Update on health care reform

If a patient asks me “how much is this visit going to cost?” the only honest answer is, “I have no way of knowing.” How can a patient plan for the coast of the visit? How can the practice as a business work on guesses?

It’s just the way we as a nation have decided on. If I charge, say, $90 for a visit, the patient’s insurance company may have contracted with me to have the visit discounted to $60. Then the patient may or may not have met their deductible or their out of pocket. They may or may not have money left in their HSA.

Shopping around for a good price doesn’t work all that well either. Prices tend to be set at the level of the insurance company. And do you really want to see the doctor with the best deals?

But let’s say you have an unusual medical problem and you want to visit a bevy of specialists. Most people would rely on their primary care doc to coordinate this, but some folks will go off on their own based on their own research. Because different medical systems and different offices use different record keeping systems, each doc has no idea what the last one did.

Frequently, a patient will come to me with a folder full of results, many of which duplicate tests I’ve already done. Even emergency departments rarely contact the patient’s doctor to see what’s been done recently. Services are regularly duplicated.

The government has been pushing for the adoption of electronic medical records (EMRs), paying incentives, but eventually collecting penalties for offices that stick with pen and paper. There are a lot of pluses to EMRs, but prevention of redundant services isn’t yet one of them.

You see, my office may choose one company, the nearby hospital another, and none of these systems talk to each other. There’s a lot of competition in the EMR marketplace, which is good, but it means that one of EMRs most important features—improving communication between providers and preventing duplicate services—isn’t going to happen.

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  1. SurgPA

     /  November 15, 2012

    You have two topics here that both deserve much greater national discussion; the true state of EMR usage and cost-transparency&market economics applied to healthcare. I’ll add my two cents to the former.

    “You see, my office may choose one company, the nearby hospital another, and none of these systems talk to each other.”
    It’s worse than that. My clinic recently adopted Epic systems as our EMR, abandoning an old home-grown system. Our local hospital – a separate organization (where we do 95% of our surgeries and 50% of our inpatient care) – also utilizes Epic for both inpatient and outpatient services. And yet our two Epic EMRs don’t communicate. I understand HIPPA issues, but there needs to be a national standard database format to facilitate transfer of records electronically. Ironically, many of our patients believe this already occurs and are frustrated that it doesn’t/can’t. As I see it, two of the main benefits of EMR are instant intercommunicability and the ability to data-mine for population-based statistical analysis. Unless we can get our EMRs out of their silos, we’re missing out on the true benefit. (ok, really, we need a unified national database, but the libertarian government-is-bad streak in this country will prevent this for the foreseeable future.)

  2. Old Geezer

     /  November 15, 2012

    @SurgPA, the problem is even worse than you describe. What you describe is similar to what I was discussing with my wife the other day; that two people can sit down next to each other, each on his own computer, and not be able to communicate because one has a P.C and the other an Apple product. It is as if you and I could not drive down the same roads because the one’s designed for Ford products could not accommodate cars from GM. We would simply not have put up with that for very long.

    I agree that here is a place where government could set a standard, but I despair when I’m told that the Census Bureau has the 1970 Census data all on tape, but does not possess any machine that can read these tapes. If the government can’t keep track of its own I.T. issues, how are we to rely upon it to help us with ours?

  3. DLC

     /  November 17, 2012

    consider this: recently I had a birthday. in honour of same, my state’s medicaid provider left a message on my voicemail that I should seek a colonoscopy for colon cancer screening. If I had been living in the USA as envisioned by some, I would not have had medical insurance and so would not have gotten that warning. Nor would I have been able to afford the colonoscopy itself. Instead, I would have had to wait until symptoms presented for CRC. Which, as we all know, would have been too late for a happy outcome. So. no medicaid, no cancer screening, no DLC to post happy messages here. I’m keeping my fingers crossed over the colonoscopy, which is to take place next week. not looking forward to it, but looking with hope toward hearing “you’re in the clear”. If it isn’t, then I’ll have to deal with that as it comes. but at least I’ll know.

    • DLC

       /  November 21, 2012

      Just a note for the curious. the colonoscopy went okay. no polyps or tumors, no biopsies needed.

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