>With all of the factors leading to an overall increase in individual health literacy – self- quantification technologies, ubiquity of mobile devices, instantaneous information and communication – there is a crescendo of demand to improve how we make and keep people well.
People want to know what the Doctor knows. They want to understand the reasons for (often unnecessary) tests and procedures. People want to have some measure of control over their healthcare. What patients are demanding even extends to how they are treated in the waiting room, and the ability to bring their own information into decision-making about their health. This is not to say all patients are reasonable, or that people always know what’s best for themselves. I am a pretty terrible patient, as my wife reminds me.
I’ve seen articles written by eminently qualified experts stating they know exactly what is wrong with healthcare, and exactly how to fix it! Choose any ten of these pieces, and you will find 9 different ways on exactly how to fix it.
What’s mind-numbing to me, when reading about exactly how to fix it, is the level of focus on infrastructural and institutional changes. Whether it is legislation-driven or generated by a cultural shift, there is a stark imbalance of focus on changes Doctors need to make, and how to help them change. The “Demand it and they will comply” method seems to avoid ownership in anything more than demanding change. The size of the magic wand needed to change healthcare without changing perceptions and behaviors of the providers themselves will be large indeed.
Instead of adding myself to the “exactly” list, let me just share a few challenges to healthcare value, based on Lifetime Health Diary’s “get out of the office” approach to getting answers to problems challenging our clients. You can put these in whatever order you wish, but I hope to show why it is urgent to pursue better healthcare value now.
Most Doctors feel required to schedule patients for tests and procedures simply to protect themselves from being defendants for under-diagnosing or misdiagnosing a patient. Interestingly, while we complain about all the tests we have to go through, we seem not to be biased toward suing for being over-diagnosed. The cost of this common practice is injurious to healthcare value on many levels – and increasingly on the pocketbook of the healthcare consumer.
Growing patient caseload
In 2012, total healthcare expenditures were approximately $2.8 trillion. By 2020 – just around the corner, really – total healthcare expenditures are expected by most accounts to reach $4.6 trillion – in part because 16% percent of the US population will be over the age of 60 then. Most Doctors are experiencing escalating caseloads even before accounting for people newly covered under the Affordable Care Act. A primary care physician today averages a caseload of 3500-5000 patients. You can imagine the waiting room scenario and quality of care as the caseloads continue to rise.
Increase in bad debt and charity care
Increases in premiums, higher jobless rates, and higher deductibles – among other things impacting the underinsured and the uninsured – have contributed to a rise in uncompensated healthcare. In a January 2014 fact sheet by the American Hospital Association $45.9 billion in care went uncompensated in American hospitals in 2012, equaling 6.1% of hospital expenditures. In 2012, 41% of adults in the US reported having medical debt or problems paying medical bills.
Survivability of practices
Electronic medical records, meaningful use, ICD-10, and an increasingly health aware population are only a few of the forces placing financial pressure on medical practices. In a Physicians Foundation 2012 survey, 77% of 14,000 Doctors were pessimistic or very pessimistic about the future of their profession. Smaller practices are particularly vulnerable, as they have fewer resources available to accommodate needed changes.
What can we do now?
As you can see, making Americans healthier in comparison to what it costs to achieve has significant challenges. Patients are beginning to understand that innovations in medical technologies, and the passion applied to healing, are light years ahead of how practicing medicine impacts them. Meanwhile, Doctors are trying to find ways to just survive the profession-shaking demands being leveed on them.
With all of the challenges to solve in American healthcare, one thing is clear. Private practices have a higher chance to survive, if they make the following changes now: optimize operations to remove revenue loss, invest in patient-engagement technologies, focus like a laser on patient satisfaction, and fanatically measure patient population outcomes.