THE PROBLEM: MANY MEDICAL BILLS ARE INFLATED WITH UNNECESSARY CARE
veryone agrees that making health care more affordable is a good idea – but having clinicians take responsibility for protecting the patient’s wallet requires new skills, training, and tools.
Health care clinicians ultimately determine how 90% of health care dollars are spent. However, it is challenging for clinicians to know how their decisions will impact what patients pay.
Increasingly, clinicians are finding that patients expect them to look out for their wallets. Costs of Care has collected hundreds of stories from patients, clinicians, and administrators that demonstrate that high value medical decisions benefit individual patients and society at large.
Just as the patient safety movement helped clinicians think about how to prevent unintended harm, a new movement is needed to help clinicians think about unintended financial harms as well.
The idea of the practicing clinician in a face to face encounter with a sick patient, simultaneously balancing diagnostic and/or therapeutic choices as well as analyzing cost is probably not possible, unless computers and analytics are utilized. Physicians are trained to put the patient and diagnosis first. It places the provider in the untenable position of balancing health vs costs. It is an unreasonable demand which also effects quality of care.
Providers have faced during the past two days an increasing bureaucracy they must face to treat a sick person. They are like the lobster in the pot slowly brought to a boil. Now we have reached a point of no return. Roughly 50% of providers are burned out, depressed, or considering quitting. Many of them have only been in practice 10-15 years. They are not retiring but they are finding new methods to continue practice life. Part-time salaried, locum tenens, allied health consulting, and health technology.
All of these further decrease physician accessibility. The insurance industry and payment models also contribute to the problem by decreasing physician accessibility with closed panel plans, HMOs, Medicare Advantage Plans. The Affordable Care Act insured millions of patients, however these same patients cannot access health care. The ACA was an insurance/payment reform, not a health plan.
The ACA will be amended/repealed, otherwise it is a waste of taxpayer money. The additional blow back is the number of health insurer mergers, allegedly to save money and/or created an indomitable market presence. A federal judge this week blocked the proposed merger of Aetna and Humana for that reason.