The Healthcare System Disaster by an Anonymous Physician

This comes from a physician who prefers to remain anonymous.    It is his own diatribe against the healthcare system but because he is employed, he is afraid to leave his name because the high chance of retribution. I understand.  His points are right on the mark:

The healthcare system is a disaster and things will only get worse. Medicine is so backwards it may never get turned around. A healthcare provider can save 100 lives, have 1000 uneventful patient encounters but run into one patient having a bad day and it’s all over. The email chain of finger pointing begins. The analysis of the event goes on for weeks and weeks. At the end it is all because some patient didn’t get a Z-Pack. “My doctor usually gives me a Z-Pack so I won’t get bronchitis”.

What drives the healthcare system at the bottom is the common cold ($15B a year spent on visits and medications), seasonal allergies ($25B annually) and Google (de facto source of medical information for the common man). Patients go to their nearest quick care, walk-in or urgent care center for anything and everything. America is all about convenience, why not healthcare too?! There are urgencies that aren’t emergencies and entrepreneurs have stepped up to fill that void. However, a cough for 1 hour, congestion for 2 days, a rash for 6 years and most urgent care complaints aren’t even urgent. Little 8 year old Bobby’s sinus infection for 6 months can’t be allergies (although he is allergic to dogs, 2 are in the house but live in the basement and he never touches them). Tell a patient that they or their child has allergies is akin to telling them they have cancer. “I get this every year but I don’t have allergies”. “I looked it up online and I have a sinus infection. I need an antibiotic”. The fact that most upper respiratory tract infections are viral has no bearing on patients what so ever. Antibiotics or bust. Give out the Z-Pack like water, patients are happy, they “liked” us on Facebook, the survey numbers prove it, must be doing something right. Don’t get me started on the weak parents. As the saying goes you can’t fix stupid BUT you sure can make money catering to it. Exploit the fact that people are selfish, short sited and needy. Insurance companies will pay for urgent care because the alternative is the emergency room, the lesser of 2 evils. “We can’t keep the knuckle heads out of the ER but if we can divert them and save a few bucks why not?!” If you build it they will come, and they do (doors open to doors close).

Meanwhile up the street at the hospital, insurance companies are denying care, downgrading care or suggesting alternatives to the tune of  billions of dollars annually. An entire industry has developed to recover funds for healthcare systems due to downgrading and denying services. Executive Health Resources, a company that arose because of the medical review industry was sold to United Healthcare for $1.5B in 2010. The industry’s retort is the review system assures care standards are being met and financial resources are not being wasted. The billions of dollars saved is actually being spent on cough, colds and allergies in ERs, urgent care centers and primary care offices. When will insurance companies start denying ER or urgent care visits for sinusitis and bronchitis? If patients actually had to pay 100% out of pocket for these and other useless visits how many of them would wait a week or two to allow their illnesses to run their course?!

Healthcare is so complex that insurance companies (Blue Cross and Blue Shield) hire other companies (Health Advocate) to help patients navigate the system. RVUs, patient satisfaction scores, magnet status, centers of excellence, “Top Doctors”, no pass zones, “no fall” mandates, culture of safety, patient centered homes, pre-certifications, prior authorization, formularies and many more medical code words from the bureaucracy of medicine. Healthcare is big business and big business has taken over healthcare but the American people aren’t healthier and aren’t safer. Costs are rising and U.S. healthcare “rankings” are still behind many less developed countries. “Medicare has increased doctors’ rates by only 4% since 2001, while the cost of operating a practice has risen more than 20%”. How does that work?

