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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.

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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.

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.

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?

Sure, cheaper medications sound great.  Everyone would like to save a little money on their prescriptions.  But the promise of lower cost for medications in the health care reform bill may have implications a lot greater than a few extra dollars in our pockets.  Many of us still fill prescriptions even if they are expensive because we know we need them.  But for people on fixed or lower incomes, sometimes it becomes a choice between getting the meds and paying rent or buying food, and medication seems like the thing that can go.  But data shows that not taking medications faithfully, which about half of all Americans do, costs more than $100 billion dollars (the total cost of the reform bill) in avoidable hospitalizations and approx. 89,000 avoidable deaths each year.

In a new article on Medscape.com, they stress that “medication non-adherance is a treatable disorder.”  New laws that will close the Medicare “donut hole” in prescription drug coverage are just the beginning of the changes that are promised.  The implementation of EMR systems and the increased use of electronic prescriptions could help doctors better track who is filling their medications in a timely matter and who is not.  Then they can conduct follow-up appointments to determine why the patient is not taking the meds and what needs to be done.  Also, shifting doctor pay from a fee for service model to one where doctors are rewarded for patient outcomes will hopefully result in doctors taking more time to ensure their patients are compliant.  They need to have a real stake in their patient’s overall success, including the patient’s choices about medications, some argue.

So do you think this true?  Do you think these changes will help patient adherence, or is this an invasion of privacy and more work for already stressed out physicians?  How responsible should a doctor be for whether or not their patient takes their meds?  Is it any different from judging a teacher’s performance based on how a kid does on a standardized test?  Will it save money in the long run?

No one can deny that times have been tough for every industry in the US in recent years, and the health care industry is no exception.  And whatever changes the new health care reform act may bring about won’t happen for some time.  According to a recent survey discussed on Medscape.com, the financial struggles of the health care industry are having adverse affects on patient safety.   Some of the findings of this survey are summarized below:

1. More layoffs in hospitals and clinics result in fewer staff to attend to patient needs.

2. Facilities are delaying the purchases of new equipment and the implementation of technologies and are therefore unable to offer patients the latest treatments and procedures.

3. Patients themselves are delaying treatment and surgeries so that when they do come in they are in worse condition and more complicated and expensive care is needed.

4. Medication safety has decreased due to elimination of many medication safety officer positions, increased job responsibilities for pharmacists, and medication shortages.

Only time will tell if new legislation will help with these issues or not.  Patient safety should be an obvious priority.  Maybe funds need to be redirected in these areas in the meantime so that this economic downturn does not result in disastrous issues for patients and hospitals alike.

A recent blog on Medscape.com discusses something we at MD Alliance Billing have been emphasizing for a while now – the importance of physician involvement in the social media world.  Now it seems that more and more doctors are doing what the article’s author, neurologist Dr. Andrew Wilner, has been doing for a while – getting involved in sites like Facebook, Twitter, and other social media outlets.  In fact, Dr. Wilner quotes a recent survey that shows that social media use among doctors is up 50%, especially among younger physicians.  More and more physicians also have their own personal blogs.  So how does a doctor who is new to the idea of having a professional presence on these sites navigate the perils and pitfalls?

In his article, Dr. Milner introduces us to the Massachusetts Medical Society’s online CME program “Social Networking 101 for Physicians”.  He says this program has a lot of good information about the risks and benefits of participating in online communities, such as how to make sure your online practices comply with HIPAA regulations.  Milner stresses that doctors need to remember that everything they write online is available somewhere on the internet forever, so extreme caution must be exercised before posting anything.

It is exciting to see more doctors embracing what is obviously not just a passing thing.  With over 350 million users on Facebook alone, not counting Twitter and other social networking sites, there is certainly great potential to reach, educate, and help people.  The potential for interacting and sharing with colleagues, advising and assisting patients, and encouraging new patients and new business is limitless.  If you are careful, cautious, and vigilant, there is no reason why participating in social media can’t enhance your medical practice and advance your career.

These days more and more people are turning to the internet to research medical information, interact with physicians, and even purchase medications and supplements online.  While there is a lot of good, truthful information out there, there is also a lot of false, exaggerated, and downright dangerous stuff too.  How do you know what sites to trust?  A couple in Springfield, MO just pleaded guilty to fraud in a case claiming that they sold millions of dollars of misbranded and unapproved dietary supplements and medications on their websites, claiming they had been proven by the FDA to cure all kinds of diseases when in fact they had never even been tested.  

Based on a survey released just today by Pfizer, there is so much counterfeit medication available online that the Royal Pharmaceutical Society in Great Britain released a statement urging people to be very careful when buying medications online and to look for an approved seal on the websites of legitimate online pharmacies.  Unfortunately there really isn’t any kind of regulation for online medical information, so just like with the rest of the internet, it pays to be skeptical and savvy.  Obviously if your doctor has his or her own website, that information can be trusted (assuming you trust your physician).  Other well-known sites like WebMD are usually pretty well regulated by the patients and physicians who use them, but it always best to discuss with your doctor any information you find online and to especially consult with them before purchasing or taking any medications from an online source. 

If you are a physician, we strongly encourage you to get online yourself – create a website or blog and be a frequent participator in the online community.  Your patients are already out there – wouldn’t you rather know they are getting the correct information from you then something incorrect, dangerous – perhaps even deadly – from somewhere else?

Can you imagine visiting your family doctor – by web conference?  Or can you as a physician imagine treating a patient who is hundreds of miles away by streaming video connection?  The use of satellites, web conferencing, and other internet data exchanges in the practice of medicine is called telemedicine, and there is a great debate going on right now about its potential usefulness and its possible drawbacks.  The main issue seems to be although most technology experts agree it could very beneficial to the medical community, doctors and nurses are very resistant to accept its use.  Why do they fear this kind of technology?  A recent New York Times article discusses the issue – the positive contributions that this kind of technology could make and the negative reaction many healthcare professionals have towards using it with their patients.

Many physicians feel that the doctor-patient relationship cannot be duplicated online, and that having multiple doctors consult remotely on their patients is an invasion of privacy and interferes with the way that doctor has chosen to interact with his or her patients.  Many doctors do believe things like websites, some social media interaction with patients, emails, and other forms of technology can strengthen the doctor-patient bond, but actual online visits, treatments by web conference, and remote consultations by multiple doctors will create impersonal relationships and damage the trust in the relationship.

I think it comes back to the same debate people are having over social media, web/teleconferencing, and other ways of relating to people and creating community over the internet.  Can you actually have real relationships, cultivate community, and interact on a personal level through the internet?  Or is real effective communication only face to face?  Can you imagine how people first reacted to the telephone – a technology we take for granted as a vital part of communicating with people?  Could things like telemedicine be a similar advancement that will just take time to get to used to?