Health care from the trenches: Change must come from us

A patient came to see me with terrible shoulder pain, which I suspected was caused by an acute rotator cuff tear. As any good orthopedic surgeon would, I ordered an MRI. My radiology tech, however, was not permitted by Medicare to perform the study.

Now, my patient needed to secure an appointment for an MRI across town. Then, after the MRI, she needed to schedule another appointment with me so I could review the images and discuss a treatment plan.

This process took several days and multiple appointments when it should have only taken one appointment and a few hours to come up with an effective treatment plan. This kind of run-around is not an isolated incident, but an incident I suspect many of my fellow clinicians can relate to.

I’ve been in the trenches of the U.S. health care system for over 25 years, and in those 25 years, the system has devolved into a nightmare.

The problem

U.S. health care is becoming increasingly entrenched in bureaucracy, and health care providers have little to no say in how to give effective, efficient care to their patients. We can’t even get paid fairly without deciphering endless walls of medical codes only intelligible to trained professionals.

Staff at insurance companies with no medical training are the ones who dictate what constitutes reimbursable care. Their interference fundamentally disrupts the doctor-patient relationship, delays or prevents delivery of care, and presents new obstacles to new approaches that would improve patient outcomes and reduce costs.

Since the implementation of the U.S. Affordable Care Act, health care in America has become an even greater bureaucratic nightmare than before. What started as incremental interference in the relationship between doctor and patient with the passage of the Medicare Act of 1965 is now an impenetrable barrier made up of governmental and health care insurance industry red tape. The result is higher costs and greater inefficiencies.

Despite the political debates and media coverage on health care policy and reform, there remains little or no feedback from the people in the trenches—the physicians and other health care professionals who provide care to the patients. It is imperative that we, as clinicians, challenge the increasingly entrenched bureaucracy in our health care system. Doctors, nurses, and patients need to have a voice in the problems engulfing care.

Like many who set out to be doctors, I joined the profession because I wanted to help and to heal. I want to be able to provide my patients with the care they need, at the time they need it, minimizing any interference to that process. With the ever-increasing cost and complication in our health care, this ideal has become impossible to attain.

It is imperative that we educate Americans on the root causes of the problems in our health care system and demand meaningful reform—not just reform for reform’s sake.

The solution

What can we do to make health care reform meaningful? These are seven of the most crucial things that need to happen to improve the state of our broken system.

1. Involve health care providers in the health care conversation—not just politicians, lobbyists, and insurance administrators who have no medical training or experience in patient care.

2. Get rid of the middle-man—administrators and insurance companies—to create a more efficient and less bloated system. Additional administrators only add to the cost of health care while doing nothing to contribute to actual care.

3. Require hospitals and health insurance companies to become non-profit. Eliminate multi-million-dollar salaries to executives for “withholding” care to keep costs down and their paychecks up!

4. Encourage more all-in-one facilities so patients do not need to wait weeks for results they should be able to see in a few hours. Not only does this streamline care, but it significantly reduces costs as well.

5. Require increased transparency in health care pricing.

6. Teach doctors to collaborate rather than to compete. They must stand together in the health care debate, offering solutions rather than capitulating to lobbyists and insurance companies.

7. Educate the public on the issues doctors and patients face from today’s inefficient health care system. Change can only come from a public that demands it.

Change must come from us

We, as a profession, must accept some blame for many of the developing problems in health care delivery. No, I am not suggesting that we caused the problem. I am stating that we have had ample opportunities to manage the debacle and even to reverse some of the disturbing trends, yet we rarely allow our voices to be heard.

Is health care reform impossible? It certainly isn’t. But we, as doctors, need to step up to the plate, to stand up to the growing bureaucracy in the system, and make sure our voices are heard. The change will be long, slow, and painful, but we can’t allow the system to continue to swallow us whole. The change must come from us.

Alejandro Badia is an orthopedic surgeon and author of Healthcare from the Trenches. He can be reached at Healthcare from the Trenches and on Facebook and Instagram @badiahandtoshouldercenter.

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