Healthcare: E.R. Doc on roots of our broken system

"Forcing doctors and nurses to focus more attention on record-keeping,
coding and reimbursement does not promote good patient care, and is
not cost-efficient....Physicians and nurses should do what they do
best and continue putting the needs of the patient above shareholder
and institutional interests. We can afford quality health care but
only if we eliminate the middlemen."

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ER doctor analyzes health reform debate

By Dr. Michael T. Rey
Asheville (N.C.) Citizen-Times
Oct. 23, 2009

This country needs radical reform to fix a health care system that
currently encourages poor-quality medical care and costs too much. A
universal single-payer system would put the focus back on patient
care, where it belongs, and reduce costs.

In my 30 years as an emergency room physician, I have seen the quality
of patient care plummet as a result of a lopsided reimbursement
system. Family physicians and general internists cannot make a living
providing basic health care unless they cram more patients into every
hour, spending less time with each. Other doctors can make a very good
living if they are "procedural specialists" (doctors who treat a few
medical problems, in a limited anatomic area, and do so using a
diagnostic or therapeutic tool).

This happens, in part, because billing codes favor "doing" over
listening, talking and thinking, even when the "doing" has no proven
medical benefit. An example is the "vertebroplasty" procedure that has
proliferated recently, in which a physician injects glue into a
patient's spine to bond vertebral compression fractures. A Mayo Clinic
study published in the New England Journal of Medicine questioned
whether vertebroplasty works, yet this lucrative procedure, performed
by orthopedic subspecialists, attracts more and more doctors, while
the number of general orthopedists, surgeons, internists, and family
practitioners declines.

Third-party payers (health insurance companies, preferred provider
organizations and HMOs) have tried to improve efficiency and increase
profits by controlling the behavior of doctors and nurses, rather than
by reducing paperwork and redundant documentation. Thus, under the
current system, doctors focus on producing patient records that are
designed less to document important clinical events or enhance patient
care, and more to maximize revenue and reduce liability. Nurses spend
less time at patient bedsides and more time at computer workstations.
Medical conferences now allocate large blocks of time to coding and
billing strategies.

Each insurance company has its own forms, fee schedules and
documentation requirements, resulting in wasteful duplication of
effort. Out of every health care dollar, a cut must go to the
transcription service, the company that assigns billing codes and
makes sure the physician's documentation supports the codes, and
collection services. Hospitals hire less clinical staff (nurses and
medical technicians) and more clerical staff (billing, coding, and
insurance collections experts). Entire floors of hospitals are devoted
to appeasing the administrative requirements of hundreds of third-
party payers.

Forcing doctors and nurses to focus more attention on record-keeping,
coding and reimbursement does not promote good patient care, and is
not cost-efficient.

A single-payer, public plan [not to be confused with "public option"
but instead an improved Medicare For All -ED] would eliminate wasteful
administrative requirements and ensure that economic factors unrelated
to patient care no longer drive health care decisions. Physicians and
nurses should do what they do best and continue putting the needs of
the patient above shareholder and institutional interests. We can
afford quality health care but only if we eliminate the middlemen.

The need for universal care is undisputed - our nation already
acknowledges that no one should suffer pain, disability or death as a
result of being unable to provide proof of ability to pay. The federal
Emergency Medical Treatment And Labor , passed in 1986, requires all
hospitals and ambulance services to provide care to anyone needing
treatment [in fact, however, they are unfortunately *not* required to
treat you, only to *stabilize* your condition (or claim they think
they have), an important point the public often misse -ED]

Having acknowledged the principle that everyone is entitled to care,
we should now fund that care. Like automobile insurance, health
insurance must be required, available and affordable for everyone.

Some opponents of health care reform argue that taxpayers will have to
pay too much for a single-payer public plan or see it as a "government
takeover." They forget that most health insurance is already
government insurance. Medicare and Medicaid payments provide more than
half of the average hospital's revenues. Few of those who heckle the
president at town hall meetings will refuse Medicare insurance when
they turn 65.

Our nation can no longer afford to accept the propaganda of third-
party payers [the for-profit insurance giant corporations, drugs-for-
profits companies etc], who claim that a free-market model is
appropriate for health care. Their free-market model has resulted in a
slow but unrelenting decline in the quality of medical care.

Dr. Michael T. Rey lives in Waynesville [North Carolina]. He is a
board-certified emergency physician and fellow of the American College
of Emergency Physicians. He has practiced in Western North Carolina
for 27 years.

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Protect yourself and your family, with information or to take action:

http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php

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http://www.healthcare-now.org/

And Myths vs Facts about Single Payer:

http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php
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