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Monday, November 30, 2009

Framing a conference on making health care affordable

Tomorrow will be my first attempt at bringing the health care providers from my community together to discuss how we can change our practices to make health care more affordable.

I approach it with some level of trepidation due to the fact that doctors can be pretty defensive about change. Nevertheless in many one on one conversations I’ve noticed that all of us are to some extent disgusted by how much health care costs, and by the fact that this means that many people don’t have access to good care.

So what will I say to a group of internists, nurses, family practitioners, radiologists, orthpedists and surgeons (if they show up)?

I hope that it won’t be me talking at them, since I already know what I think. But I will have to get the whole thing rolling.

I am co-facilitating this with a radiologist who is motivated to change our doctors’ ordering habits for radiological procedures so they are at least ordering the right tests and not repeating tests unnecessarily.

I intend to say:

I’ve talked to many of you over the last months about the costs of health care. I’ve been doing thinking and research on the subject, and I think that, although we do a god job with our patients, the whole process costs way too much. Some of that is because we order too many tests when we are busy or because we are worried about malpractice, and some of it is because there are so many demands on doctors that we have trouble organizing our efforts. Many of us have adopted computerized medical records, and though they improve the quality of followup and documentation, they are sometimes distracting, and slow us down and focus us away from our patients. Technology and pharmaceuticals have exploded since most of us finished our training, and it is hard to keep track of which medications or procedures are really worth the time and expense.

The result of these factors is that our patients end up going to emergency rooms or quick care offices for things that could be better handled by their primary care doctors, and end up with testing that is expensive, and often unnecessary. We spend much of our time keeping track of preventive medicine recommendations and being glorified record keepers and ineffective nags in the service of smoking cessation, weight loss, colonoscopies, mammograms, pap smears and other preventive strategies.

We have very little knowledge of what the things we order cost our patients, and so they end up with huge bills that often profoundly affect their finances and so their overall social health.

There has been much talk about health care reform, and I have paid attention to a good bit of it. What I see is that legislators have lots of ideas for improving access, though they don’t necessarily agree with each other, but they really do not know how to address reducing costs, which is the basis for most of the debate. In some ways this is good. If legislators make rules to reduce medical costs, they are liable to be rules that don’t make sense from our standpoint. I think reducing costs is something that we, as providers, can do best. There are limitations to what we can do as a small community, but this is our community and it is a place to start.

What I would like to do today is sit together and talk about what we do that is effective in our practices, and what things we see happening, or do ourselves, that contribute to the high cost of health care. I would like for us to come up with some concrete ideas for ways to improve our efficiency, our and our patients’ well being and move medicine in the direction we want to see it take.

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