Healthcare costs and billing

Clearly, the fee-for-service system of physician payment is disastrous. It encourages expensive overuse, over-billing, longer hospital stays, repeat hospital admissions, and fraud. In both the Medicare and private systems.

By Jack E. Lohman

There must be a better way, but as the Boston Globe points out, it may not be “pay-for-performance.”

Surely when an institution performs poorly, more education and training is warranted. But when performance is low, the question was asked “do we then cut resources,” when more resources may be what they need.

I don’t know that answer and will leave it to the experts. Perhaps other penalties can be applied later.

But a national patient database is needed now!

We’ll either do it right away, as we should, or we’ll do it twenty years from now after all of the interested parties admit that we should have done it twenty years earlier.

But here we have it; a free-market mentality. Hundreds of software houses are developing database solutions to sell to hospitals and clinics, and they are all doing it “their way.” And some hospitals are doing their own thing with their own software people.

The problem is, NONE of the private systems will be compatible (though some database requirements do exist).

Imagine this…

Whether we have national healthcare or not, we at least need a national patient database. Actually, we have the start of one already. It’s the VA Medical System’s VistA database system. The VA doctors use it and love it. And it was developed with taxpayer funds and it is free for the asking.

So IF we were smart, our government would expand and designate VistA as our national patient database.

  1. NO patient names, SSI numbers, addresses or phone numbers. ONLY a dual-password for security purposes.
  2. Retina scans and fingerprints for ID in case of unconscious patient, recorded on ID card
  3. When visiting a doctor or hospital, ALL drugs and medical treatments and diagnoses are input to the system.
  4. Doctors can look up a patient’s history and see all diagnoses, drugs and medical treatments and surgeries
  5. Access all info via Internet from anywhere in the world
  6. Alert on overuse of drugs and drug reactions, and watch for fraud

But doctors can learn from it too…

  1. See how other doctors have treated similar diseases, and their successes
  2. Will lead to better medical care, comparing other doctor’s care
  3. See other doctors usage and success with various drugs
  4. Alert on bad drug usage, interactions and side effects

And for patients looking for a good doctor…

  1. Compare doctor’s specialties and success rates
  2. Compare feedback from other (confidential) patients, see who is highly rated
  3. Will create competition and individual incentives
  4. Allow nurse confidential judging of physicians

One Response to Healthcare costs and billing

  1. Worse about pay-for-performance is that doctors will be incentivized to NOT take difficult patients that have a low chance of correction. The BEST system is salaried physicians, like the Cleveland Clinic and VA Hospital. Or socialized medicine, but we are programmed not to want to go there.

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