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    Who is ruining the healthcare system?

    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 Jeffrey Gene Kaplan, MD, MS, a senior pediatrician and retired physician executive. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Jeffrey Gene Kaplan, MD, MSI recently had a medical experience that is telling of the bureaucratic interference the average U.S. patient has to contend with.

    A few months ago, my pulmonologist who sees me for obstructive sleep apnea (OSA) said I was doing great and I didn’t need to come back for a year. I did, however, need a different full-facial mask for my C-PAP machine. The durable medical equipment (DME) company who supplies the mask demurred. They stipulated that I had to return to the pulmonologist. Medicare rules.

    Reexamining the 80-hour medical resident workweek

    It is no exaggeration to say that I spent many hours and made over 20 phone calls to check on the availability and coverage of this item.  In addition, I had to start the entire DME authorization process over because I switched from Medicare Complete HMO to regular Medicare with Supplemental coverage.

    What a waste of time! In healthcare information technology jargon, the above completely misses the objective of interoperability as it asks me, the patient and the specialist’s staff to ‘jump through hoops’ and do a lot of rework and duplication.

    The DME vendor outsources prior authorizations to the Philippines. Needless to say, we had a difficult, often unintelligible conversation, but that’s not the point of this diatribe—my equipment was in good repair. Only the mask wasn’t doing its job. It didn’t fit right. It kept sliding into my eye.

    MOC, recertifications are ‘cancers’ doctors should rally against

    Worse, the OSA was not being managed and that can mean preventable hypoxic brain injury.

    Next: Who Is ruining healthcare? 

    Jeffrey Gene Kaplan, MD, MS
    Senior pediatrician, Ezras Choilim Health Center, Inc. and retired physician executive.


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    • As a physician with nearly 40 years in the clinical practice of medicine and a business expert in the business of medical practice it astounds me that no one really understands what is ruining medical practice today, actually over the last century. The widespread frustration across the medical profession can be drilled down to one primary issue. It's a money thing. In case you scoff at that let me let you in on a business secret. When a doctor can't earn enough money to stay in practice, something must be wrong with his or her medical practice business. All business experts know that the reason doctors can't earn enough money to pay for kids college, bankroll a retirement plan, and recognize that their profession has essentially dumped them, is because they don't know how to run a business efficiently and profitably (were never taught). They can't run the medical practice business profitably because they don't know how to earn money. They don't know how to earn money is because they were not taught business principles and marketing strategies. Whose to blame for that? Without a business education as part of the preparation for the practice of medicine, all those doctors are predestined for financial failure to some mild or severe degree. The only way to avoid it is to become an employee, a sacrificial lamb making money for somebody else instead of themselves. If all doctors were gifted with a business education at the start, physician attrition would probably disappear, financial failure of medical practice would be rare, and 95% of doctors in private medical practice would have the business tools to earn as much money as they wanted whenever they wanted. And they would remain fulfilled and satisfied with their profession. Since the medical academic and medical school community refuses to offer a business education, which can easily be done using digital methods and cost almost nothing, in my mind is the real reason doctors are quitting etc. As a matter of fact I haven't talked to a single medical doctor, that when they were a medical student were ever told a business education is critical to private practice nor told them why. Doctors will continue to remain ignorant of business expertise and continue to suffer with the increasing restriction on fees and incomes until they are all forced to become employees ---- a perfect political government plan to rule the practice of medicine. Curtis G. Graham, MD, FACS, FACOG, Penn. "62
    • simple...progressivism's 74 year old battle to destroy the free market in healthcare starting with The Economic (Un) Stabilization Act of October 2, 1942 imposed by FDR thru an extraconstitutional executive order. Everything since has attempted to fix the problems started by FDR by further imposing the exact cause of the problem, i.e. the centralization of healthcare. The person receiving the product has been separated from the costs of the product thus leading to massive price increases. Now, the government coerces the individual under penalty of law to buy healthcare at the exorbitant NON free market prices itself has caused. Another consequence has been that the person receiving the product, i.e. the patient, is no longer a relevant participant in the decision making process whether that be financial or medical. This is always the consequence of progressive policy, i.e. the destruction of the individual. Read Marx for more information.
      "The business of medicine is medical business; it is not insurance business; it is not a shell game by them. It is a right, not a privilege." And there is lies the key to the problem with American Medicine - Medicine is treated as a commodity, something bought, sold and traded, not people TREATED as human beings with a basic right to health care. I have been burnt out, and it was refocusing on why I became a doctor - the health of the person in front of me, and not the billing code, or the desires of some other entity to add unnecessary tests to the visit, that got me past all that. And believe me - I've gone through, filling out forms for things that I scratch my head"didn't I just do all this?" that I know drives yet another new physician out of healthcare and into something else.
    • what you describe as causing your burn out is derived from the thinking that healthcare is a 'right' and is not a commodity. What you describe is the result of 74 years of the disruption of the free market that has left patients and doctors out of the decision making process and has resulted in the centralization of the money and power in the hands of our hopelessly corrupt government and it's insurance company cronies. If the patient were empowered, as the free market allows, to pick what works and doesn't work, what is good and isn't good, what is too expensive etc, we would have a just system instead of the top down soviet centralized system we have now. Just remember, the ONLY system that improves access, improves quality and keeps prices under control in a moral fashion is the free market. By supporting centralization. we end up with a hopelessly corrupted system with massive cost increases, paper work, centralization, coding,economic and moral dislocation etc. Centralizing healthcare and it's destruction of individual sovereignty is not a moral system.
    • Anonymous
      The healthcare system is not "being ruined", its already ruined, done deal, over. Sad thing is that articles still talk about "coping" for burned out physicians. I have met the enemy and he is us. Plain and simple, physicians are responsible for the "mess" of healthcare today. Apathy, total lack of teamwork and unity, refusal to just say no to Medicare, medicaid, insurance companies, lawyers, hospital administrators/boards, the US Government, and so on and so forth. Wanna screw over US physicians?...get in line take a number. We actually welcome it and some of those destroying medicine even have the initials MD behind their names.

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