My thoughts on this article:
One of the biggest misconceptions held by medical students today is that family medicine is not one of the more challenging specialties. Coupled to the fact that family medicine is one of the lowest paid specialties, it’s no wonder that few of our brightest med students choose to enter a field where there is, ironically, the most need for good physicians.
The following should be considered a truism in medicine and is dangerously overlooked: “But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.”
If the U.S. healthcare system started focusing on preventative care and finding the roots of patients’ health problems rather than treating the problems after they’ve already surfaced, we could save an exorbitant amount of money that is usually spent on expensive prescription drugs and procedures. The 39 year-old patient with uncontrolled diabetes and hypertension is a great example of this. Most physicians would have simply increased his insulin dose and changed his high-blood pressure medicine, but instead Kathy Jackson, a nurse practitioner, visited the patient at his home and found that he was living in a completely unsanitary environment, one where taking medications regularly is the least of a patient’s concerns.
The Camden Coalition demonstrated on a small scale the enormous impact that practicing preventative medicine could have on our healthcare system: The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. [The patients] averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction.
Until the U.S. adopts a sensible, single-payer/Medicare-for-all system, this is an excellent temporary solution: “…to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.” Reinventing medicine from the inside, so to speak.
The diversity of career opportunities within medicine is one of the many things that initially attracted me to this field. It was great reading about physicians like Brenner who monitor ER visitation rates in cities like Camden and use the data to improve the lives of their patients and reduce costs by starting house call services, to physicians like Gunn who analyze patient data from clients who provide healthcare benefits and discover trends such as the fact that the top five percent of spenders account for sixty percent of the spending. This is known as healthcare hot-spotting. “We’ve been looking to Washington to find out how health-care reform will happen. But people like these are its real leaders.”
If patients can’t afford regular physician checkups and preventative care, they will have no choice but to wait until their health takes a turn for the worse and then show up at the ER. This ends up being significantly more expensive than if we would have simply made preventative medicine affordable in the first place. This is similar to the healthcare systems of Mayo Clinic and other Group Employed Model (GEM) clinics such as Bassett, and kind of brilliant: “The Special Care Center reinvented the idea of a primary-care clinic in almost every way. The union’s and the hospital’s health funds agreed to switch from paying the doctors for every individual office visit and treatment to paying a flat monthly fee for each patient. That cut the huge expense that most clinics incur from billing paperwork. The patients were given unlimited access to the clinic without charges—no co-payments, no insurance bills. This, Fernandopulle explained, would force doctors on staff to focus on service, in order to retain their patients and the fees they would bring.”
The use of health coaches is another great idea that should be more widely implemented. Overall, the Special Care Center system reduced emergency-room visits and hospital admissions by more than forty per cent. Additionally, surgical procedures were down by a quarter. And most importantly, the patients were markedly healthier. There was also a twenty-five percent drop in healthcare costs for the union.
Politics as usual is the major hurdle to implementing these much needed changes in healthcare at the national level. I’m reminded of this quote: “Medicine is a social science, and politics is nothing but medicine on a grand scale.” Rudolf Virchow