Today healthcare has such narrow goals such as improving access to care, containing costs, and boosting profits. These goals are misaligned with the interests of patients because they mainly focus on increasing the volume of services, not delivering good outcomes. Well, I get why, as the pressure is on particularly for independent hospitals who primarily serves those that are on Medicare and Medicaid, which reimburse a fraction of what private level insurance pays. 

It goes back to continuity of care. This is a process in which a patient is led by a comprehensive team that is consistently involved. The primary care physician (PCP) becomes the central point of care management and communication. There are several studies done to prove that this concept increases the quality of care. Think about it, if you saw the same doctor all the time, it would allow them to accumulate knowledge of your history over time. We lack PCPs; we need to recruit more PCPs because they are the “healthcare organizers.”

Healthcare systems are terrible at working together and forming centralized care. Fragmentation is one of the biggest reasons patients fall through the cracks and don’t get the care they deserve. For example, a patient comes through an ER at a rural hospital complaining of chest discomfort and mild anxiety. EKG, labs, and other diagnostic testing confirm a myocardial infarction (MI). The patient is prepped for the cath lab; however, the patient’s regular cardiologist doesn’t have privileges to perform the catheterization. Plus, the patient has significant kidney disease and is being seen by a nephrologist, who also doesn’t have privileges. It is noted that the patient sees over eight different doctors who are from three various health care networks. This is not integrated care; all portions of care are done in several other locations caring for the patient in a silo manner. This causes duplications in care, delays, and communication errors. In this scenario, no one is measuring progress, timelines, costs, or quality of care.

The current payment module doesn’t work. A bundled approach focuses on patient outcomes, not the number of services. Just because you are receiving more services doesn’t necessarily mean you are receiving good care. With this module, patients are only required to pay a lump sum to a healthcare provider, making it vital for providers to fine-tune the actual care needed and total cost of care. These bundle payments reduce costs for the payer and provider. This module strives to improve patient outcomes, which prevents further patient complications and litigation issues.

It’s hard to believe that the healthcare sector can get away with not being transparent when it comes to pricing.  I have to ask where the Federal Trade Commission (FTC) is? After all, it is their job to protect consumers.  I don’t know of any other sector that doesn’t have to show a price for a product or service before purchasing.  So, why does the healthcare sector continue to get away with it?  Informed consumers make better decisions.  It gives patients the ability to shop around for the best price.  No different if you were shopping for a car.  Numerous studies show variation in prices for the same procedure, even by the same physician.  For example, an appendectomy in Ohio varies from $12,704 to $47,884, depending on the hospital. So, what is a fair price? Without a regulated price system, this will continue to happen.

Procurement practices such as Pharmacy Benefit Managers (PBMs) to Group Purchasing Organizations (GPOs) are utilized by most American hospitals to help lower product prices, though the data suggests something else. In particular, GPOs have estimated inflating healthcare costs by $37.5 billion, including $17.3 billion for government payments for Medicaid and Medicare. These “pay to play” costs basically fall back on patients and taxpayers.

The culture of “wellness” emphasizes screenings. You would assume that is a good thing. However, beware of screenings that fish for disease as collateral damage. It is sometimes referred to as “predatory screening.”  Routine screening for asymptomatic patients is medically unnecessary. Dr. Martin Makary, in his book called “The Price We Pay,” talks about this exact phenomenon. Money driven clinicians perform and order unnecessary procedures that don’t move the needle on the patients’ health, such as bone screenings before the age of 65, stenting and ballooning leg vessels, EKGs for low-risk patients, and the list goes on. These low-value medical services make up $101.2 billion of our healthcare expenditures every year.

Lawsuits are common in the healthcare sector. Anytime a medical company or hospital is sued, the cost gets defrayed to patients. It’s no different than if wages go up; costs eventually trickle down to consumers. That is why tort reform has the potential to reduce health care costs. Reducing the number of malpractice claims, limiting malpractice awards, screening cases before they go to trial, plus reducing defensive medicine where physicians order testing and treatment to safeguard against medical malpractice are all potential options. This could be a slippery slope because how do you protect patients from negligence?

Medicine is altruistic in nature. Those who choose this career path want to serve without excess expectations. It traces its roots back to the Hippocratic Oath. Take Jonas Salk, he invented the polio vaccine. You see, he did not patent his vaccine. It was calculated to be worth $7 billion. Salk believed the vaccine belonged to society. He didn’t consider profiting from the vaccine, his sole purpose for creating it was to reduce the risk of contracting the virus by disseminating the vaccine as widely as possible. Unfortunately, modern medicine shows that altruism in medicine is declining, maybe even dying. For Salk, the pay wasn’t the motivator; it was the people.

You also must take into consideration personal accountability. Society is not a very healthy one; COVID-19 exploited that. 50% of the US population has a chronic illness, equating to 86% of our healthcare costs. When you look at these disease processes, most of them are preventable. It all goes back to the basics of eating right and getting enough exercise. Take-out, processed foods, and liquid sugar continue to plague and are just as addicting as any opioid substance. It takes discipline to want to take care of oneself. Of course, no one likes to hear this; they would rather go to the doctor and get a cholesterol drug to lower their LDL versus taking steps to eat better and exercise. We live for the easy life. It’s not very often you hear a doctor tell a patient to lose weight. You see, that doesn’t make for a very good patient experience. Patients get irritated and find it offensive, so most physicians avoid the topic.  

The list goes on, but there are many fingers to point at, as you can see. The first step is acknowledging the problems. Then we need to prioritize where to start and a big step is knowing that we need to support health, not just healthcare. Stop incentivizing behaviors that draw poor outcomes. We need to get back to the mission of healthcare which is to improve the health of society; then we can get rid of all the wasteful spending.