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Thursday, April 29, 2010

What the health care reform bill is actually doing

Lately I have been attending various administration level functions at our hospital, as the doctor who has ideas about reducing costs.  I suspected, when I began rabble rousing, that the hospital administration would passively or even actively oppose open discussion of where money was being wasted, since most of that wasted money seemed to go directly into the hospital's accounts.  Apparently the hospital associations have been reading the writing on the wall for some time, and have realized that there will be cuts in their revenue. The administration was already interested in cost transparency when I began to push for it, and the CEO as well as members of the board have been very receptive to various ideas that would improve quality and efficiency, even to the point of considering options for providing a health care package to our whole community.

In a meeting lately, a representative of the corporation that owns our hospital spoke, during a talk I gave, on the corporation's efforts to understand the provisions of the bill and prepare for the impact on hospital functions.  The lawyers don't really understand it all yet, but are working hard to see which pilot programs we would be eligible for, and where we need to tighten up with regard to quality and spending.

Recently I got two letters from different insurance companies, one a government payer, one a private payer, about their new plans for requiring certain information from doctors before approving non-emergency imaging procedures, such as cat scans and MRIs.  The radiology department itself hopes to make these unnecessary by policing the appropriate use of these tests to avoid duplications and excess radiation exposure.

Are all of these changes mandated by the health care reform bill? No, not at all. Were they ongoing before the discussion of reform began? No, certainly not in my awareness.

I am coming to the conclusion that the entire painful process of debate, public protests, political grandstanding and eventual passage of a flawed and ridiculously long and complex bill has had some profoundly positive consequences.  Doctors, who have frustrated me by their apparent lack of engagement with this whole process, have been bombarded with the issues in the media for months. They can't help but realize that cost and waste and lack of transparency are issues. Realizing this cannot help but influence their conversations with patients and their practice styles. Because the bill is long and hard to comprehend, doctors and hospitals are projecting all of the problems of our health care system on the bill, and are attempting to solve problems that have either not been solved by the bill, or in some cases, not even addressed.

Because so much that we do in medicine carries a high pricetag, even small changes in the efficiency of our practice will result in huge dollar savings. I would not be at all surprised to find that in a few years the estimates of savings from the congressional budget office significantly underestimate the savings we actually see.

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