Healthcare is now all about the marketing of “magnet status” or “centers of excellence”. Medical directors love to report savings and goals reached. The patient centered home sounds great but how is the patient centered home going to fit in with 15,000 urgent care centers? In a society that wants instant results, tweets and Instagram, it is next to impossible to keep the attention of a diabetic day after day to exercise and eat properly. All the experts say “chronic care” is where money is being spent and where the most savings will come from. Chronic care takes time and no one wants to pay a doctor to actually sit and talk to a patient. Patient care for patients that don’t want care but a prescription. You can’t make people walk daily for exercise, stop smoking, eat fresh vegetables or any other simple thing that will improve their health. At the same time providers have to see more and more patients to keep those RVUs up. There are CPT codes for extended visits but they are never paid by insurance companies. “Above cap” services are also never paid. Why remove a mole or trim a nail if the office won’t be paid? Send them to urgent care or a specialist. How many insurance companies really pay for an email, text, phone call or other non-visit contact with a patient that impacts care while saving time and money? None of them. It’s all talk and no money to back it up. A patient calls, emails or sends a text. It seems simple enough. A treatment plan is initiated. All goes well, until it doesn’t. Then the lawyers come out of the wood works. Dr. X why didn’t you see patient A in your office? How could you decide a plan of care without having examined the patient? To avoid that scenario Dr. X says “go to the ER or your nearest minute clinic”. Not only is a provider not paid for telemedicine but they open them-self up to legal action.

Young people are not going into Family Medicine or Primary Care. The best doctors with the most experience are becoming Concierge doctors. They make more money, spend less time on paperwork and more time actually being doctors. Obamacare will cause an expansion of the current Medicare and Medicaid systems. Trying to find a physician in the suburbs that actually takes Medicaid is like trying to find an overweight supermodel. Good luck with that.

This nation can never repay its veterans for their sacrifice, never. The first law in the colonies covering veterans was enacted in 1636 by Plymouth to provide money to those disabled in the colony’s defense against Indians. That said, and no disrespect, in a country with truly limited resources can we continue to provide welfare for Veterans? Overweight, smoker, diabetes, depressed or whatever you have there’s a claim in there somewhere you just have to work hard and eventually that check from the VA will come. If they only give you 10% keep at it, that 100% service connection and freebies galore are well within your grasp. Are you already compensated for a service connected disability? Great stuff, get a civilian job and then get disability from the private sector too!! Got fired? The wife’s insurance is too expensive? Hey aren’t you a veteran?! Come on down the VA can take care of you, for free. You mean you don’t really want care from the VA, you just can’t afford your medications? O.K., done. Can’t afford Viagra anymore? The VA has your back. Addict? Don’t go out on the street for your Percocet, you know who will take care of you, don’t you? The DEA can’t touch a VA provider so don’t worry about your supply getting cut off.  “The AP found in reviewing millions of VA compensation records that diabetes is now the most frequently compensated ailment, ahead of post-traumatic stress disorder, hearing loss or general wounds. VA officials use a complex formula when awarding benefits and do not track how much is spent for a specific ailment, but AP calculations based on the records suggest that Vietnam veterans with diabetes should receive at least $850 million each year”. (mike baker, AP)

There are so many areas of healthcare that need to be addressed it’s like an old car with 200,000 miles. It runs but… FMLA is a joke. Really sick people don’t use it that often. A patient goes for radiation 3 days a week for cancer treatments and doesn’t miss a day of work. The scammers use it to take off from work every chance they get. Don’t want to work at all? Fake it until you make it. That disability check will eventually come in. 14 Million on disability and rising. All 14 Million can’t do anything? Go to work, I dare you and see how fast you are cut off. Why work when you can get a check and free healthcare?! Greatest country in the world. Poor Mitt Romney, what was he thinking trying to be a whistle blower. What a dope. Welfare wasn’t reformed just moved to different agencies.

And let’s not forget about our clinical reminders because as long as it can be tracked and reported healthcare is operating as it was meant to be (see concierge medicine above). The real money is in personal injury, worker’s compensation, chronic pain, Suboxone treatments, erectile dysfunction, sick notes, Botox injections, weight loss or anything that pays cash. DO NOT go into primary care (see concierge medicine above). You know something is wrong when Cardiologists are selling their practices to health systems.

This is just the beginning. I’ll write again.

I hope he does!