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    Putting process over patients continues to hurt healthcare

    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 this blog by Anish Koka, a cardiologist in private practice in Philadelphia. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    I had the special pleasure of going to a cardiology grand rounds being given by a new breed of physician: the cardiac hospitalist.

    The problem with healthcare, you see, is that we don't have enough specialists. What began as a nascent movement spurred by an influential New England Journal of Medicine editorial in 1996 discussing the need for a new breed of doctors who specialized in taking care of medical inpatients is now spawning subspecialization within the field. 

    Like most stories, this one requires context.


    FURTHER READING: Where will the healthcare debate lead us?


    The nation has perpetually been on the verge of being bankrupt ever since we became civilized enough to ensure senior citizens would have healthcare. Unbeknownst to most Americans, the moment President Lyndon B. Johnson signed the law affirming the nation's commitment to healthcare in 1965, an all-out assault on the nation's wallet began. It was a gold rush. The richest house in the neighborhood on Halloween was giving out an unlimited number of candy bars. You just had to go ask.Dr. Koka

    Hospitals asked a lot, and the cost of taking care of medical inpatients rose from $3 billion in 1967 to $37 billion in 1983, according to the U.S. Department of Health and Human Services (HHS).

    Alarmed by the massive inflation in costs, Congress in 1983 mandated a change to how hospitals were paid. Whereas hospitals used to be paid based on the costs hospitals said they incurred after the fact, they were now to be paid a flat prospective rate based on the patients’ admitting diagnosis. Bundling payments by diagnosis codes put intense pressure on hospitals to be more efficient in care delivery. Reducing the length of stay of hospitalizations became paramount to ending the year in the black. 

    The prior model that used to consist of primary care physicians splitting time in the hospital and the outpatient setting was deemed inefficient. Keep a pool of physicians in the hospital focused on getting patients out of the hospital rapidly, and allow primary care physicians to stay in the office full-time to see more outpatients, unburdened by demands to run over to the hospital to see patients.

    Next: The bigger picture...and a problem

    Anish Koka
    Anish Koka is a cardiologist in private practice in Philadelphia trying not to read the writing on the wall. Follow him on twitter ...


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      They are turning us into bureaucrats, day by day. It's not about patient care it's about meeting requirements. Unless there is a major change healthcare will become ever more expensive, inefficient, impersonal and worse for patients. I am not looking forward to the care I will receive as I am getting older and will require more care.

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