Journalists typically aren’t schooled in high-level advanced economic thought. I am certainly no exception to that rule.
But after covering the business of healthcare for 25 years, that doesn’t stop me from looking at some standard operating procedures in healthcare and scratching my head in bewilderment.
Systems evolve over time, and healthcare is no exception. Providers respond to various stimuli. Sometimes, the consequences are intended; at other times, the evolution has unforeseen and counterproductive results.
Healthcare is dealing with the results of choices made years ago, resulting in the world we have today, and undoing those choices is often painful and expensive in the short-term. However, I firmly believe that they must be addressed for the system to be set right, to encourage cost-efficient, effective and safe care.
Here’s my top-of-mind list of five things that need to be fixed if American healthcare ever is going to achieve its full potential.
Increase the number of primary care physicians. Alas, this is easier said than done, even if it sounds like it makes perfect sense. Currently, 70 percent of the students graduating from medical school are opting to become specialists. There are many reasons behind this, but chief among them are the dollars. Some specialists are making three and four times what a primary care physician earns on average – if times are good for PCPs. And with the vagaries of Medicare payments and threatened rate cuts, times don’t seem good now.
There are other economic disincentives for those who might consider providing primary care, such as overhead expenses, administrative hassles, malpractice rates, technology investment and so on. It’s no wonder that an increasing number of physicians are giving up the dream of having their own independent practice and are seriously considering becoming employees of hospitals or health systems. With promising reform initiatives such as patient-centered primary care predicated on having a supply of PCPs, these economic factors need to be reversed.
Reverse the dwindling number of registered nurses. The demographics look grim for nursing. The average age of nurses is high, and more nurses and nurse educators will be retiring over the next dozen years. The number of nurses entering the profession isn’t large, and many aren’t staying in hospitals more than a couple years; they realize they have options and aren’t willing to work in difficult environments.
Studies have indicated that patient safety and care improve when nurses increasingly provide hands-on care for patients. There needs to be a serious, impartial study of the effects of increasing nursing intervention, and hospitals need to reverse the negative aspects of their working environments. With costs to recruit nurses now running in the tens of thousands of dollars, employee turnover represents a huge waste of money.
Provider-payer transaction cooperation must rise. Estimates suggest that 25 percent of America’s healthcare dollars goes to administration, and that’s an unpardonable waste of money, not with the financial pressures that healthcare places on providers, health plans, employers, consumers and the nation. With the nation expected to spend $2.4 trillion on healthcare in 2008, that would mean $600 billion spent on administrative expenses. Are you kidding me?
Providers and payers need to convene immediately to figure out how to streamline healthcare administration in every way possible, whether that be through real-time transactions, eliminating proprietary formats and plan-specific claims requirements, or other means. Funds could be poured back into disease management, improving patients’ quality of life and saving even more money downstream.
Reform malpractice laws and scale back defensive medicine. The specter of legal action undergirds a significant percentage of medical testing and physician decision-making. There has been some tinkering with malpractice reform over the years, and some states have enacted legislation. The issue needs to be seriously studied, and there needs to be a unified approach that protects everyone, including providers and patients.
Implement electronic medical records. Just having a computer running a gee-whiz software program won’t solve the healthcare crisis, but it would provide the data, communication and information for providers to do a better job. If medical histories could be seamlessly shared, there would be better care and fewer