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Dear President-elect Obama: Part 6 Why Dont You Listen To Practicing Physicians?

Posted Dec 21 2008 8:56am


Stanley Feld M.D.,FACP,MACE

I am asking your administration to use common sense to repair the healthcare system. So far I have only seen political strategy. A strategy that I predict will fail as I predicted the Republican Governor Romney’s universal healthcare strategy would fail in Massachusetts.

No one in your administration is asking for advice from the physicians in the trenches. The practicing physicians are your workforce. The administrators and consultants at large hospital systems and mega clinics are not your prototypical workforce. Practicing physicians are experiencing the bad effects of the faulty healthcare policy of the past. Those healthcare policies have commoditized medical care and destroyed the patient physician relationship. I will explain the patient-physician relationship in the next blog. I am afraid you are about to compound past errors with Tom Daschle’s proposals at a very high cost to taxpayers.

Our present problems are not the result of bad intentions on the part of the federal government. They are the result faulty regulations piled upon faulty regulations to correct the previous faulty regulations. Stakeholders have been driven to adjust in order to benefit from these complex regulation to protect their vested interests.

Willie Sutton said we should go where the money is. In healthcare the biggest waste of money is in:

  1. Administrative waste; $ 200 billion dollars per year
  1. Ineffective chronic disease management: 80% of the healthcare dollars spent or $1.6 trillion dollars per year
  1. Lack of a universal electronic medical record: $75 billion dollars per year wasted in production time, duplication of testing, and illness from medication errors and communication errors.
  1. Defensive medicine: $160 billion a year.

Tom Daschle should be going where the money is and solving these problems. He should not instituting a bureaucracy that will not improve care or save money.

Two hundred billion dollars is wasted on administrative costs. These costs are passed on to consumers. All the stakeholders inject wasteful administrative costs into the system.

The largest administrative cost is generated by the healthcare insurance industry. It has grotesque executive salaries and excessive service fees. Since the healthcare insurance industry administers Medicare and Medicaid services for the federal government, the federal government is paying those costs plus a commission. Mr. Daschle should be focused on discovering the actual cost of healthcare insurance.

The second large waste of funds results from the complications of chronic disease. The estimate is the complications of all chronic diseases cost the healthcare system 80% of the healthcare dollars. If the healthcare system cost our nation two (2) trillion dollars last year the complications of chronic disease cost the healthcare system $1.6 trillion dollars. Diabetes mellitus cost the healthcare system $200 billion dollars last year. One hundred and sixty billion dollars ($160) was spent on the complications of diabetes mellitus. CMS estimated that the cost is even higher at 90% of the healthcare dollar spent for chronic disease complications.

There is little support for physicians to develop chronic disease management in their offices. Therefore physicians have little incentive to invest resources for chronic disease management. The government has supported pilot studies that have shown chronic disease management is ineffective. Chronic disease management is not ineffective. The way the pilot programs delivered the management was ineffective. Patients must be taught how to manage their chronic disease to avoid the complications of their chronic disease. If they effectively managed their chronic diseases patients could reduce the complication rate of their disease by at least 50%. Fifty percent of $160 billion dollars would result in an $80 billion dollars savings to the healthcare system. Effective chronic disease management is not supported by the government or the private healthcare insurance industry. Systems of care could easily be set up with rewards for physicians and patients who execute chronic disease management effectively.

A universal electronic medical record could be distributed by the government. Physicians would be charged by the click for it use. There would be no up front cost per physician ($60,000) for the EMR software or or maintenance service fees. All updates would be free and downloadable. Adoption of the EMR would be rewarded and the physician would pay a small fee by the click deducted from the service provided.

Defensive medicine costs could be eliminated with common sense malpractice reform. Texas malpractice legislation could be a model. It has decreased malpractice claims by over 60%. The plaintiff attorneys have taken an income hit and are trying for rescind Texas medical malpractice reform.

Your administration should be going to where the money is rather than developing a more complex bureaucracy with the potential for abuse. Repair of the healthcare system should be consumer directed with the help of the government and not government directed.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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