Monday, August 17, 2009

Sensible Health Care

A doctor writes into the Daily Dish about the issue of the cost of health care:

I am a pediatric emergency room physician. I want to second what
the surgeon said
in his comments about saving the system money. In most
health care situations, there is absolutely NO incentive for physicians to do
so, and in many instances there are incentives to waste/spend as much money as

For example: when a young teenager comes into the emergency
department with chest pain, there is something like a 1 in 10,000 chance that
the pain comes from a serious cause in the heart or the lungs. In almost
every case these rare serious causes can be ruled out by talking to the patient
and their family and by examining the patient. In the vast majority of cases no
tests or specialists are needed. The visit can be brief, reassurance can be
offered to the patient and their family, and the bill should be around $200.
However, there is nothing to prevent me from ordering a whole battery of tests
in this situation, and I have seen other physicians and emergency departments do
just that.

EKG to rule out a heart attack, chest x-ray to look for pneumonia or a
collapsed lung, chest CT scan to look for a pulmonary embolus, outpatient
cardiac monitoring, referral to a cardiologist, lab work to look for infection
or electrolyte abnormalities, etc., etc. What started as a $200 visit is
now closing in on $15,000.

I can tell you from experience this happens every day in ER's around
the country. Furthermore, if I order a lot of tests and give a lot of referrals
to specialists, I make more money because I just made the visit more complicated
and I bill based on how complicated the visit was, the hospital makes more money
because they get to use all those expensive machines they invested in, and I
generate business for my colleagues in cardiology. Often, the patients are
happier with the "mega work-up" as well. There is absolutely no downside for me
to ordering tons of unnecessary tests (the same is true for unnecessary and
expensive medications). Rare exceptions to this are the best health care systems
in the country (Kaiser, Mayo) that actually do give physicians feedback
regarding their efficiency and outcomes. Not coincidentally, these systems spend
less money per patient and deliver the best care in the country by pretty much
any measure you can come up with.

No comments:

Post a Comment