The Daily

Our Healthcare System Is Getting Worse, Not Better

My blogs about Quality Fraud pick up items like the $54,000 Air Ambulance Ride and the $6,000 ER Visit Without Treatment.

For thirty years, our healthcare delivery systems have been changing dramatically and repeatedly. These changes were caused by two primary factors: the market and the law. In some instances, market changes caused a reaction by the Legislature. In others, the Legislature initiated changes (usually at the direction of the healthcare industry that funds political campaigns).

Whatever the cause, health care consumers and the Courts have been forced to adapt to the ever-changing healthcare delivery systems forced upon us by the market and the Legislature.

As an example, thousands of sick and disadvantaged Florida children lost their health care a couple of years back as a result of the State’s refusal to accept the Medicaid expansion. The refusal to get on board with the new health care plan has had disastrous effects in Florida for consumers and healthcare providers.[1]

Now, physician groups are suing to force the Government to continue payments under the ACA to cover $10B+ in risk adjustment payments. This is just one of the most glaring examples of how our healthcare is treated like a political football.

When we lurch from one healthcare system to another, patients across the State face consequential decisions. In the past, families wrestled with HMO’s and PPO’s (victims of the changing landscape preferred by the market and legislatures) with their restrictions on the ability to get timely referrals for specialist treatment when needed. In the recent past, there was also the problem of “pre-existing condition” exclusions in health insurance policies. If your health insurance carrier chose to deny payment of significant health expenses raising this exclusion, you were effectively uninsured. Millions of the sickest learned this lesson the hard way. It is no coincidence that uncovered medical expenses is the number one cause of bankruptcy in America.[2]

Without understanding the market in which you live and access health care, it is impossible to appreciate the value of the services being provided. This is why many people are worried when they become sick abroad or in a strange place. Your local healthcare market can feel the same if you do not appreciate the environment in which your providers are treating you.

In 2013, Time magazine published an important piece of journalism by Steve Brill on the opaque nature of the healthcare market, explaining in detail what makes it so inefficient.[3] The title of his piece “Why Medical Bills Are Killing Us”, begs the question – why don’t we know more about why?

This means understanding the nature of your hospital institutions and the doctors’ offices you frequent, as well as the doctors and other practitioners who work there. It also means appreciating their background, training, and experience; their compensation and incentives for performance; their history of potential misconduct or malpractice.

Surgery is a good example of the need to be pro-active in protecting your rights as a patient – to achieve a healthier and faster recovery. Before performing surgery, every hospital and doctor will require you to sign an informed consent sheet – frequently the first time a patient is formally faced with signing off their consent is in the operating room as the anesthesiologist hands them a waiver for signature. If you are lucky, there’s been a short conversation in the doctors’ office in the days leading up to surgery. However, most of these conversations are brief talks with a nurse and do not go into the detail of the doctors’ knowledge and experience with known complications and risks.

How informed is your consent? Do you know what the surgeon is charging? Do you know what medicines or anesthetic agents the anesthesiologist is using? Do you have an anesthesiologist or a nurse anesthetist administering your anesthesia? What about the infection rates at the Hospital? Have there been MRSA outbreaks at the hospital? Or the Day Surgery Center? How often do the most serious complications occur? Are you predisposed to any of them, making their occurrence more likely?

What happens should the worst occur? What resources are available to help you climb back to health? Are you limited to referrals your doctor is willing to make? Where are the resources to investigate the options on your own? Are they even publicly available?

 

[1]2013 effects: http://www.msnbc.com/rachel-maddow-show/rick-scotts-stunning-health-care-ruse-florida?cid=sm_fb_maddow;

2015 effects on children: http://health.wusf.usf.edu/post/9000-cut-childrens-medical-services#stream/0

Effect on HIV patients: http://www.miamiherald.com/news/local/community/gay-south-florida/article56255620.html

2016 Effect on Hospitals: http://www.miamiherald.com/news/health-care/article65202472.html#storylink=cpy

[2] http://www.cnbc.com/id/100840148

[3] http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

 

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