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Let the Light Shine

Posted June 1, 2013

Our healthcare system is enviable in many ways, the technology to diagnose and treat tragic injuries, surgical device innovations to make once deadly heart conditions treatable, and the ability to turn terminal cancer diagnoses into a chronic disease. Advances in medication therapy, immune therapy, and stem cells among other advancements have produced amazing positive outcomes for many patients. The price is not enviable-we spend more than any other industrial nation for the diagnosis and treatment of disease.

Many ask “Do we get what we pay for?” It is a real conundrum because more money does not equate to more medicine. And, more medicine does not translate to better care. We spend more but Americans do not live longer than those in other industrialized countries nor do we live better. In fact, an amazing 87% of our nation’s healthcare bill goes to the treatment of chronic conditions. However, our current healthcare system excels at the treatment of acute emergencies and does not fare as well helping those with chronic conditions to avoid becoming a patient for life.

We hear about the broken system when it comes to hospital-acquired infections. They affect over 2 million annually and kill over 100,000 each year. Preventable medical errors including medication errors are also deadly, one of the top five causes of death in the U.S. The side effects of properly prescribed medications are also often serious and even life-threatening. Death is listed in the Physicians Desk Reference as a side effect of certain medications.

Yet, the medical system is also broken financially. Many of us are hospitalized annually with no information about what it will cost me and/or my insurance company. After all, many of us have been culturally conditioned to believe the mentality of bill my insurance company.  

Why is this of interest to health-care consumers? It is clear many patients are treated on the basis of their insurance coverage limits rather than treated on the basis of what is best for their condition. Penn State research indicates that as much of 90% of what physicians order many strictly fall under the category of defensive medicine. That is, doctors soon learn to practice with the thought their medical decisions and recommendations may be scrutinized so over-diagnosing and over-treatment with all its inherent risks is a reality for today’s patients.

With government now paying for more than 50% of our nation’s healthcare bill, the Centers for Medicare and Medicaid Services now reveals the prices charged at 3,337 hospitals nationwide. The challenges for our nation’s hospitals are many. They include $41 billion in uncompensated care during 2011 alone. Hospitals deal with more than 1300 insurers each of which have different plans with multiple requirements for payment. Click to read further.

On the coin’s other side, the variation in prices for identical procedures is staggering. St. Bernard’s Medical Center in Jonesboro, AK charges $15524 for a spinal fusion. Temple University Medical Center in Philadelphia, PA charges $219273 for the identical surgery. Click Bills expose broken payment system USA Today 5/16/13 to read further. And published research over 5 years indicates that exercise can exceed surgery for a positive outcome at five years. The cost for exercise therapy is in the hundreds of dollars. Structural problems with one’s spine do not uniformly translate into functional problems.

Hip and pelvic fractures, common among our nation’s seniors, cost on average $3986 per patient per year at Wooster Community Hospital in Wooster, OH. The cost at Walnut Creek, CA located John Muir Medical Center is an amazing contrast. It is $64016 per patient per year. 40 states already require hospitals to publish charges but does any patient realize this or even care? Click here to read further

Yet, is it the role of government to highlight and address these astonishing differences in the cost of healthcare? Patients do not die more frequently at the hospitals that charge far less nor do they have a better outcome at the hospitals that charge much more. Clearly, government intervention in healthcare since the early 1960s has not had a positive effect on healthcare outcomes or costs.

Recently, research highlighted that hospitals and medicine in general make more money when complications occur. Simply, there is no incentive for medicine to change. After all, money drives the system. That is true for hospitals, for physicians, for labs, for medical device manufacturers, and for pharmaceutical companies. No one view success as “look at how little this cost and how little money we made from this patient’s care.”

If one has no skin in the game we may be destined to continue to do the same thing and expect a different result. Most medical costs are paid for by third parties. Hence, the patient is not motivated to know the price, shop for a bargain, and expect to get what they pay for. After all, that is the way capitalism works and exceeds, isn’t it? Dr. Regina Herzlinger at Harvard School of Economics has written several fascinating books on bringing market forces into medicine. Click here to read further.

Larger companies who have felt the pinch of healthcare costs have begun to negotiate with certain institutions to provide hip replacements for that firm’s staff. The same is true for back surgery, for heart surgery, and other commonly performed procedures. The results are dollars saved and better outcomes and hospitals even indicate they will not charge for care that results in complications.

Click here to read further.

The results tell us it is time to stand up to political correctness. Politicians afraid to risk votes of those who rely upon Medicare and/or Medicaid often turn a blind eye and a deaf ear to true reform. The truth is that neither Medicare nor Medicaid is financially sustainable. We may have no choice but to change. Unfortunately, many see the system in its last stages and seek to get theirs while the going is good. It won’t be easy and it won’t be fast but if we change the incentive from paying more for complications, i.e. a poor outcome, change is possible.