[Anecdotes] Bitter Pill, Better Prescription

What do doctors have to say about ? I sat in on a Grand Rounds discussion today where physicians – young and old – explored the consequences of the high cost of health care. Their questions and comments were provocative.

 

• Why don’t we have a general medical record to integrate hospitals across the entire region? Won’t this reduce duplication and health care costs?
• Do hospitals intentionally want to keep doctors in the dark on the costs to patients in order to keep hospital revenues streaming?
• There’s supposed to be interoperability but in reality none of these EMR systems want to communicate with one another. When will the federal government mandate a “common bridge” to link all these various EMRs together?
• Maybe it’s best to save money not in acute care – like the ER – but in chronic disease or office-based care where a lot of the testing is unnecessary or could safely be deferred.
• Will a focus on cost-consciousness cause the quality of health care to suffer? Will doctors skip important tests or medications to save costs and thereby harm patients?
• In Canada, the mindset of a clinician is as a “gatekeeper for the system.” What will it take to put that mindset into the American physician’s thinking?
• Will an integrated health care model like Kaiser Permanente save money for the overall health care system? If so, why isn’t everyone doing this?
• How do we cut back on expensive costs such as ICU care and End-of-Life care when circumstances are unlikely to improve for the patient?

Listening to the commentary it appeared that the physicians were hoping for cost-savings from electronic medical records – . However, there exists a faith and hopefulness that better EMR integration can lead to less duplication in the medical system and ultimately save money when patients “hospital shop” (getting the same work-up over and over again because they go to different, non-integrated facilities).

Physicians seem disturbed about how much medical care costs, . While some want access to , perhaps to reduce marginally-effective or cost-inefficient care, others worry that saving money for society might result in decreased patient satisfaction and, at worst, risk of litigation.

Lastly, the doctors feel that the best way to save on health care costs are to go after the big bucks in the system. Thus, there should be an emphasis on palliative care, intensive care, and entitlement spending (Medicare and Medicaid). Hopefully, physicians across the country are discussing the costs of health care amongst themselves in order to uncover workable solutions to a crisis of which, in my opinion, is still just beginning.