Implementation of a rational system of medical care

The patient entered her private solo physician’s office and handed her medical ID card to the doctor.  He put the card in his desktop reader and reviewed her medical history.   All of her visits, vaccinations, medications, tests, x-rays etc from all providers were inscribed on the data chip in the card.  The card also included insurance and billing information.  At the end of the visit, he updated her information on the ID card at his desk and returned the card to the patient.  The completed entry on the card was processed centrally and the physician received his payment in a few days, no rejections or delays possible.

Is this story a science fiction fantasy?  No, this is an everyday routine patient encounter in France and it is similar in several other countries.

In fact offices can get by in France without even one administrative assistant.  Contrast this to the hordes of billing specialists we have in this country.  Why are we in the US light years behind in the implementation of a rational system of medical care?  Why do we have a system that is so fragmented that efficient and economic practice is impossible?  Why does the average American physician have to spend an ever increasing percentage of his day in administrative tasks and billing hassles while having to hire an ever increasing number of billing and insurance specialists to keep up with the ever changing requirements?  All this is in the setting of an American ‘system’ which eats up nearly twice the GNP of other European and Asian countries who yet manage to have better patient outcomes than we do.

One possible solution is that we need a national health system.  That could solve the problems but implementation of the French system does not require a unified governmentally controlled system.  All it takes is a national mandate that all insurers are standardized and follow the same rules.  In the US we have Medicare, Medicaid, the VA system, 50 states, and probably over a thousand insurance companies all with different rules, regulations, and requirements.  Obama will spend many billions on encouraging electronic medical records (EMR) but it won’t accomplish a fraction of what a much simpler implementation can do with standardized rules.  The financial encouragement and penalties the Feds are proposing will not lead to transportable records and unified billing.   What the Feds should do is develop one standardized system, give it to all providers for free or at nominal cost, and then require that all patients, providers, and insurers use it.

What stands in the way?  We seem to have political paralysis on this most vital of issues.  Our system is almost entirely for profit, yet two of the most widely supported and efficient systems are non profit government run, Medicare and the VA system.  Indeed the VA system is as close to ‘socialized medicine’ as could be imagined.  Vested interests i.e. for profit health insurers have spent fortunes deriding Obama’s relatively modest and incomplete final bill as socialized medicine.   This is despite the fact that public option was defeated.  When fully implemented the majority of Americans who don’t have Medicare, Medicaid or the VA will still be dependent on insurers whose main responsibility is to their shareholders.  They’re under no mandate to provide affordable health care for all.   Instead of a discussion on how to reorganize our health system into an efficient economical system for the entire population, we get totally spurious criticisms, most famously the “death panels.”

The new regulations under Obamacare will make health insurance more available, but will do nothing to make medicine more economical and efficient.   The coming mandates to implement EMRs will effectively force most physicians to either join large groups or to retire.  Doctors will earn a bonus for implementing EMRs, but the requirements to earn the bonus are so complicated that even some of this country’s largest private systems have said they cannot implement it.  As it stands doctors will be increasingly penalized for failure to implement an approved system, though no one really knows exactly what is required.  Clearly the government itself should design a system and make it available to all at an affordable price.

Other proposals such as forcing doctors to document quality of care and putting the financial onus on them to do it will only accelerate the trend of forcing small groups out of practice.  Where I practice many long and well established practices are selling out to hospitals.  We are clearly on a path that will see the end not only of solo practices but of smaller group practices as well.  I did not go to medical school to spend my days overseeing business management.  It’s nigh time we developed a system that allows doctors to practice medicine and simplifies the business aspects instead of making them more complicated with every passing year.

Joel Sherman is a cardiologist who blogs at Medical Privacy, A Patient Oriented Discussion.

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