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I Demand From Healthcare…

I am not a politician and can imagine being one is not easy. I’m told they are all in it for the money and are narcissists. I think I read the same thing about doctors. But I think healthcare needs a little help, and I’m unsure how much my actions will change healthcare without legislative change. So, here are my healthcare demands.

I also realize that everyone thinks the solution to a problem is always somewhere beyond their actions. In writing this article about my demands from healthcare, hopefully, I’ll figure out what my responsibilities are, too.

1. Transparent Pricing

If you’re going to play the health insurance game, you must publish all of your prices. Whatever you are reimbursing or charging any entity, your prices must be clearly displayed.

A medical group cannot charge one insurance company two different prices for the same procedure, and a health insurance company cannot reimburse two different practices for different amounts for the same procedure.

A knee replacement probably shouldn’t cost $89K at one place and $4.5K at another, unless, of course you can prove to me that your sprinkle fairy dust and your outcomes are way better, which you can do with #5 below.

2. No Corporate Practice of Medicine

If I’m a physician and hold a state medical license, my clinical decision should be the source of truth. No corporate entity can turn over my decision unless they can prove to a physician regulatory panel (#6) that I’m practicing bad medicine (#5).

We even have a law against the corporate practice of medicine; it’s just that it’s not enforced. Similarly, we have a vehicle decibel law, but my lovely neighbor gets to rev his Harley as loud as he wants on a Sunday morning. It’s not that I don’t want him to enjoy his ride, but if we have a law, let’s either get rid of it or only create laws we can enforce.

Currently, attorneys, court of law, your employer, medical guidelines, Uptodate.com, the state medical board, CDC, FDA, and your local state health department can decide how you can and can’t practice medicine. This is simply too many chefs in the kitchen.

3. Moratorium on Malpractice Suits

No physician can be sued unless gross negligence or intentional harm is proven. Not only must these be proven, but they must happen in the background without the physician being notified that it’s happening, or no record of it can show up unless the physician is found guilty.

I don’t want my delicate senses bastardized by your greedy attorneys or upset patients. Medicine is tough; people will die, and nobody wants that to happen. Some states have tried everything possible to minimize such claims.

If there is a disagreement about how things should have been done or if the patient feels they overpaid and wants restitution, they can take their case before an arbitrator or a medical panel (#6).

4. Universal Medical Licensure

If I have a CA medical license, you, TX, must prove to the rest of the US why I shouldn’t be allowed to practice in your state.

The only caveat I’ll give you is that if you have perfect access to primary care in your state (#8) and your state health literacy is in the 80th percentile (#9), you’re welcome to deny me a state license.

I’m all for administrative bloat to fuel the economy but when the majority of health dollars are going to admin, it’s time to demand more from our healthcare system.

5. Health Outcome Measures

This is the most significant point; all roads lead to this. Whatever you do, pay for, or don’t reimburse, whether you’re a commercial group, the government, a PA, or a physician, you must demonstrate better health outcomes for the patient.

What’s a better health outcome? We don’t need to get crazy here. We can start with:

  • Heart attacks
  • Strokes
  • Childhood mortality
  • Maternal mortality
  • Hip fractures
  • Cancer survival
  • All-cause-mortality
  • Obesity rates

Dr. Prasad has discussed surrogate endpoints in much better ways than I ever could.

6. Physician Regulatory Panels

Every physician must rotate through this panel once a month. You and six other fellow physicians will be randomly chosen to review all cases, regardless of their nature.

If it involves a patient, you’re gonna hear the case. Before the case goes before a judge, a lawyer, an arbitrator, or a state medical board, it must go before fellow physician peers.

Oh, you think that’s unfair because physicians will likely look out for fellow physicians?! Great, you found the problem; medical training must be changed in that case.

Denmark and Sweden have systems where physicians can report poor outcomes without fear of being sued. This is a step in the right direction.

7. Interoperability

My health data is my health data. You cannot sell it or use it in any way without my permission. You sure as shit can’t use it to figure out how to market more services to me or bill more off my back.

For this to happen, we need patients to be responsible for their health data. Did you get an MRI done? In the same way you’re responsible for having your account password, you must hold the DICOM images for your studies.

