Saturday, July 18, 2009

My Comments At the National Press Club, Washington DC

For those interested in what I said at the National Press Club, in Washington DC on Friday, here's it is, though it was shortened due to time constraints:
Today, we come here not as experienced politicians, layers, policy pundits, big-money insurance or health care executives, but as doctors and nurses – just like one of those you want to see when you or a loved one is struggling with a complicated medical problem or lying awake at night wondering what to do. My face is the one you want to see – NOT a nurse coordinator.

And because I know you, because I have treated you, and have trained extensively and seen your problem before, seeing me can literally mean the difference between life and death.

I can be there for you because I still find enough reward in my job. I am still able to stay devoted to it, because I have professional freedom, because I love helping, and because I give my family a good living even as my kids see their Dad rushing off from dinner, a ball game, or holiday event that they will never remember.

And yet, some of us are watching the evolution of a health care delivery system that appears to care more about the system than the very patients it is supposed to treat. One only has to look at the diagram of the recently-proposed health care system interconnections, to realize that the health care providers and consumers are on opposite sides, separated by so much regulation and oversight, we wonder who stands to win.

It seems we are about to underwrite and unprecedented $1.6 trillion in government spending for a huge bureaucracy that piggybacks on two other government systems that are already nearly bankrupt: Medicare and Medicaid.

You may recall that we tried once to provide affordable housing for everyone at low cost or no cost through convenient government-run and regulated mortgage deals, only now we see the consequences of that effort to our economy. Make no mistake; we are now about to offer affordable health care to everyone through similar creative government-run insurance and oversight regulators. Like in the housing failure, do we really know what we’re up against? What happens when we realize that we can no longer afford our new plan? What cuts will make then?

Now many people have worked hard to develop a plan for health care system reform. People from all political persuasions, economists, scientists, and scholars have tried to create a new way of providing health care to every American. There is no denying this is a laudable goal.

But when it comes to health care, where should we invest the most? In the infrastructure or the caregivers? What will government-mandated cuts to the salaries of some of our best and brightest caregivers in an effort to balance the cost of such a system mean to our patients? We hear seemingly well-reasoned essays about how it’s the caregivers that are the problem because we order all of the expensive tests.

But why do we?

Is it to make a profit? Or might those tests be necessary to establish the cause of that lump you felt? While we certainly could go without some tests to save money, to doctors, the legal implications of doing so risks our very livelihood. Can we really continue to ignore the threat to your pocketbook that ever-rising malpractice premiums create?

Now the President has suggested that if I just use comparative effectiveness research to make my decisions and stay well within their recommendations, I will not get sued. But every patient walking through my door has the potential for virtually infinite constellations of diseases. Every one practicing medicine here today knows this. In the new era of health care delivery proposed, will my job be to parse these complexities into formulaic protocols in order to get paid and avoid litigation? Most patients don’t fit into these boxes. While treatment recommendations from such research are helpful, they can not take the place of personal and private discussions between the doctor and patient about their treatment. Simply put, coercive enforcement of this policy to mandate treatment by protocol is an assault on the doctor-patient relationship.

Moving on, I work in a hospital with one of the most comprehensive electronic medical record systems in the country. I have seen first-hand the potential benefits of such a system to provide world-class care to our patients and improve communication between doctors. It brings test results and images right to my desktop so I can explain results in real-time with my patients. But while these are some of the wonders of such a system, the information overload presents its own problems.

First, I must type and type really fast. As such, I look at monitors more and you less.

Second, our current billing system requires that I code every diagnosis you have, and place it in a computer form. Our current coding scheme, developed by our own American Medical Association, contains 17,000 non-descript codes that must be correctly entered or else you won’t receive your insurance payment, Insurers have used these for years to justify claim denials. Beginning 1 October 2011, these codes are set to balloon to some 155,000 codes. Tell me, how many computer programmers will be required to update our current systems and how many denials will you experience then, all in the name of cost savings?

Finally. all of that data that I enter is just too tempting for hospital leadership to ignore. “How do we do things better? Where can we cut?” they say. “Could we offer new goods and tests on your behalf in the name of ‘prevention’ and ‘wellness?’” We’re all about prevention to save money these days, after all.

But I have seen a different motive: the bottom line. Computers, you see, are as much business tools as they are medical tools, maybe more so. The rush to widespread implementation of the EMR without dealing with these conflicts is simply not in the interest of the doctor-patient relationship.

In hosptials, we rationalize the deployment of hoards of oversight bodies, government regulators, performance enhancement specialists, market researchers, safety monitors, and hall monitors - all to make sure that we have the safest, most cost-effective healthcare with glowing “quality scores” published on our websites. More recently, we have made this an economic necessity for our struggling hospitals. How cost-effective are these strategies? As doctors clear their desks once a year to get ready for inspections, do they truly make a difference? How many ward nurses have had to be let go to make way for these regulators?

I think most patients want their doctors to be happy, engaging, and happy with their vocation. After all, when they can stay focused, attentive, and engaged in their patient’s care, patients do better. But these are uncertain times. If a doctor dares to question the rush to government health care today, they are labeled as unsympathetic to the uninsured, unsympathetic to the unemployed, unsympathetic to the plight of the illegal aliens, unsympathetic to the chronically ill, or “you just don’t get it.” You see you just don’t have the right to have the common sense you have.

