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Author Topic: I'm just thinking...  (Read 1018 times)
Preacherman0
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« on: Sep 12, 2009 at 21:50 »

I can't honestly say that I'm in favor of the currently proposed reform of health care (see Finny's post from a few days ago).  But I'm still waiting for someone to tell me:  Why is the CURRENT plan so fantastic?
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SCacalaki
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« Reply #1 on: Sep 12, 2009 at 22:41 »

I've gotta say preach, I don't think anyone here has been against reform.  I think former threads here speak to that.

What direction reform goes...that has been the discussion.  The discussion from myself and the two physicians on this board have been re: the difficulties with the current government-run health care insurer, Medicare, and state-run M'caid and the severe difficulties with reimbursement and timeliness of payment from these groups.  I believe most think that a single-payer will open health care to most, thereby increasing the demand on the health care system.  If the single payer were to reimburse at the same rate (or near) as M'care, it would be difficult to keep private physician offices open, and likely pushing the burden back to the ER and hospital-based physician practices.  Not what anyone is hoping for.

So my main concern is reimbursement...what will it be under the reform?  M'care-like?  In the middle between M'care and private?  Somewhere close to what the private insurance companies were paying (which wasn't great but it was better than M'care and M'caid)Huh??

I believe it was you who complained a few weeks ago that your doc didn't spend enough time with you.  Well, with the reimbursement rates as it is now, physicians (especially PCPs) have to double and triple book, use PAs and NPs as front line service providers, and get in and get out.  I wouldn't expect that to be better under any reform as demand likely increases and there just aren't enough physicians currently.  This pushes appointments farther out in the future, lessening patient satisfaction and creating some frightening situations for patients whose health may suffer from an appointment that should be 4-6 weeks from the initial appointment, but the schedule only allowing an appointment in 8-12 weeks.

The one thing I think good about the current situation, from where I sit, is the value placed on patient satisfaction.  I hope that continues with any reform.  What drives this push is the competition amongst hospitals to show that they are the best place to receive care, via single bed rooms, quick appointment times, continuity of care, and one-site care for multi-specialty services.  I believe hospitals could find a way to continue this best practice, though I doubt all would.
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Preacherman0
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« Reply #2 on: Sep 15, 2009 at 15:27 »

Quote
I believe it was you who complained a few weeks ago that your doc didn't spend enough time with you.  Well, with the reimbursement rates as it is now, physicians (especially PCPs) have to double and triple book, use PAs and NPs as front line service providers, and get in and get out.  I wouldn't expect that to be better under any reform as demand likely increases and there just aren't enough physicians currently.  This pushes appointments farther out in the future, lessening patient satisfaction and creating some frightening situations for patients whose health may suffer from an appointment that should be 4-6 weeks from the initial appointment, but the schedule only allowing an appointment in 8-12 weeks.

The one thing I think good about the current situation, from where I sit, is the value placed on patient satisfaction.  I hope that continues with any reform.  What drives this push is the competition amongst hospitals to show that they are the best place to receive care, via single bed rooms, quick appointment times, continuity of care, and one-site care for multi-specialty services.  I believe hospitals could find a way to continue this best practice, though I doubt all would.

Yes, that was indeed me who lodged that complaint.  I still question whether or not we have "true" competition in the current system, where insurance companies seem to dictate what medicine you can take, what physicians you can see, etc.  Costs are clearly going up, and I would question whether or not the quality of care is proportionally improving.  Please keep in mind that I'm talking as a consumer, and have little inside info into how the system works.  I still find that waiting times for appointments, surgeries, etc. are pretty unreasonable; however, one thing that you can do in the current fabric is make enough noise to get moved up in the rotation or at least propose that you can look elsewhere for care.

My gripe here is with people who act like our system is perfect.  There is a large cry (at least from my state) to simply keep things as they are without any changes or reform.  It seems that the system is most perfect for those who can afford to pay, and the rest of the populace must live with whatever they get.  I don't know that we should accept that as the best case scenario. 

