When We Conflate Health Care With Medical Care

From Marilyn M. Singleton, M.D., J.D.:

“Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly, and applying all the wrong remedies.” -Groucho Marx

The politics of selling the Affordable Care Act (ACA) focuses on promising health and wellness. Somehow, having “coverage” is supposed to get you to a primary care doctor, who will keep you healthy. And if he doesn’t, he will be held accountable by not being paid.

The fact is that “healthcare reform” is not going to cure America’s health problems.

Physicians, think tanks, and politicians are pointing out a myriad of problems with ACA. But most of them miss the main point, which starts with calling it “healthcare reform.” The term, and the conversation about it, conflates health care and medical care. But they are not the same thing. Individuals are in charge of their own health care. Physicians provide medical care to those who become sick.

(Read the rest, especially the comments)

As I and others see the problems with "wellness initiatives" promoted by politicians and the insurance industry as cornerstones of our efforts to cut costs in our medical system, we should consider if institutional financial incentives will thwart any effort to achieve cost savings as physician productivity quotas are increasingly turned to as the driving force de rigueur for hospital profitability. Unfortunately, physicians are losing their ability to be stretched much further, especially as they struggle to keep up with the mushrooming number of inefficient certification and data-entry requirements, flooded e-mail in-boxes, and coding requirements necessary to continue practicing medicine in our new "reform" era. Then add the increasingly frequent hassles doctors are experiencing with their patients' insurance claim denials that go on for months. Medical care suffers as a result. Even our frontline force for quality medical care, nurses, are being stretched thin as many of their ranks are either let go or recruited as cleaning crews on top of their other patient care responsibilities.

Meanwhile, the insurance companies are recording record profits as Americans pay more and more into our system.

But, hey, thanks to the Electronic Medical Record and health care "reform" it sure is easy to order another colonoscopy in the name of "wellness" and "health care," right?

-Wes

Never Mind the Trolling

It was just another concerned patient: another victim of a screening test… a patient caught by our trolling net of screening tests for the worried well.

This time is was a “screening” for atrial fibrillation: charged to the patient and their employer under the guise of a corporate “wellness” initiative:

(Click image to enlarge)

Never mind that the “EKG” wasn’t really an EKG, but rather a “screening” that contained only six of the usual 12 EKG leads, so if an “abnormality” was found, another real EKG would have to be performed.

Never mind that no one would explain the results to her, but rather sent this letter describing a “suspected abnormality” whose findings are “described on the enclosed rhythm strip:”

(Click image to enlarge)

Never mind that the patient could not read the findings “described on the rhythm strip.”

Never mind that the patient’s short PR interval was not identified.

Never mind the patient already had an EKG in the past and had already had an electrophysiology study (which was normal).

Never mind that the screening company, in their effort to “spread good health practices” fails to mention how to perform “lifestyle modification” or “risk factor management” in their cover letter.

Never mind that all of the other tests performed by the screening company for carotid/stroke, abdominal aortic aneurism, peripheral vascular disease aren’t real tests either, but different “screening tests” that will require more tests if an abnormality is found.

Never mind a cardiac electrophysiologist charges the patient several hundred dollars for “clarification” of the scribbled interpretation of the rhythm strip: “Bradycardia.”

Worse still: never mind that taking a pulse would have served as a much more cost-effective “screening” test for atrial fibrillation in most patients.

Regarding ways to save money to our healthcare system and patients…

… oh, never mind.

-Wes

Machiavellianism Run Amok

Imagine, such cavalier disregard! Where is the respect for such a caring corporation when workers behave in such a manner?

Whirlpool Corp.'s suspension of 39 production workers at an Indiana plant who were seen smoking after declaring themselves eligible for a $500 annual tobacco-free insurance discount may signal the end of the honor system that rules most corporate wellness programs, experts said Tuesday.

The action also underscores the difficulty of enforcing so-called voluntary programs when fines or incentives grow big enough to encourage cheating and snitching, they said.

How could simple workers look at their company's wellness program with such a jaundiced eye? Don't they realize that their company wants what's best for them? How could these workers so cynically take advantage of the corporation when everybody knows that only the corporation is supposed to take advantage of the workers. Could it be that the simple working man or woman is also capable of acting disingenuously?

Say it ain't so.