The honest truth is, if I could help the uninsured, and unemployed and chronically ill while preserving my relationship with you – I would. If I could solve these problems while preserving my love for medicine – and the devotion of my colleagues, I would.

Fortunately, I believe we can.

But we can’t do that and continue to fund the gravy train. And that gravy train is the multi-billion dollar health insurance industry with executives who made over $24M annually in 2007, the $800B pharmaceutical industry with executive compensations of over 25 million dollars the same year, the over $24 billion spent in one year in our country on new hospital construction, the nearly half a billion dollars in political campaign contributions from health care special interests a single year (2008), and the 55-80% increase in malpractice insurance premiums that your doctors have paid over the past 5 years.

Yes, there are problems with our current system, too many to describe in this brief press conference, but for the first time, a serious dialog about our problems and how to solve them is underway. How these reform ideas really translate into reality, how they look to those of us on the ground, has to be played out before our patients are put at risk. The only people who can play that out for you are the frontline caregivers. If we don’t have the time or patience to do that, we’ve got a problem.

There are creative ideas afloat, like insurance-free medical homes costing less than a dollar a day for unlimited access being test-run now to address many of the concerns of the lower income and chronically-ill in America that doesn’t involve a middleman, unless you want one. There is the idea of open source health information technology that would promise greater scalability, intercommunication between health care facilities, and cost transparency. Better still, billions of dollars of taxpayers’ money could be saved on drug and device costs tomorrow – that’s right, tomorrow - if we stopped wasting those dollars on direct-to-consumer advertisements on the Nightly News.

You see, there are real clinically-involved doctors and nurses eager to become part of the solution who refuse to believe that they are the problem.

And that’s why we’re here today. Not as a passive voice that bows to the whims of those who with much larger financial stakes in the industry or as someone who has no clue about health care delivery, but as concerned doctors, nurses, and nurse practitioners who are eager to propose real solutions for reform.
-Wes

4 comments:

Chrysalis Angel said...

Excellent.

Keith said...

Wes,

Excellent post, to which I find broad agreement. It seems the bottom line is that the ability of medical care to consume more and more of our GDP has attracted every middleman and corporation to obtain their slice of the ever expanding pie (at least up till now). Meanwhile, physicians have sat passively by allowing others without day to day knowledge of what is important in medical care to dictate to us what is important. Unfortunately they often get it wrong and run the strong potential to actually worsen the situation rather than improve it.

I heard today the billions of dollars that are now beginning to slosh around Washington in an attempt to influence the ongoing process, and most of it is not coming from our medical societies; it is coming from all the assorted buisinesses that have cropped up over the past years that have upped the costs of health care. This is probably the reason that Obama wants to get health care reform done quickly, because the longer it goes, the more time for all these interests to organise and lobby against any change. But the change will only be successful if it stabilizes or reduces health care costs and I don't think the things you mentioned will make a dent in this cost. Only putting more economic pressure on hospitals so they cannot engage in their incesant war of building new fancy facilities to compete against each other and wringing the excesses out of some overly compensated areas of medicine will do the trick. Only providing comparitive reasearch that will look at less expensive treatments in comparision to new more expensive treatments allow us to know whether the fancy new device or drug is really worth the hundred fold increase in cost. As I mentioed before, the job of goverment should be to fill in the holes of items that will be good for society as a whole, but for which the capitilist system of profit driven motivation does not provide. Who will look at cost effective procedures and meidcations if there is no profit to be made from the discovery? It is the work of goverment to provide the funding for this important research that will tell us which of what we do and order is wasteful to the system and what isn't. Frankly, that should include processes like the introduction of electronic medical records, which does not have alot of proof that it will save our health care system money, and research into the effectiveness of private health insurances ability to restrain health care costs. It bothers me that we waste so much of our wealth as a country on things that bring little to the table in improving health, while so many others cannot even get basic health care. This needs to change!

Margaret Polaneczky, MD (aka TBTAM) said...

Nice job, Dr Wes.

Bill said...

Wes, it is great to see doctors getting involved in healthcare reform. As CEO of a 450 employee company, i am very concerned about what will happen to not only healthcare costs with the proposed legislation but the doctor-patient relationship.
What has worked for us is consumer driven healthcare with an HRA where our people are incented to participate in their healthcare by asking questions about why they need diagnostics, drugs, etc. They are rewarded by saving money but have access to whatever healthcare they need. Also, what has worked is paying people to do 5 things for their health such as blood work, physical, etc to uncover early stage issues to keep costs down. If individuals take control of their health then we can save money in the current system. Our company is well below the rate of medical inflation and it is only because our people have decided to take a proactive role in their healthcare and get their heads in the game. I think some form like what we are doing would work to drive down healthcare costs; it is not the only answer just part of it.
Thanks for your involvement as I think a team of doctors can have a great influence on where this healthcare reform ends up. Your team should take this right to Capitol Hill and get involved with the House and Senate!