It seems like every day new technologies are emerging in every field, and the medical field is no exception.  Perhaps one of the most exciting uses of these new technologies are wireless health devices that allow physicians to monitor patients’ conditions from anywhere and at anytime.  Wireless pacemakers can be monitored by physicians and adjusted remotely if necessary.  Home “telehealth” – doctor/patient video conferencing, wireless monitors that deliver info by cell phone or over the internet – these are becoming increasingly important to routine patient care, especially for those with chronic conditions.

Another new technology that’s getting a lot of use in the medical field are the “smart phone” health applications.  Cell phones such as the iPhone and phones that run the Google Android system have the capability to allow doctors and patients mobile access to medical records, instant messaging and video connections, and more. 

The main problem seems to be reimbursement – these technologies are so new that a reimbursement process for them has not really been established.  Many doctors and patients who are using these are finding them worth the initial cost, especially since it seems that they save money in the long run.  But of course others are afraid to adopt technologies, and there may be a steep learning curve for some.  But these technologies are not going away and will probably become more and more common, and more and more important, to our daily lives and our health.

A recent debate on Medscape.com brought up an interesting topic – should doctors care about money?  There are many people who believe that doctors make a lot of money already and that people in jobs that care for others shouldn’t be concerned about how much they make.  Patients don’t want to think their doctor is in it for the money and doesn’t have their well-being as his or her top priority. 

But realistically,many doctors struggle financially, especially family practice docs and primary care givers.  There are some specialities that do make lots of money, but unfortunately so many people want to go into those specialities that there isn’t a need for them as much as there is for general practice doctors.  So those that do go into those needed areas find themselves struggling with expensive school bills, costs of setting up a business, and less income than perhaps they had imagined.

And of course your doctor cares about you, but let’s be realistic – doctors have families and lives to support so they are obviously going to care about their bottom line.  Doctors often work very late hours and have very little time for other pursuits – and they should be compensated accordingly.  And the work is difficult, risky, and emotionally draining.  Not to mention the constant fear of lawsuits and the cost of insurance and legal protection.  And many doctors are really small business owners, having to cover payroll, business expenses, rent, utilities, etc.

So yes, doctors should care about the money they make.  Should they care about it more than they care for their patients?  Of course not, but most doctors don’t.  It’s finding that balance that we all can live with and that’s fair to everyone – that’s where the challenge really lies.

There’s no denying that social media is here to stay, and it is becoming more and more important as a real source of communication for people.  But many hospitals still think that things like Twitter and facebook are not important and certainly not useful in the health care industry. 

 But more patients are expecting to be able to interact online with the businesses and services that they use, and hospitals are falling behind.  Only about 10% of hospitals are engaged in social media, and many of those use it very little.  It is no longer enough to just have a website with information – people expect to be able to interact with someone on that site.

A recent article on Healthcare Finance News urges hospitals to get involved more in the social media networks, saying that basically without it, they “don’t exist”.  How can hospitals use social media in a productive way?  The article outlines some ideas:

  • Damage control – if a situation occurs, there is no faster way to spread information than social media – get your version of the story out there and people will appreciate the quick response, will pass it on to their networks, and it will gain credibility
  • Build a reputation – share positive stories about patients enjoying your services that can be passed along and shared
  • Measure success – develop goals for your social media use and then use one of the many tools available to track site usage, outbound and inbound links, etc. to show how much traffic your site is getting and how many people are sharing your info with others

According to a recent study summarized on Medscape.com,  about 50% of all patients don’t fill their prescriptions.  It is estimated that $100 billion dollars in unnecessary hospitalizations and $177 billion dollars total in direct and indirect health care costs are a result of people not taking their prescribed medications.  But why?  Why don’t people fill their prescriptions?

Some say it’s a lack of education – patients do not understand why they need the medicine so they don’t use it.  Or patients are prescribed medication that they have adverse reactions to and rather than discuss them with their doctor, they just quit taking it.  A lot of it could just be forgetfulness, especially if the doctor hands the patient a paper prescription that they have to deliver to the pharmacy and then wait for.  And of course there is the issue of cost – many people do not fill their prescriptions because they cannot afford them. 

Electronic prescriptions can help the problem but do not solve it – still about 22% of all e-prescriptions are never picked up.  Hopefully provisions in the health care reform act, such as the closing of the Medicare donut hole in prescription drug coverage, can assist people with the cost of their medications.  But I think it really comes down to education – doctors taking more time to describe to patients why the medication is important, even life saving, for them to take.  And for doctors to make sure they are prescribing medications that are indeed necessary.

As more Americans become insured under the health care reform plan, the need for primary care doctors is going to become substantial.  This week in Washington there is a meeting going on to figure out how to deal with the increasing need for primary care doctors and the decreasing number of medical students going into primary care.  Leslie Kane, a blogger on Medscape.com, addresses two of the changes being currently discussed in her recent blog post.  They are:

1. Increase the 10% primary care bonus currently called for in the health care reform act – a 10% bonus is nice, but it is doubtful that it will be enough to draw students away from more lucrative specialities.  10% more for primary care doctors still cannot hold a candle to what some specialists make, and the hours are longer and the work more grueling in many cases.