If this kind of thinking keeps going on, the "wellness" boys are going to have to fold up their binders and brochures and head back home.

-Wes

Addendum 26 Apr 2008 - A roundup on the issue is offered over at the New York Times.

The Money and Marketing in Wellness

“Firms’ Health Clinics Cut Costs”
- Wall Street Journal, 9 Apr 2008
As a business person interested in improving your bottom line, wouldn’t you want to read this? Such a catchy concept, isn’t it? Especially if you get to build a six million dollar facility to “cut costs.”

"On-site clinics have undergone a huge transformation," said Marne Bell, a senior consultant at Watson Wyatt. "There's much more emphasis on prevention."

Gone are the days when on-site clinics were the sole preserve of manufacturing companies that founded facilities to treat employees' work-related injuries. Some three in 10 large employers -- from financial firms to hair-care companies -- have on-site clinics, offering everything from primary care to travel medicine, pregnancy support and nutrition counseling. Walt Disney Co. just broke ground on a $6 million, 15,000-square-foot health-and-wellness center for employees at Walt Disney World.

Those consultants at Watson Wyatt are so clever. I’m seeing the savings, aren’t you?

I mean, more lunchtime walks and taking the stairs instead of the elevator really makes a difference. Just think, you might burn five more calories taking the stairs rather than an elevator and this surely has been correlated with more days on the job, right? Or maybe the cost savings is because they never have to build any more elevators? (No, the disabilities folks won’t allow that.) And talk about savings, look at what most of these clinics do:

Preventive services, such as health screenings and immunizations, are the most common type at the latest wave of clinics, according to a recent survey by Watson Wyatt and the National Business Group on Health (WWBNGH).

Wow. Thanks for the info, WWBNGH! Screenings. Immunizations. I stand in awe. But I don’t know, don’t screenings require the worker to leave work to get screened? And how much money is saved on those immunizations? I mean, I’ve HAD all of my immunizations when I was a child, and now I just need an annual flu shot or maybe an occasional tetanus shot, so how many immunizations would I need to get in those clinics to break even on the construction costs for one of those six-million-dollar clinics?

Or maybe, just maybe, there’s an ulterior motive at play:

Four in 10 clinics offer pharmacy services, making it easier for those taking medications to fill their prescriptions.

Because of employees' concerns about privacy, clinics typically are run by outside parties. For example, Pepsi Bottling Group Inc. has contracted with Johns Hopkins University School of Medicine to operate clinics at its plants. CHD Meridian Healthcare LLC and Whole Health Management, which recently were purchased by Walgreen Co., and Marathon Health are among the vendors that specialize in providing work-site clinics. Depending on the scope of services, clinics can be staffed by physicians, nurse practitioners, registered nurses in isolation or in teams that can also include specialists, such as nutritionists.

There we go. The money. It’s all in finding the disease, isn’t it? Testing. Testing. Testing. Testing. We’ve gotta be SURE folks don’t get sick, right? And pharmacy services? Oh, baby, now we’re talkin’ dough!

And it needn't stop there.

"We recognized that there was going to come a point where we couldn't pass on the additional cost of providing health care to employees," said Jeff Shovlin, vice president of benefits at Harrah's. "We concluded that the only way to control costs was by helping employees to get and stay healthy."

The clinic, which is open to employees and their family members enrolled in Harrah's medical plan, has extended weekday opening hours and is open half-days on Saturdays. Patients get faster medical attention and longer appointments, for which they pay $10 copays.

A major focus is to delve deeper into patients' medical issues, educate them about healthful lifestyles and direct them to wellness programs.

Ooops.

Mr. Shovlin slipped. He actually said it: “We couldn’t just pass the additional cost of providing health care to employees.”

Oh, sure you can, Mr. Shovlin! Here’s how: by shovin' the concept of your “major focus” to “delve deeper into patient’s medical issues” to your employees! Just find those sick ones so you can remove them from your insurance pool or give them a higher premium! What a deal! You see, that’s how business works, Mr. Shovlin! You scratch my back and I’ll scratch yours. That’s right, Mr. Shovlin, if you find the sick patient’s for your insurer, we’ll give you a lower price on your policy with them.

Money, money, money.

Oh, baby, you gotta love "wellness" and those 12,000-square-foot gyms!

So here's the question: when a patient gets cancer, how exactly does your clinic and gym cut costs?

-Wes