The media has been focusing on the healthcare reform for a while on whether to repeal and replace OBAMA’s healthcare with something more sustainable. Today, I am going to talk about something bigger than just anesthesia. I feel that as a healthcare provider, it is my duty to give feedbacks on our current healthcare system.
First of all, I feel that our healthcare system needs to be reformed. Let me give you an example on the unnecessary cost due to the failure of the fragmented system. My dad lived in Houston a few years ago. He has no significant medical history, no HTN/DM/obesity/CAD. He has no family history of HTN/DM/CAD. He has good exercise capacity, MET>4. He had number of lab tests done because he is over 65 including chemistry, hemotology, chest xray, EKG, GI scope. When he got all the tests done, he wasn’t given a copy of his lab/test results. My parents moved to California last year and they had to find new primary doctors. All the same lab tests were ordered by the new primary doctors. As we can see, the primary failure of today’s healthcare delivery system is our fragmented health care in its delivery. This fragmentation contributes to the spiraling costs and poor quality and performance of healthcare system. The main issue is the lack of policies guiding the health care system at the national, state community and practice levels. For example, at the provider’s level, they may care for the same patients but not aware of it within or across the system, which often results in medical errors, waste and duplication of testing, Primary care is a good example of this poor delivery system. In order to change this situation, providers both within and across the system should have access to patients’ clinical information at the point of care via electronic health record systems. All the providers should review each other’s work to reliably deliver high-quality, high-value care.
In addition, the fee-for-service should be reformed because it creates a clash force among different providers, facilities and insurance companies. For example, high-cost medical interventions are ordered by the providers/facilities to receive higher value reimbursement whereas high value primary care is not well reimbursed. They should coordinate and collaborate with each other to delivery the efficient but high quality patient care. Furthermore, advanced nursing practioners and/or physician assistants should be fully utilized particularly in primary care setting to increase accessibility and reduce cost of care. For instance, my parents had to make an appointment with their primary doctors well ahead of time by a month or two to be able to secure a spot. There are no NPs/PAs available as their primary providers. Similarly, CRNAs as anesthesia providers that can work independently or under supervision, can play an important role in pain management and anesthesia where there are more Medicare beneficiaries. Medicare significantly cuts down anesthesia payment by 40% in 2010, resulting in inaccessibility to anesthesia services to people living in poverty and without health insurance. CRNAs provides an excellent value by reducing workplace costs while delivering a high quality of anesthesia service. This will significantly reduce the cost for the facilities and pass the saving to the insurers in the upcoming health reform.
I used to work for Kaiser and I feel that Kaiser is a great model for us to learn from if we want to reduce our overall healthcare costs. The reason that Kaiser has a place in the future in healthcare reform is that it combines insurance plans with its own hospitals and clinics, thus, there is no clashing force among hospitals, insurance companies, and providers, nor fragmented healthcare delivery. Specifically, prevention medicine is a priority and they did a great job with it. For instance, they follow up diabetic patients well and come up with ways to ensure their compliance. Hence, Kaiser can save money over the long run by reducing diabetic associated diseases. We need to rethink about our healthcare system fundamentally. Our health spending is estimated to grow 1.0 percentage faster than GDP per year from 2017-2026 and it would account up to 19.7% by 2026.
It is time for us to re-engineer our healthcare system!