Starve a doctor and pay more for less effective and wasteful healthcare. Check out this NY Times op-ed piece.

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Starve a doctor and pay more for less effective and wasteful healthcare. Check out this NY Times op-ed piece. For many years I have been saying that the insurance carriers with their constant whittling down or physician payments were doing a disservice to us that would cost us much more than we ever dreamed of. Most new outlets echo the same nonsense, blaming the big pharma, physicians, fee for service, etc. for the cost of care. Of course, there are other cost drivers however, the insurance industry has helped medicine in the United States become very expensive by not allowing first contact providers such as your family doctor to be able to do their job by making it impossible to spend more time with patients that need it. Some examples of this are; Hospitalist: Doctors that visit you in the hospital instead of your doctor visiting you, at roughly 3x the cost. If you have wondered how this works, ask your family doctor who may complain that they communicate poorly with him and add little value to your stay or comfort, since we would rather see our doctors visiting us instead. Years ago, insurance carrier stopped paying your doctor to make those visits. The 10 minute office visit: There was a time when your family doctor saw their job as the person who spends time talking with you and doing your work-up to determine your problem and the appropriate path. In today's world, your doctor likely talks to a screen rather than you and is referring you to doctors who look at your parts, rather than you and run expensive tests which most often are expensive and negative. Your doctor does not want to do this, they just cannot afford to spend more time or they will go out of business since they used to be well compensated for their time which was used to pay their staff, overhead and salary. This is a huge cost driver. The rise of surgicenters: Doctors such as gastroenterologists have developed surgicenters, since they get ridiculous facility fees, yet they are paid so poorly for procedures such as a colonoscopy. In the end, this insurance idea has us paying more for the care than we would have paid years ago when the healthcare provider was adequately reimbursed. In the chiropractic world: Doctors of chiropractic are constantly discounted by plans that are paying less than they did 12 years ago and every year, they look for additional cuts in reimbursement. Most chiropractors are working longer, seeing more patients and unfortunately, some have cut corners as they are paid less, which in the end results in less effective care. In NY, some plans such as GHI were paying chiropractors and other specialists as low $27 for a visit, which resulted in high volume, low effectiveness care and corners being cut. Of course, there are many other examples however, if we can move the model back 40 years, we would have a more effective and less expensive healthcare model that was more personalized. A good start would be to go to a Medicare like model (of course, some will be yelling choice and other slogans, but when I renewed my insurance under Obamacare, I was left with few good choices that were all at prices that were obscene) which would simplify access to medical doctor since there is only one network, and allow the insurance carriers to sell Medigap for those who want to purchase it. We have those systems in place, your deductible would be much lower, doctors would face one payer and you would have great interstate access, while the ability to negotiate with vendors and hospitals is known to be greater. Anyway, check out this doctors essay SANDEEP JAUHAR  

OF all the ways to limit health care costs, perhaps none is as popular as cutting payments to doctors. In recent years payment cuts have resulted in a sharp downturn in revenue for many hospitals and private practices. What this has meant for most physicians is that in order to maintain their income, they've had to see more patients. When you reduce the volume of air per breath, the only way to maintain ventilation is to breathe faster.

As our workdays have gotten busier, we doctors have had less time to devote to individual patients. An internist I know in private practice used to see 15 patients a day. "Now reimbursement is so low I have to see at least 30," he told me. "If I stay in the room more than 10 minutes, my assistant will call me and tell me to hurry up."

Racing through patient encounters, we practice with an ever-present fear that we will miss something, hurt someone and open ourselves up to legal (not to mention moral) liability. To cope with the anxiety, we start to call in experts for problems that perhaps we could handle ourselves if we had more time to think through a case. The specialists, in turn, order more tests, scans and the like.

And therein lies the sad irony of the health cost containment paradigm in this country. There is no more wasteful entity in medicine than a rushed doctor.

The Institute of Medicine, a federally funded research group in Washington, has estimated that wasteful health care spending — i.e., spending that does not improve health outcomes — costs about $750 billion in the United States every year. Excessive paperwork and administrative costs explain some of this waste, but unnecessary or inefficiently delivered services, especially in hospitals, account for by far the largest chunk. Total payments to physicians, in comparison, are much smaller, making up a fifth or less of the money this country spends on health care.

But even though physicians' salaries account for a relatively small fraction of health care costs, physicians' decisions may affect upward of 80 percent of total health spending. We order tests, prescribe drugs, hospitalize patients and — one of the costliest decisions a doctor can make today — call specialists for help.

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