Where are your recommendations for the patient side of the equation. The patients have, within their power to do more about the cost of health care than all your recommendations put together.

Smoking, obesity and lack of physical exercise are directly responsible for almost ever one of the top ten reasons people are hospitalized in this country.

When was the last time you saw a 5 foot 8 cross country marathoner in the hospital for type II DM. Or COPD?

Having just seen an ER report on an assisted living patient transported to the ER for a asymptomatic hemorrhoid discovered by her aide during a bath, that even the patient knew “what it was,” I have my doubts that we will be able to reduce ER access in any fashion.

JCAHO and others are even encouraging such practices by requiring hospitals to set up “fast track” processes to take care of such non-emergencies.

In other communities, hospitals are advertising their ER’s for sore throats and other “grandmother would know how to take care of this” medical problems.

EMTALA and malpractice make it impractical to discourage such visits, and often the transportation (at least one way) is free!

Such factors make reducing the payment for such services the only deterrent, penalizing hospitals even further. I don’t see much incentive for patients not to abuse the ER under those constraints.

As for EMR and electronic record availability: I have my doubts that the referral centers will change their habit of finding locally produced studies, CT’s MRI’s, etc., to be sufficient, even if electronically available, when evaluating referred patients. I await such proof of reduced costs by electronic medical records, except in a budget limited system such as the VAH.

The reality is that some form of rationing, whether determined by physicians, fixed budget hospitals, or bureaucrats, will be needed to control health care costs in the future.

MEDPAC, by the way, just recommended to CMS that the equipment component of imaging payments now be based on 45 hours of use per week, rather than the previous 25. If enacted, that will result in a substantial reduction in Medicare payments for imaging in the next Medicare year.

Jim

“Now clearly, ER physicians have a high exposure to malpractice claims”

What is their exposure, either in general or relative to other types of physicians, and to what extent does additional testing reduce it? If that’s why they’re doing it, does anyone know if extra imaging actually works to reduce that exposure?

Specialist physicians want it this way. See my post at Emergency Physicians–When in doubt, they image

/Steven

I think that CT in the ED is an easy target; but is unlikely to make much of a dent in health care costs. I think the largest “misuse” or overuse of technology lies in the early adoption of new gadgets before there is good evidence behind them (CT angiography of cardiac vessels is a case in point) – which I think is basically your point about the adoption of new-fangled drugs.

Our Health Care System

The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:
The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
Our children.
Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget.
The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if they are numbered correctly to treat and restore others. Also, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today. Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely. It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible. Because the following needs to be corrected regarding the U.S. Health Care System:
Access- citizens do not have the right or ability to make use of this system as we should.
Efficiency- this system strives on creating much waste and expense as it possibly can.
Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp
Dan Abshear

Why do they always blame life expectancy and infant mortality on Healthcare when this should be weighed against lifestyle. We are an overweight out of shape reality TV watching mostly couch potato country. We eat crap food full of trans fats, MSG, high fructose corn syrup and all kinds of preservatives. Our food supply is poisoned with heavy metals, pesticides and hormones. Go to Europe they don’t watch TV they walk everywhere they eat a fresher lower fat diet (usually). Also we have a higher mortality rate because we have a higher murder rate and many more mothers addicted to drugs giving birth to babies addicted to crack or heroin.