Your data, your responsibility. Why? Because otherwise, you’ll be taken advantage of. That is what Livv is trying to accomplish.

I despise HIPAA because PHI is used as a way to make medical groups and health insurance companies richer under the guise of “protecting” patient information. Trust me, I’m much more worried about my home address getting out than someone knowing that I had my balls chopped off (aka, vasectomy.)

8. Free Primary Care

The federal government must employ a 1:1,500 ratio of primary care physicians for any given community. I’m not just saying they should put up a position nobody in their right mind would ever fill. But a competitive salary where a private practice physician can set up shop in any city, anywhere in the US, tasked with 1,500 lives and handle their primary care needs.

Subsidize their loans, office rent, EHR, whatever, it doesn’t matter. You will give them compensation package that allows every single American access to basic primary care.

Need a specialist? Better buy health insurance or save money to pay for that specialist. Primary care? Always free. Frankly, I don’t care if it’s PAs, NPs, or MD/DOs, but the catch is that #5 must always be proven and met.

9. Health Literacy

What is the health literacy of the community you are in charge of as a mayor or governor? That’s your impact rating, and if it’s in the gutters, then, sorry, you need to spend more money on that.

I don’t care who you use to educate the public – put it on the health insurance companies, barbers, church leaders, or administrative staff, but you aren’t going to put it on the doctors. If you want to put it on the doctors, you must take something else off their plates.

10. Mental Health Parity

Are you paying for birth control, fractures, eczema, asthma, and diabetes? Then, you’re also going to pay for anxiety, depression, insomnia, schizophrenia, substance use disorder, and burnout. Don’t like it? You’re welcome to get the fuck out of medicine and start your business in the food industry – I hear fast food is doing quite well.

What About The Doctor?

Let’s say I’m ordering CBC panels for everyone. Since we have interoperability (#7), the physician panel (#6) can run random audits to see if my higher CBC ordering has resulted in better outcomes because I picked up more anemia or more asymptomatic ITP (yeah, right!). If so, great, Dr. Mo, please continue ordering your CBCs.

If not, you will be given a private letter of reprimand because you’re wasting resources and your patients aren’t having better health outcomes, which is the only thing we care about in healthcare (#5).

What about recertifying with ABMS for my board certification? That’s simple, too. Let’s look at the patient outcomes (#5) for all orthopedists and compare the outcomes of those who are board-certified to those despicable ones who aren’t. Oh, snap, it’s the same. Great, you’re welcome to continue to remain board-certified, but we can no longer conscionably demand that anyone be board-certified.

2 replies on “I Demand From Healthcare…”

Comprehensive. I like your ideas. But I dont believe much of anything will change in US Healthcare until a crises when all paid parties have to give up something for the system to survive. Now a few parties benefit way too much to incentivise them to negotiate. Probably just like Social Security, different groups have to give up a little for it to survive; we have to get to a millimeter of the edge of an abyss before doing something meaningful.

When it comes to mainstream US healthcare I don’t expect or would care for much to change. What I cherish about the US economy is the many parallel systems that exist simultaneously. You are quite correct in saying that we’d have to come together for major change to take place but that’s above my pay grade.
1. Transparent Pricing – this is something we already have in the cash-pay models.
2. Corporate practice of medicine – if I’m not contracted with any insurance company then they can’t overturn my clinical judgement.
3. Malpractice moratorium – avoiding malpractice insurance and doubling down on arbitration is the closest I can see us getting to this ideal.
4. Universal medical licensure – if anything, we are headed in the wrong direction here and not much I can do about it.
5. Health outcome measures – universally, not much I can do about this. Individually, I can help my patients decide on what is best for them based on real outcome data and not just surrogate markers.
6. Physician regulatory panels – again, out of my hands but arbitration is the closest thing to this.
7. Interoperability – also a fail for me but at least I can get my patients to collect their own data.
8. Free primary care – this definitely requires all of us coming together if we believe this is worthwhile.
9. Health literacy – as an individual physician I’ll have a tiny impact on this globally but I’ll have a 90% success rate with my own patients.
10. Mental health parity – I feel completely unequipped to handle most mental health cases which is a sad statement in primary care.

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