 |
|
 |
 |
| |
|
|
| |
| Healthcare Reform Outside the Box: Top-down or Bottom-Up? |
 |
by Donald Correll, M.D., FACEP - May 31, 2011
|
We’re caught in a system that seems like its going one way only: To ever-increasing costs and ever-growing utilization. Whether you’re for or against “socialized medicine,” that is what greater than 50% of our business is in most healthcare venues. You can be against the present system but, nonetheless, we’re caught in it. In trying to address the system’s shortcomings policymakers continue creating more of the same in various permutations.
As everyone knows, the present system has failed to control costs. The reasons for this are manifold. Here are some:
-
Medical providers are deriving financial benefit from increasing services that may or may not be indicated (but not you or me, of course)
-
Increasing and improving technology has become the “Standard of Care” (term the plaintiff bar loves)
-
Due to increasing survival the population continues aging
-
Increasing medical liability in real or perceived terms by medical providers is increasing the practice of defensive medicine
-
Patients and families are demanding and expecting increased services
-
End of life care that did not exist several decades is leading to vegetative and moribund patients kept alive per family’s request who have no financial concerns in the care
-
Hyper-specialization of medical professionals is leading to costly compartmentalization of training and patient care
-
Procedure reimbursement is favored over evaluation and management reimbursement
-
Shortage of healthcare providers is increasing the cost of care
Our healthcare system is mainly a Top-down System, especially as pertains to the financing of it. It has taken to restricting payments and mandating medical behavior from a Central Authority (The Top). This approach has failed to control costs. Here’s how it has become manifested:
Restriction of Payments
-
DRG’s
-
Accountable Care Organizations (ACOs) – new and upcoming
-
Health maintenance organizations with capitated payments (not loved by some)
-
Usual and customary charges (in the beginning)
-
Co-payments for some classes of patients
-
Fee schedules
Mandated Medical Behavior to Control Costs
-
Length of stay initiatives
-
Admission bouncebacks not being reimbursed to decrease this from happening
-
Core measures
-
Best Practices and Evidenced-based care initiatives
The result is: Well-intentioned healthcare cost containment measures fail to promote sufficient individual and system incentives to control and possibly decrease costs. Mandates and Core Measure Initiatives, which may be of benefit to patients, fail to address human nature in a proactive and constructive manner for cost containment.
Therefore, I recommend that we create incentives for the desired utilization behavior we want. These incentives to control healthcare costs must be mainly through a Bottom-up approach. I recommend that this approach take the following form:
-
Patients would receive payment, or benefit, for not over-utilizing healthcare (you get what you subsidize).
-
An annual patient account (a modified Health Saving Account) would be provided from existing expenditures.
-
Payments for healthcare would be paid on a percentage of charges from the patient account.
-
Disease management, such as hypertension, diabetes, cholesterol, immunizations and congestive heart failure, would be paid fully from the central third party payor without involving the patient account as long as program targets are adhered to by the patient or family and by the medical provider.
-
Any residual amounts remaining at the end of the specified time period would be divided between the patient or family and the central third party payor on a percentage basis.
-
In the event that the patient’s account was totally depleted, the third party payor would reimburse healthcare costs as performed currently for that annual period.
Example for Discussion Purposes
Medicare or Medicaid patient would have $2,000 per annum placed in their account, which can only be accessed to pay medical bills. CMS would pay 80% of a bill and the patient’s account would pay 20%. At the end of the annual period, if $1,000 was left in the patient’s account, the patient or family would receive 50% as cash and the rest would be returned to the patient’s account for the following annual period with additional amounts deposited by CMS to achieve $2,000 again.
Conclusion
With this Bottom-up Approach, healthcare providers would see a decrease in healthcare utilization in many areas of practice. Conversations between patients or families and medical providers would address not only the necessity of tests, procedures and treatments but also address the actual costs that would be incurred to the patient or family. This would generate not only cost containment but also produce savings that could decrease the cost of healthcare. For some it may not be pleasant to have these interactions, but the alternative is to continue in a non-sustainable system that will require rationing of care and payments from the Top-down.
Donald Correll, M.D., FACEP
Author of Acute Care Protocols for Physician Assistants and Nurse Practitioners and also The Practice Guide for Physician Assistants and Nurse Practitioners
www.acutecarehorizons.com
acutecarehorizons@gmail.com
870-423-4008
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
|
|
|
| |
|
|
 |
 |
|
 |
 |
 |
|
