THIS AGAIN?


Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care.  As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.

Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.

As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that  surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.

No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.

GIVE ME ONE HOSPITAL BILL PLEASE.


A funny thing happened on my way to pay a medical bill. I have paid the same medical bill twice and as such have decided to not pay any bill until I get the second notice. So a few day ago I decided to pay the latest bill in the hospital instead of mailing a check to the billing company out-of-state. After much effort I found the correct billing office and presented my bill. I them got what I thought at first was a pleasant surprise. The clerk told me that she did not see a balance owed in the system. She repeated “You do not owe anything on this account”. I was perplexed since the bill I had in hand clearly stated that I owed a significant outstanding balance. As I left the office I began to wonder how many times this situation occurs. What would have happened if I had mailed a check to the out-of-State billing company? How many bills have I paid that were in a similar situation?

This experience has allowed me to revisit an idea that I have expressed to others in the medical community before. I would like to see the morass of medical bills be corralled and only one bill be sent to the patient. Broadly this is how I see it working:
a. all bills are processed by each provider or facility within 20 days of discharge of services,
b. all bills are presented to central biller within 30 days of discharge of patient,
c. one bill presented to patient within 60 days of discharge,
d. all patients have 30 days from receipt of bill to arrange payment.