At the same time, I doubt we're going to be able to create the "perfect" system.  Someone, somewhere, is going to have to pay for all of this, and that fact cannot be ignored.  I don't know what the answer is, but I am not satisfied saying that we should do nothing.  And I do wish the President would be a little more willing to listen to some alternative voices and be a little more cooperative on the issue.
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SCacalaki
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« Reply #3 on: Sep 16, 2009 at 11:56 »

I guess the things you've spoken of relate under the health care umbrella, but I do think each has its unique place in the health care debate.

Competition...likely not enough currently to cause any real change in price.  Very few (if any) lost cost options.  Usually must be employed to have a shot at "affordable" health care.

Costs rising v. quality increase...agree.  Though both M'care and BC/BS have set forward pay for performance guidelines.  It is a five-six year implementation, which gives gradually decreasing bonuses to physicians and hospitals for moving to electronic health records, e-prescribing, reporting/improving outcomes above a certain %, etc.  Now, I can say that while the word "bonus" is a bad word in light of AIG, et al, my hospital has participated in M'care's PQRI for the past two years w/o receiving a bonus despite meeting the goals.  Again, no surprise from me as it is a gov't program that ebbs and flows with the economy.  And we strive to have the highest quality possible, as there is true competition between hospitals for patients (which I like, as patient satisfaction and safety are top priorities, with physician and employee satisfaction a close second/third).

http://www.cms.hhs.gov/pqri/

I admit to not knowing as much re: the BC/BS quality program.

I doubt many think the system is perfect.  I have health insurance but was hit with a large bill when we lost the pregnancy earlier in the year.  I was kind of surprised, though we did go out of network, which reduced the coverage %.  Though, when you have arguably the best hospital in the country (Johns Hopkins) next door, I'm willing to pay the extra. 

I lived in SC for 20+ years.  I think some who can afford health care are uncertain of change and whether they will like the change.  Which is a typical response to any change that might alter the status quo.  I also think that per southern mindset, gov't intervention is always viewed with suspicion.  Elderly are concerned about what will happen to their M'care benefits.

And I don't blame the uncertainty from some people.  Nothing concrete has been laid out (possibly today's revelations provide better insight IMO).  Public option?  Co-ops?  Single payer?  Etc.



There will be no perfect system.  As mentioned elsewhere, physicians, PAs, NPs, etc., aren't going to settle with being paid less.  So if reimbursement is lowered over the patient base/payer mix, there has to be a way to make this up.  More patients seen is a good idea as the demand is higher.  But this means less physician one-on-one time per patient.  msdmnr and doclogic (and other physicians) may not like this but increasing usage of PAs and NPs as a lower-cost alternative to multiple physicians at a location could keep costs down...but likely patient satisfaction suffers as patients want to see a "real doctor." 

Another option already exists....excluding insurance plans that reimburse at < 30% of the charge.  Medicaid is already excluded by many offices across the country.

My guess is that you will see more affordable insurance plans but that the one-on-one time that you would like from your physician is never going to return to what it was 20+ years ago.  Though, many physicians are now offering "boutique" services, requiring a one-time payment per year ($1400+).  Maybe an additional small co-pay.  But some physicians have moved to this b/c they were so fed up with the insurance companies.  Allegedly it allows for more one-on-one time with the physician, appointments whenever needed, etc.  It wouldn't cover emergency visits nor visits outside of that particular office.  But if you had a good PCP and felt comfortable passing on specialists, it might work.

It's not a good system.  I hope for reform but one that doesn't limit a hospital's abliity to employee great physicians and clinical staff, nor limit the ability to raise capital to purchase new equipment to make a patient's visit faster, easier, and more comfortable.

My hospital has recently implemented a Lean/Six Sigma plan across the hospital to improve processes and reduce costs.  I'll let you all know how it goes for my various departments.

Increasing taxes doesn't bother me, if it is for health care improvements. 
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SCacalaki
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« Reply #4 on: Sep 16, 2009 at 11:58 »

And so I don't unintentionally convey inefficiency and waste on the part of healthcare, I'm on my lunch break at home (live a few blocks away).  Back to work
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