As a double board-certified physician in internal medicine and gastroenterology, Matthew Moeller penned a letter in 2013 to CaduceusBlog and reprinted in the KevinMD blog that garnered 72K shares.
The author of What It’s Like to Become a Doctor: A Year-byYear Journey from Medical Student to Practicing Physician, Moeller trained at the University of Michigan and at Henry Ford Health System in Detroit and currently practices gastroenterology in Michigan.
Moeller shares his thoughts on how to achieve better and more affordable care.
Q How are healthcare costs and reimbursement tied to better healthcare?
A Unfortunately, the medical billing system is unique, confusing, and wrong. The charges (bills) that patients see in the mail are not what doctors get paid. These are inflated numbers derived from contracts between hospitals or groups and insurance companies. In fact, those bills do not go to the doctor at all, but rather to the hospital.
Doctors’ payment systems confuse patients and cause much anxiety when patients try to decipher a bill. It apparently is even perplexing to lawmakers and to the president, who try to modify reimbursement yet do not understand how doctors get paid.
Doctors are getting paid much less than it appears. We need to simplify costs and reimbursement and make bills more transparent so patients know exactly how much the doctor is getting paid.
Q Are there legislative changes that could bring about more affordable care?
A Doctors have a calling to help patients, but as we all are human, we all make mistakes. It is important that patients who are injured by medical mistakes be compensated as the law is supposed to allow.
However, the law is supposed to sort good healthcare from bad healthcare. Instead, it is run ad hoc, jury by jury, with no set standards. The system may favor a doctor even though a mistake was made, or it may favor a patient if no mistake was made. This unreliability leads to defensive medicine — doctors ordering tests and procedures just to prove that they did something or excessively documenting trivial facts to prove they looked at everything.
Having said that, if the doctor did do something wrong, the patient is still taken advantage of under the current tort system. Thirty-nine percent of cases take three years to settle, and 60 cents on the dollar goes toward lawyer fees and administrative costs. Patients definitely deserve to be compensated for poor healthcare, and this current system fails them.
The answer rests in healthcare courts described by Common Good founder Philip K. Howard. He proposes that expert judges without juries would determine what is good versus bad care. This would provide consistent standards of what is required in specified healthcare situations. It would benefit patients because they would not spend three years dealing with the jury system nor pay trial lawyers for a case they may not even win; it would benefit physicians because they could act on their best professional judgment without the threat of being held liable when they did nothing wrong. It would let us do our jobs without being smothered by lawyers looking over our shoulders, yet provide patients with fair, consistent rulings in cases of being wronged.
By creating clear standards of care, healthcare courts will allow judges to dispose of weak and invalid claims quickly while also disincentivizing doctors and insurers from defending cases in which they are clearly at fault.
Q How can patients take a role?
A Increasing patients’ roles in their healthcare would lead to higher patient satisfaction and lower costs. For patients to play a larger role, hospitals’ and doctors’ prices need to be more transparent and reflect true costs so patients know what they are buying. Currently, that is impossible. Hospital and doctor bills make little sense, are inflated (as described earlier), and do not reflect true costs, leaving patients confused about actual costs of their health.
During the final six months of our lives, we spend up to 50% of our total lifetime healthcare dollars. In America, when patients are extremely sick and brought into the hospital, everything in our medical repertoire is used to keep them alive. Costs can be up to $10,000 per day of ICU care, not including other aggressive measures.
Doctors are not introducing hospice to patients early enough. Instead, many families are faced with their loved ones spending their last months in an ICU, hooked up to breathing tubes, only prolonging the inevitable. Patients and their families are being deprived of spending that time at home in a more comfortable setting.
Many patients’ families want more and more treatment even though it is futile; however, with our culture in medicine of always appeasing the family members and patients, we daily deliver care that is likely hopeless. It costs hundreds of thousands of dollars and does nothing to prolong the patient’s life. I believe that a lot of this type of care could be prevented if doctors had more frank discussions with their patients and their families about their prognosis.
Q What role does preventative medicine play?
A Chronic illnesses such as heart disease and diabetes end up being expensive for Americans as they age. We are good at treating complex medical problems with patients who are very sick, but not very good at reducing medical costs through preventative medicine. We are good at bringing a new state-of-the-art drug to the market, but bad at preventing the need for that drug in the first place!
Although Americans spend a lot of money on healthcare, the United States is ranked lower than most other [developed] countries on healthcare outcomes because we do so little to prevent patients from getting sick in the first place.
Q Are there other money-saving measures that hold promise?
A Rein in the number and salaries of hospital administrators. A May 17, 2014, New York Times article by Elisabeth Rosenthal summarizes this issue well. While reimbursement for office visits and procedures falls to less than 50% through many of the exchanges and other government-based programs such as Medicare and Medicaid, CEOs and hospital administrators continue to financially outpace their colleagues in other sectors of business.
The number of administrators has risen 2,500% over the past decade while the number of doctors has risen by single-digit percentage points. In addition, the high salaries of these administrators account for to up to 30% of all healthcare costs.
I believe that by empowering patients in the healthcare system through health savings accounts, reforming our tort laws, making costs more transparent, being more realistic about end-of-life issues, and living healthier, we can create a system that can benefit everyone.
Adapted from What It’s Like to Become a Doctor: A Year-by-Year Journey from Medical Student to Practicing Physician by Matthew Moeller, MD. https://shop.physicianleaders.org/collections/all/products/what-its-like-to-become-a-doctor-a-year-by-year-journey-from-medical-student-to-practicing-physician