In an op-ed in USA Today physician Marty Makary makes the counter-intuitive assertion that there’s too much health care in the United States:
The study by Washington physicians is part of a broader movement of physicians. In fact, their findings are consistent with research my Johns Hopkins colleagues and I conducted. We asked over 2,000 physicians across the U.S., how prevalent is over-treatment (excluding the respondent’s own practice)? On average, the doctors said that 21% of medical care is unnecessary.
Breaking down the waste by type of medical care, they reported that 22% of prescription medications, 25% of medical tests and 11% of procedures are unnecessary. These findings validate previous estimates of the Institute of Medicine that suggest that nearly one-third of health care spending is wasted on clinical and administrative costs that do not result in better health for the American people.
Our present system pays for care not health. How big a surprise can it be that we’re getting more care including some that’s actually deleterious? Oft repeated: if you subsidize something you’ll get more of it.
Rather than considering the op-ed analytically, let me just make a few scattershot observations.
- I predicted that electronic medical recordkeeping would increase costs and that’s what has happened. Anyone who’d ever observed how a physician’s office actually functions could have told you that.
- The biggest problem with EMR is and always has been physician non-compliance.
- If you have to hire someone to follow a physician around and transcribe everything the physician does for entry into a computer, EMR can never save costs.
- The idea that Jeff Bezos, Warren Buffett, and Jamie Dimon can “fix health care” is fatuous.
- The best we can do is change the incentives and, unless you believe that everybody up and down the health care food chain is going to take a pay cut, even that won’t do much.
- The entire health care delivery system needs an overhaul and that will be fought tooth and nail by everyone who’s a part of that delivery system.
At the VA, it is not possible for anybody to avoid EMR, and nobody gets a helper. There is little paper, and there are no paper records. It would be nice if the vital signs equipment was connected electronically.
For those worried about vets getting freebies, there are multiple screens with enough drop-downs, checkboxes, and radio buttons to discourage most specialist referrals.
I have no idea of the cost savings if any, but the advantage is the integrated system. My medical records are available to anybody with the proper authorization – tests, notes, medications, etc.
For my wife’s Obamacare, I can pay online, but I do not have access to any billing/payment history.
Did I mention the VA website for re-ordering medications, secure email, lab test history, and appointments?
We are now up to 10 hospitals in our network, with a couple more on the way. I believe that we have a grand total of 5 physicians who have a scribe. I don’t EMRs are especially relevant to what you posted, but since you did choose them, I have decidedly mixed feelings. It doe slow things down sometimes. OTOH, I do a lot of urgent and emergent stuff. My patients in their 70s and 80s often don’t remember what meds they are taking and half of their history. The EMR has that. It also lets me data mine and find useful stuff. ( I have corrected several staff over the last few months on the overuse or under use of various drugs or procedures that I would not have known about absent the EMR. Of course (we have EPIC) the EPIC reports were useless but we have found an after market outfit that provides us useful data.
As to your cited article, I have noted many times that physician salaries need to be up for discussion just like everyone else’s, but how you cut that pay is very important. Just cut physician fees across the board and you may not see much decrease in overall spending.
Steve
As a patient, I find the rush to EMR has left physicians, etc with less time to listen as they click thru the punch list that comprises a medical history now.
Unneeded tests, procedures, yep does happen sometimes its seems profit motivated other times seems to be a way of keeping patients happy. How to fix those factors shrug.
Lets also remember the military’s medical system, Indian Health Service, VA all use salaried medical staff, federal bid laws, formularies, practice guidelines etc and still have the same problems with cost as private practice. Maybe a closer look at the cost of medical supplies as well as pharma and fees.
While worrying about EMRs, which at least have some positives, there is tons of stuff going on like what is described at the link. Nearly every day now I make choices about interventions based upon what drugs (and fluids) are available, not necessarily what is best.
https://www.nakedcapitalism.com/2018/03/so-bad-the-doj-woke-up-saline-bag-makers-look-to-have-endangered-patients-via-illegal-tying-and-price-gouging.html
Steve
That’s what I mean by the incentives. Everybody’s incentives point them that way. Keeps the patients happy, the physicians’ billing up, the pharmaceutical companies and labs revenues up. What’s not to like?
Even the insurance companies are happy. Nowadays most “insurance companies” bear no risk. They’re administators who get a percentage of the amount processed as their fee.
How do we get out of this pit of “incentives” without climbing a ladder of bones?
Sounds like not only monopoly laws need to be enforced; but the US should make it a policy to fragment parts of the healthcare market. Maybe extra high tax rates on executive compensation in these companies.
I think it will take a long time and needs to be done gradually. We have several generations of health care providers who self-selected with certain assumptions that are not going to happen. Doing that will take determination from all parties and, frankly, I’m skeptical we can maintain that.
The greater likelihood is that we’ll just keep buying more health care than we can afford to the detriment of the balance of the economy and society. Your “ladder of bones” is more likely to happen if there’s some sort of catastrophe.
I’m a big believer in standards for a lot of things. A set “standard” for a medical record will not save the world, but it will make a lot of stuff simpler and easier which is good in its own right.