Stanley Feld M.D.,FACP,MACE
The problem is the government can not do it. It is up to us the consumers and electorate to force the legacy systems to change. Alvin and Heidi Toffler’s book Revolutionary Wealth sums it.
In the section on Inertia vs. Hyper speed they say, “As we look at our institutions and how they interact it becomes clear that what America confronts today is not simply a runaway acceleration of change but a significant mismatch between the demands of a fast growing new economy and the inertia of the institutional structures of the old society.”
I think of the government, the insurance industry, the hospitals, big Parma, all facilitator stakeholders as the old society and physicians and medical researchers as the new society.
“Can a hyper speed 21st century information/biological economy continue to advance or will societies slow paced malfunctioning obsolete institutions grind its progress to a halt. Bureaucracy, clogged courts, legislative myopia, pathological incrementalism can not but take their toll.
Something, it would appear would have to give. Few problems will prove more challenging than the growing systemic dysfunction of so many related but desynchronized institutions.”
Why doesn’t the healthcare system do something about the obvious things? They do not do anything about the obvious because the obvious is counter to ossified dysfunctional facilitator stakeholders’ vested interests. The complications of chronic disease are the biggest cost to the healthcare system. Why doesn’t the government mandate payment for systems of care for the complications of chronic disease and the prevention of the onset of chronic disease.
Rather than do something to prevent the complications of chronic disease, these institutions block the innovative progress of the advances in the use of informational and biological technologies. In fact, they punish medical innovation with non payment.
The following are two of hundreds of simple examples to illustrate the point.
Osteoporosis is a chronic, silent debilitating disease that severely reduces quality of life after osteoporotic fractures occur. Only 30% of people eligible for Bone Mineral Density testing presently receive Bone Density testing. We have to do better. Medicare does not pay for Bone Density testing of men. Just as many men have osteoporosis after age 70 as women. Our system waits around until they have a hip fracture. Prevention is cure in osteoporosis. The complications of osteoporosis cost the healthcare system $20 billion dollars per year. Early detection is essential. The mismatch between legacy institutions and science is clear. The government and private insurance institutions are discouraging systems of care for osteoporosis by decreasing the compensation for bone density testing by 75% in the next three years. As soon as these plans were announced the sale of Bone Density machines fell dramatically. The government even found an expert witness to say that Americans’ do not live any longer than people in other country even with our technology. A generalization out of context and unrelated to osteoporosis. The implication is technological advances do not help us save or live better lives.This is disinformation at its best. Apparently, the legacy institutions do not realize that consumers are smarter than they think. With the help of the internet consumers will be able to cut through this disinformation.
Important advances have been developed that have been under utilized or over penalized. The old institutions have not caught up with the speed of info-biological advances.
Another stunning example is that companies have created devices to monitor patients’ vital signs, function and movements at home that can be transmitted electronically to the doctors office in real time. This is a very exciting concept. Not only can people live in their homes longer as they get older, they can be monitored and treated either on the phone or on the internet by their physician in real time. The physician could use his medical judgment to alter medication to avoid congestive heart failure or impending complications of lung disease. This simple act could avoid many emergency room visits and hospitalizations as well as increase the quality of life of the patients suffering from these chronic diseases.
The government and the insurance industry pay home healthcare agencies to collect this data but do not pay the physicians for interpreting the data. As a result this innovative approach to disease management has been underutilized.
In 2001 The American Medical Association (AMA)/ Specialty Society RVS Update Committee (RUC) commented to CMS. CMS had specified that it would consider comments on the Clinical Practice Expert Panel data, the physician self-referral designated health services, and the interim RVUs for selected procedure codes identified in Addendum C. namely payment code (CPT) 99091, a code for reimbursement for physician interpretation of patients collected data. Medicare considered these extra telephone or email interpretations (consultations) as being part of the previous office visit and did not publish the code or reimbursement schedule for non face to face consultation. Finally, in 2007 they published the code but not a payment schedule. Therefore, each consultation for the physician’s opinion requires an office visit. Lawyers and other consultants charge for telephone advise routinely.
The antiquated mentality of the government and the insurance industry is not only costly to the healthcare system, it has discouraged the development of innovative telemedicine. Telemedicine is a valuable technological tool that is slowly appearing in the healthcare system. It can dramatically improve the quality of care and decrease the cost to the healthcare system. What more could a person with head trauma in a distant place want than an expert reading his MRI at 3 a.m. and recommending immediate action.
“Something, it would appear will have to give. Few problems will prove more challenging than the growing systemic, desynchronized institutions. If Americans want the enormous benefits of a worlds’ leading economy the United States will have to root out, replace, or radically restructure its legacy institutions which stand in the way. As change accelerates further institutional crisis will not be limited to the United States.
Some countries my find the threat more difficult than the United States whose culture at least smiles on change makers.”
Consumers are not only smiling on the need for a change in the culture in medicine and the healthcare system. They are fed up with the facilitator stakeholders’ holding them and their healthcare dollar hostage. They are demanding change. All they need is a Pied Piper. Well, the leaders are in your midst, all they need is a posse. You can sign up for my posse at firstname.lastname@example.org. You will receive your official membership card like a Captain Midnight ring.