1. Remove failure to diagnose as a legal basis for a lawsuit.
To spend billions on testing "just to make sure" when your medical training says you already know the answer. The testing that is the result of that 0.5% chance you are wrong. No matter how much we try, we will never get it right 100% of the time. And that 0.5% unattainable goal is what drives much of the testing. As a society we need accept failure as a part of success. Some people may die, but many more will die as we bankrupt our system of care.
Premium Link Upgrade are bankrupting our system.
2. Make futile care determinations legally binding.
Withdrawal of support in futile situations would not be a legal basis for a lawsuit. Refusal to escalate care could not be a basis for a lawsuit. If you want all care all the time, we will end up with no care, all the time.
Unmanaged expectations are bankrupting our system.
3. Super regional or national EMR system used by all players
If I can access a patients data base, I can get it right more often with less error and less testing. If the patient can update their own EMR data base of personal information, I can get it right more often with less error and less testing. If you have every primary care office, every specialist office, every hospital, every nursing home using EMR's that don't communicate, you have, in effect, a country of doctors who all speak different languages. Communication saves money
4. Establish a high speed medical Internet for digital imaging accessible by all players
Place the EMR on this high speed Internet. Along with it, place all digital imaging. If my patient had an MRI 1000 miles away on vacation, I want to know about it. If they had one last week at the outpatient radiology center in town, I want to know about it. Repeat testing happens because it's just easier than waiting for records. Doctors frequently only trust themselves or other doctors they know well. So a film is much more important than a verbal report of the film. We need to see the films ourselves or it will get repeated. Because trusting an unknown physicians
Communication is key.
5. Establish a national patient narcotic database for access by all physicians.
One of the most common medical complaints is pain. Pain is a symptom. A very subjective symptom. It is wrought with ***** potential. Combined with the fear of failure to diagnose, evaluating pain is expensive and is one of the most difficult jobs of all physicians. Knowing how much narcotic a patient is using and when and where they are filling it saves money.
6. Make inpatient treatment of ******* or **** ***** mandatory for any qualified admission related to ***** or overdose.
If you are entitled to spend my tax money, I am entitled to see you in rehab, as many times as it takes. **** ***** is expensive to the system in so many ways.
7. Fund chronic disease management interventions
In the current system, every aspect of care is fragmented. The primary care doc. The specialist, the ********, the economics/social factors of care. Coordinating new models of disease care delivery will save money. Real time decisions with all players present makes decision making unified. A care plan visit . Not an office visit.
Our hospitalist group has daily am rounds with ******** and social work. We can save hundreds of thousands of dollars a year, in ******** costs alone. WIN-WIN. One hospital. One hospitalist group. Think of the savings. The reason docs don't talk? Everyone is too busy. Pay for coordinated care and you will be amazed at the results.
Communication saves money.
8. As far as hospital reimbursement goes, Premium Link Upgrade
In the current system of diagnosis related group ( Premium Link Upgrade ) a hospital is reimbursed the same (essentially) whether a patient is hospitalized for 2 days or two weeks for the primary diagnosis. Pneumonia? 2 days? Same payment as a 2 weeks stay. In other words money loser. Most primary care doctor admissions break even or lose money to the hospital. Not the case with procedural based admissions. Total knee arthroplasty? Cash cow. Unequal distribution of profit potential based on disease creates skewed market ****** for competition. Surgical centers. Heart hospitals. This results in the creation of profit gradients within illness groups. Competition creates value and lowers costs. It should be spread equally in the hospital system.
I need hospitals competing for my pneumonia patient, not just the arthroplasty patients Once you have hospitals competing for my non surgical/procedural patients, you will have new found competition and cost savings that go with it.
9. Accept that all people are not created equal.
If you talk to 20 doctors you get 20 opinions. Who's right? They all are. There are many ways to get to the final conclusion. And the final conclusion may be different. 20 patients? You may have 20 different definitions of quality. Of outcomes. Of expectations. Of needs. A 40 year old with heart failure will have different expectations than an 87 year old with heart failure. And they will respond differently from interventions, medications. They will have different outcomes, defined by the patient.
That's 20 docs and 20 patients. 400 possible permutations of the process and the measured outcome. Finding that 1 out of 400 is Premium Link Upgrade . Accepting this premise accepts that all people are not created equal. Shackling the delivery of health care with undefinable goals and and expectations adds money to the system of health care delivery.
10. Quality should be defined by the patients pocket book, not government
In a market economy, patients decide what value they want. Cheap? Expensive? Value? The consumer decides how to spend their mighty dollar and they accept their value for their dollar. In medicine we are told what we can get. Every one is in the same hurried, fragmented, dis conjugated care. Why? Because Medicare says to doctors, if you accept this insurance, you have to accept it in full. You may not charge the patient more.
There are no rings of value. Unfortunately, not everyone is created equal, and there will always be variations in health and income. Rich and poor. Chronically healthy and chronically ill. The current system is all or nothing. Take Medicare in full, or leave it. The ability to find a middle ground and allow the patient to decide what they want to pay is present in every other service we as consumers can buy. But not our health care.
When you bring together happy doctors and happy patients good things happen. The current hurried, fragmented care model is expensive and adds to unnecessary referrals and testing. Allow the patient to decide what they want to pay for. What they value.
11. Make outcomes transparent.
Define them and present them. Let the patient decide what is important to them.
To be continued....