2.  Pay much more money for more complex care – primary care doctors should focus on more difficult procedures and cases and get paid more for handling those while nurse practitioners and physicians assistants could deal with the more day-to-day situations that take up so much of a PCP’s time.

So what do you think of these suggestions?  Are they financially or professionally feasible?  How do you think patients would react to seeing their doctor only for more serious cases and dealing with a nurse practitioner the rest of the time?  We will have to wait and see what comes out of this current meeting and what changes might be in store for primary medicine.

We see them all the time – “Ask your doctor if ________ is right for you” – drug commercials telling us that we need the latest medication for whatever ails us.  Sure, it’s expensive, but isn’t your health worth it?  So patients are coming in their doctors’ offices demanding prescriptions for these drugs when they are not medically necessary, and many people are saying this is part of what is driving up our medical costs.

According to a recent article on Medscape.com, 84% of patients request a specific prescription or test when they visit the doctor and about 80% of those requests are granted, often even when the doctors would not have prescribed that medication for other people with the same symptoms.  Some argue that doctors are jumping to prescriptions too quickly, and that what patients really want when they request advertised medicine is a conversation with the doctor about benefits, risks, etc.  But many doctors, overbooked and under tremendous pressure to see more patients, just want to get people out the door quickly, so they whip out the prescription pad.

This unnecessary prescribing has got to be costing us lots of money.  Patient satisfaction is important, but at what cost?  Are the advertisements to blame or is it the doctors who are too quick to write prescriptions?  It seems like we need a change in the way we all  think – patients and doctors.  Patients need to realize that just because it’s on TV does not mean they need it or that it is even good for them, and doctors need to spend more time listening and talking with patients before any medications are prescribed at all.  Talk is cheap, they say – but really it is invaluable.  We can save money on medical costs and probably improve people’s health and lives in the process.

It’s been a while, but there is finally a new “Medical Manager” newsletter!  Our latest issue discusses the details of the health care reform bill, what happens now and in the future, and how it may affect doctors, insurance companies, and the medical billing and coding profession.  Enjoy!

2nd Quarter 2010 “Medical Manager”

There have been a lot of articles on the internet and in other medical publications discussing the benefits of adopting for technological advances in health care.  Of course, there are also the incentives provided by the federal government for adoption of EMR systems, use of electronic prescriptions, etc.  And yet, according to a recent article on Medscape.com, we are not seeing the use of these technologies being widely adopted.  In fact, only 1.7% of hospitals have an electronic system operating in all their units.

Reasons for the slow adoption are many, including costs of implementation, lack of knowledge, and lack of infrastructure for information sharing in many areas of the country.  These infrastructures will be time-consuming and costly to establish, and doctors will need to be trained on how to use the new technologies.  Recently a grant was established to help fund a network of support centers designed to help smaller practices select and implement electronic systems.

Many of the incentives are slated to phase out in 2014, so 2011-2013 will be the best years to cash in on them.  Which means that many doctors offices and hospitals are going to need to get busy learning about and selecting a system that works for them.  Hopefully these support centers will aid in that endeavour.  But doctors must first agree in the importance of implementing technologies – and I would venture to say there are probably many, especially smaller practices in rural areas, that just don’t see it as that important.  What do you think?

A recent article in the New York Times discusses a very interesting topic at the heart of the debate over health care reform and controlling health care costs.  The article asks if the issues we are facing today with out of control health care costs aren’t really an issue of an inability to say no to unnecessary treatments on the part of the doctor and the patient?  Americans seem to have a “more care is better care” outlook and will accept recommendations for all kinds of unneeded and potentially dangerous treatments.  This try-anything approach has had some benefits for people but it has also had some major problems, including dangerous treatments like radiation and surgery being used or overused unnecessarily.

The main problem, the article argues, is that patients are often terribly uneducated about their treatment options.  Many just blindly do whatever their doctor tells them without asking questions or finding out about other options.  Frequently there are less expensive, less invasive options that may not cost as much (or be reimbursed as well) but would be most beneficial to the patient.   Firstly we need to know which treatments work and which do not in certain cases, or which have possible problems that outweigh the possible benefits, and then educate patients about all options. 

But at the heart of the problem is how doctors are paid, which causes them to recommend the more expensive and sometimes unnecessary treatments.  A change in reimbursement policies that award better care rather than more care is crucial.  The current reform takes some steps in that direction, but ultimately more change will be needed.  It seems that the answer for now lies in patients own decisions to limit their care to the most beneficial procedures and medications.  Who knows how many billions of dollars could be saved if people were able to make smart decisions about their own health care?

Did you know that today, April 16, is National Healthcare Decisions Day?  National Healthcare Decisions Day is a day set aside to encourage people to make advance decisions concerning their healthcare and to communicate those decisions to family members and healthcare providers.  It is also encouraging families and physicians to respect those decisions. 

The best way to arrange for this is to have an Advance Directive, which is basically a statement saying what you would like to happen in the event that you cannot speak for yourself.  On the National Healthcare Decisions Day website they have lots of good information on advance directives and how to go about planning and creating one for yourself, including links to organizations that will help you through the process.

If you would like to find out more about National Healthcare Decisions Day, become a supporter of the event, or learn how you can set up an Advance Directive for yourself, visit their website or email them at mailto:nhdd@nhpco.org.

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