Skip to main content

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.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting it for tr

Old Fangak, South Sudan--Bedside Ultrasound and other stuff

I just got back from a couple of weeks in Old Fangak, a community of people living by the Zaraf River in South Sudan. It's normally a small community, with an open market and people who live by raising cows, trading on the river, fishing and gardening. Now there are tens of thousands of people there, still displaced from their homes by the civil war which has gone on intermittently for decades. There are even more people now than there were last year. There is a hospital in Old Fangak, which is run by Jill Seaman, one of the founders of Sudan Medical relief and a fierce advocate for treatment of various horrible and neglected tropical diseases, along with some very skilled and committed local clinical officers and nurses and a contingent of doctors, nurses and support staff from Medecins Sans Frontieres (Doctors Without Borders, also known as MSF) who have been helping out for a little over a year. The hospital attempts to do a lot with a little, and treats all who present ther