HEALTH CARE 2012

I am always amazed when I receive a comment on a posting years that I did years ago.

Today ,this was in my email: Rajesh Attri has left a new comment on your post "HEALTH CARE #1": "Nice post!!"

That is very pleasing but it was in June 2009 that I wrote a series of 5 postings about the changes in Health Care. Going back the easy way by clicking the link I felt the need from a consumers point of view flavored by 50+ years of intimate association with patient care to update a review of today's model.

Much of the changes are the results of the public developing a concept that health care is a commodity which can be obtained as if it were an automobile or dinner in a restaurant. That concept has been encouraged by the politicians and the social reformers.

An essential element is now almost completely absent. That is the personal relationship; the human touch and what was known as bedside manner.

This change is the direct result of the insurance carriers and the government treating it as merchandise. Every aspect has a set value in dollars and time. New Federal Laws insist that every physician's office and facility use electronic records. This is being enforced by penalizing those that do not comply with fines and reduced reimbursement.

To complicate matters; prescriptions must no longer be written but transmitted to the pharmacy electronically. The MD is punished if he/she fails to do so.

Additionally, every office must have a Photo ID of each patient, and included is a drivers license data. All records of residence, insurance etc must be updated per visit. I If any of this is missing the practice is subject to financial penalties, Big Brother is watching; shades of Orwell. I suppose after 90 years I have become a terrorist or a defrauder.

The electronic records idea for sharing information is fine in theory. However, if each different practitioner adds to it much will be of no value an ignored by the next doctor or "Health Care Provider" to see the person.

The Records themselves contain a great deal; of "cook book" information. Such data is worth only the integrity of the entering provider. Some will just check the box.

A further trouble with EDR (electronic data records) is in the fact that there are several vendors of hardware and software programs. Since the software is proprietary; some systems may not speak to others.

Additionally all records will be cloud stored. No matter what the "experts" tell us no server is safe from hackers or potential failure with loss of all data. Even a back up system is not 100% infallible. And don't forget that those who have Medicare in supplying their insurance coverage are including their Social Security number.

The electronic record systems are expensive and software licenses must be renewed annually. The cost is so great that an individual physician practice will have difficulty affording unless it is one of the exotic specialties.

These regulations and rules have caused a major change in both outpatient care and inpatient hospital care. As noted group practice is now the norm. The emphasis is businesslike and on productivity. Much of the patient's visit is conducted by assistants; nurse practitioners, physicians assistant, technicians, social workers. The doctor is now a manager who sees the patient at the end of the visit when all data has been complied. He may or may nor amplify obtaining information but will spend his few minutes with the parent based on what others have collected. The human touch is gone.

I grant that not all practice areas are as bad as above; but with fees dictated and with increased costs of running an office and practice more will fall into the above mode.

In emergency occurring out of office hours the custom now is to refer one to the Emergency Room. Your physician may then be contacted but your initial care will be in the ER doc's hands. When or if your physician or his substitute is notified depends on the ER.

The ER visit itself can be an adventure. If there is a question that may need observation the patient may not be admitted into the hospital itself but held in what is known as a n observation unit which is considered to be outpatient and merits a greater reimbursement from insurance or government carriers.

Increasingly, doctors who have outside practices no longer spend the time seeing patients in the hospital but relegate their care to a hospital employed physician. In some places or services this is required.

Briefly. health care has become a business and must be treated as one.