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medpundit |
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Thursday, October 31, 2002In the next two years, the government should issue standards to evaluate treatment of 15 common health conditions, like diabetes, depression, osteoporosis, asthma, heart disease and stroke. By 2007, doctors, hospitals and other other health care providers in the six federal programs would have to submit data to the government showing how they treat patients with any of the 15 conditions. Starting in 2008, each federal program would publicly report data comparing the quality of care available from health care providers who treat its patients. Although on the surface this sounds like an inherently good thing, in reality it’s a much more costly approach to providing medical care. For one thing, who defines what “good care” is? Just two years ago, “good care” would have been putting all post-menopausal women on hormone replacement therapy whether they wanted it or not. As things stand now “good care”, according to our government, is ordering mammograms on women in their forties although the latest studies suggest this is neither cost effective nor of a benefit to them. "Good care” is putting everyone with certain choleseterol levels on expensive cholesterol lowering medication, whether they want to take it or not, even though high cholesterol is only one of many risk factors in heart disease, one that can be controlled with diet and exercise, and one whose improvement reduces heart disease by only three to four percentage points. "Good care” is ordering $200 bone densitometries on every woman over sixty-five every two to five years. "Good care” is getting diabetics blood sugar readings below a certain average, their cholesterol below a certain number, and their blood pressure below a certain level - all of which can add up to a lot of expensive drugs and result in only a marginal improvement in outcome. The truth is, that such “quality standards” are usually reduced to easily observable data, such as lab values or claims data. The result is that the doctor becomes more concerned with the data than with the patient. That’s why you’ll find cardiologists insisting that their patients remain on blood thinners even though they’ve just bled into their brains, why you’ll find endocrinologists increasing insulin doses even though the patient is passing out with occasional episodes of hypoglycemia, and why you’ll find doctors putting people on two or three cholesterol lowering medications - all in an effort to force down a number on paper. These kinds of guidelines will only increase the overall amount of money spent on healthcare, and make doctors more likely to aim their treatment goals at achieving "averages" rather than individualizing care. Then there’s this aspect of it: The recommendations assume that doctors and other providers will take major strides to computerize medical records, perhaps with tax credits and other federal incentives for the purchase of information technology. Under the panel's recommendations, Dr. Omenn said, health care providers would have to submit "audited patient-level data," and it makes no sense to cull such information from paper medical records and insurance claim forms. Current computerized medical records systems are expensive and have yet to reach a level of design that makes them very useful. We’re still waiting for a good system that works better than paper. Although in theory, they should speed up the documentation process, I’ve had a lot of physicians and “efficiency consultants” tell me that in reality they slow down the patient flow. Forcing doctors to convert all of their current paper records to electronic ones will be a very expensive proposition, and one whose costs will end up being born solely by the physicians. If this requirement goes into effect, you can expect a lot more physicians to drop Medicare and Medicaid. posted by Sydney on 10/31/2002 06:41:00 AM 0 comments 0 Comments: |
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