The Pulse July 2008

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The PULSE

Osteopathic Emergency Medicine Quarterly VOLUME XXXIII NO. 3

july 2008

Presidential Viewpoints Peter A. Bell, D.O., FACOEP

“What Do You Want: A Patchwork Quilt or a Well-Woven Blanket?"” In looking at our American healthcare system today, it is clear that there is much to be fixed. As a patient I’m not satisfied with the cost, the quality I get for the money, and the service! As a health care provider, I’m not satisfied with the reimbursement, the quality of care I’m expected to deliver (with diminishing resources), and the time I’m ‘allowed’ to spend with the patient. It seems like the system is slowly imploding for both the patient and the provider. This begs the question, what do I suggest we do? First, do we really have a ‘system’? What we have been calling a system is nothing more than successive ‘fixes’ to a public problem. In order for a country to grow, it needs people and an infrastructure. Items like food, housing, education, and healthcare are essential components for people if we are to build a sustainable infrastructure. In our country, we continue to struggle with this concept. As a result, we have pieced together our fixes into a patchwork quilt called American healthcare. Its components are irregular, diverse, ragged, and sometimes too specific, but despite adherence at the edges, poorly connected. For example, in an age of high technology, one would hope our communications would

bind the quilt together, but no! We now have to pursue Regional Health Information Organizations (RHIOs) so we can talk to each other. Redundancy and unnecessary testing reign supreme. We are deluged by paperwork as patients and providers. And to top it all off, the insurance companies and government spend more time trying not to pay, than solving the problem. What we need is a Health Care Policy for the nation. What we have is a continuing debate fueled by politicians seeking office, special interest groups (including physicians) pursuing their own agendas, and health care expenditures last year exceeding $2.2 Trillion dollars (The federal budget is about $3 Trillion dollars, the federal deficit over $9 Trillion dollars). We need to stop the rhetoric and seriously reconsider our priorities. As a patient and a provider it may seem like I have competing interests. I would argue that it has made me sensitive to both sides of the debate. Here is what I propose: I want a new American Health Care System. I want a well-woven blanket, not another patch. My system would address access. I would assure that sufficient numbers of primary care providers (doctors, PAs, NPs) were available to meet the current and future needs of the country. Everyone would have a “medical home” and all health care needs would be coordinated through this point of service 24/7 (and would provide medical care beyond the 9-5 paradigm). In

The PULSE JULY 2008

addition, I would support an emergency medical system that functions for true emergencies. Entry into this emergency system would occur as the result of mandatory training of all patients, and breaking the current practice of ‘just go to the ER’. (We train kids in our schools on drug avoidance, safe sex, fire drills, etc. Why not include proper use of the medical system?) All medical homes, ERs, and hospitals would have an integrated network of health care providers to choose from. No more shopping for a specialist, shipping patients out of the ER, or having a paucity of services. A financial re-structuring would take place. Like our colleagues in New Zealand, the new system would be funded as a no-fault, all payers plan. Money would come from employers and the general tax base (if you read my previous articles, you can follow the money). It would pay for providers, facilities, and unexpected/adverse outcomes (formerly known as malpractice). I would eliminate the National Practitioner Data Base and spend money on quality assurance. Negative trends would be met with education, re-training, assessment, and monitoring. A graduated physician is a terrible thing to waste! So lets not! Primary care would be the focus with dollars reimbursed for preventative healthcare. Payment of services would be tied to behavior by both the physician (ex. documented the need to stop smoking, continued on page 4


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The Pulse July 2008 by ACOEP - Issuu