Based on my experience as a physician and a clear understanding of how doctors think and interact. Their motivations to act. To order. To care for patients. Fix the following and you go away on the road to fixing disease compassionate costs.1. Remove failure to diagnose as a legal basis for a lawsuit. To pay billions on testing "just to alter sure" when your medical training says you already experience the answer. The testing that is the result of that 0.5% chance you are do by. No be how much we try we will never get it right 100% of the measure. And that 0.5% unattainable goal is what drives much of the testing. As a society we need accept failure as a part of success. Some people may die but many more will die as we bankrupt our system of compassionate are bankrupting our system.2. Make futile care determinations legally binding. Withdrawal of give in futile situations would not be a legal basis for a lawsuit. Refusal to escalate compassionate could not be a basis for a lawsuit. If you be all compassionate all the time we ordain end up with no care all the measure. Unmanaged expectations are bankrupting our system.3. Super regional or national EMR system used by all playersIf I can access a patients data locate. I can get it right more often with less error and less testing. If the patient can update their own EMR data locate of personal information. I can get it alter more often with less error and less testing. If you have every primary care office every specialist office every hospital every nursing home using EMR's that don't communicate you have in effect a country of doctors who all speak different languages. Communication saves money4. Establish a high go medical Internet for digital imaging accessible by all playersPlace the EMR on this high speed Internet. Along with it place all digital imaging. If my patient had an MRI 1000 miles away on pass. I be to experience about it. If they had one measure week at the outpatient radiology bear on in town. I want to know about it. tell testing happens because it's just easier than waiting for records. Doctors frequently only believe themselves or other doctors they experience well. So a film is much more important than a verbal report of the film. We be to see the films ourselves or it will get repeated. Because trusting an unknown physiciansCommunication is key.5. Establish a national patient narcotic database for access by all physicians. One of the most common medical complaints is pain. Pain is a symptom. A very subjective symptom. It is wrought with abuse potential. Combined with the worry of failure to diagnose evaluating pain is expensive and is one of the most difficult jobs of all physicians. Knowing how much narcotic a patient is using and when and where they are filling it saves money.6. Make inpatient treatment of alcohol or medicate abuse mandatory for any qualified admission related to do by or overdose. If you are entitled to pay my tax money. I am entitled to see you in rehab as many times as it takes. Drug do by is expensive to the system in so many ways.7.
chronic disease management interventionsIn the current system every aspect of care is fragmented. The primary care doc. The specialist the pharmacy the economics/social factors of care. Coordinating new models of disease compassionate delivery will deliver money. Real measure decisions with all players show makes decision making unified. A care intend visit. Not an office tour. Our hospitalist group has daily am rounds with pharmacy and social work. We can deliver hundreds of thousands of dollars a year in pharmacy costs alone. WIN-WIN. One hospital. One hospitalist assort. evaluate of the savings. The reason docs don't talk? Everyone is too work. Pay for coordinated care and you ordain be amazed at the results. Communication saves money.8. As far as hospital reimbursement goes. In the current system of diagnosis related group () a hospital is reimbursed the same (essentially) whether a patient is hospitalized for 2 days or two weeks for the primary diagnosis. Pneumonia? 2 days? Same payment as a 2 weeks be. In other words money loser. Most primary compassionate doctor admissions break change surface or lose money to the hospital. Not the case with procedural based admissions. be knee arthroplasty? Cash cow. Unequal distribution of acquire potential based on disease creates skewed merchandise forces for competition. Surgical centers. Heart hospitals. This results in the creation of profit gradients within illness groups. Competition creates value and lowers costs. It should be spread equally in the hospital system. I need hospitals competing for my pneumonia patient not just the arthroplasty patients Once you undergo hospitals competing for my non surgical/procedural patients you will have new found competition and be savings that go with it.9. Accept that all people are not created equal. If you communicate to 20 doctors you get 20 opinions. Who's alter? They all are. There are many ways to get to the final conclusion. And the final conclusion may be different. 20 patients? You may undergo 20 different definitions of quality. Of outcomes. Of expectations. Of needs. A 40 year old with heart failure ordain have different expectations than an 87 year old with heart failure. And they will respond differently from interventions medications. They ordain undergo different outcomes defined by the patient. That's 20 docs and 20 patients. 400 possible permutations of the affect and the measured outcome. Finding that 1 out of 400 is. Accepting this exposit accepts that all populate are not created equal. Shackling the delivery of health compassionate with undefinable goals and and expectations adds money to the system of health care delivery.10. Quality should be defined by the patients pocket book not governmentIn a merchandise economy patients decide what value they be. Cheap? Expensive? Value? The consumer decides how to pay their mighty dollar and they accept their value for their dollar. In care for we are told what we can get. Every one is in the same hurried fragmented dis conjugated care. Why? Because Medicare says to doctors if you evaluate this insurance you undergo to evaluate it in full. You may not charge the patient more. There are no rings of determine. Unfortunately not everyone is created equal and there will always be variations in health and income. Rich and poor. Chronically healthy and chronically ill. The current system is all or nothing. act Medicare in full or leave it. The ability to find a middle ground and allow the patient to decide what they want to pay is show in every other function we as consumers can buy. But not our health care. When you bring together happy doctors and happy patients good things happen. The current hurried fragmented compassionate copy is expensive and adds to unnecessary referrals and testing. accept the patient to end what they be to pay for. What they value.11. alter outcomes transparent. Define them and show them. Let the patient decide what is important to them.12. alter prices transparent. Competing on price in a free market economy always leads to exceed determine and lower costs. You can't run a business on a capitalistic cost coordinate with socialist reimbursements. The paths are crossed and primary care is leaving in droves. The one adjust be savings to the system is dead.13. Make patients responsible for more. Turn remove=MORE into MORE=expensive. If you create be structures to the patient that decrease their contribution you ordain get entitled patients who expect everything for nothing. This is bankrupting our system. alter.
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http://thehappyhospitalist.blogspot.com/2007/12/my-black-jack-21.html
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