbitrary reviews then I am afraid many hospitals will be forced to close their doors. One way physicians and be more proactive is to thoroughly document why the patient is ill and needs the recommended services. We cannot expect to present skeletal notes, incongruent treatment plans, and a disorganized thought process and assume that we will get reimbursed for it. I am not suggesting that you list a differential diagnosis of a 3rd year medical student, but rather offer a succinct analysis of the patient's condition and acuity and need for treatment.

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