Wednesday, September 23, 2009

"House" is Not Health Care Reform

I really like the TV show "House". I like the characters, and I like the medical conundrums. However, while we watch Dr. Greg House and his team try lots of treatment options to save the patient, we never see the patient and the family afterward going into bankruptcy to pay for all of the attention. 

 Health care is perhaps the only industry where the provider gets paid for poor quality. Almost no other service provider gets paid if the work is not good. The plumber doesn't if the pipes still leak. The car rental agency doesn't if the vehicle breaks down. The model agency doesn't if a male shows up for the bikini fashion shoot. Yet, if the health care professional treats a patient and it doesn't work, payment is still issued. And payment is issued for the next treatment. 

 I tried fighting a bill when a cast was put on my daughter's arm so poorly the circulation was cut off to her hand. She had to go to the Emergency Department, where the cast was cut off. Not only did the emergency bill get paid, but so did the original application of the cast. 

Health care would go out of business if it didn't get paid when the service was not satisfactory. A few years ago, the president of the Minnesota Medical Association admitted that a patient has a 50/50 chance of receiving satisfactory care. Only 25% of the care given is evidence-based; the rest is physician-preference, patient-preference or based on a need to utilize the "capacity" (e.g. the MRI machine). This is just one thing wrong with the health care industry. 

 While we enjoy a show like "House", please don't let them practice medicine on you like that. You'll go broke paying for all the attempts and failures. No wonder our costs are going up. Now, in defense of the medical profession, it's not many industries that have to put up with a customer who is also the supplier, albeit a supplier/customer who is not very often disclosing the specifications or "material" make-up of what the professionals has put before them. (The education industry is like this too.) There are few parallels in manufacturing, such as in contract manufacturing when the customer supplies the material and sometimes forgets to note all of the specifications of the end-product. Contract manufacturers, however, learn quickly and adapt their contract review practices quickly because...they don't get paid for the mistakes created before they learned their lesson. Perhaps physicians and others should not get paid while they're still learning from their mistakes. Hmmm, food for thought. Within the last year, Medicare has been refusing to pay for treatments on the wrong body part, or for treatments of an infection acquired while in the hospital. Bravo!

Added note in January 2021: in the last 6 months, a state Blue Cross Blue Shield (BCBS) group negotiated with one of the larger Upper Midwest hospital systems to discontinue 'pay for service' (like the example of paying for a bad cast over a broken limb) to paying for patient outcomes--"value-based payment" and "value-based care". The negotiations were described as difficult even though it was modeled on Kaiser Permanente system and is similar to one BCBS negotiated with a smaller hospital system in the same region. But it's a great start of aligning health care operations to be like the rest of many industries: you get paid when there's quality and timeliness, not just because you did the work.

No comments:

Post a Comment