Disease Management System.

Andrew Weil is an internationally renowned writer on holistic health and wellness, I recently came across an article about him. 

Mr. Weil says "we do not have a health care system in America. We have a disease management system-- one that depends on ruinously expensive drugs and surgeries that treat health conditions after they manifest"

For details you can read this article. I agree with the idea that our main emphasis is biased more towards the health industry rather than the patient and primary care.

We do not emphasize as much about balanced diet, exercise and prevention as we do about emerging medications coming out soon or the latest and the greatest CT scan on the block. Health industry these days is targeted towards maximising profits.

Recently I overheard one radiologist bragging to the other "I have a 128 slice CT, what do you have?".  

Few months ago I had a pleasure of visiting Dr Shilpa P. Saxena's office during a meet and greet campaign for a new hospital my organization built in the area. 

She was indeed a breath of fresh air. She believes that patient makes better choices when they understand all the factors which lead to a diseased state. She is  the only physician I know who has a fitness centre in her own office. 

In her practice if a patient comes in with high cholesterol, he is not automatically prescribes Statins, but he is prescribed a regimen of work out and exercise. I wrote about obesity some time ago here, I think we need to work on these issues a little more.

I think we need more PCPs to fashion their practices along the same way.

About the picture: A new day.

Healthcare Being Sequestered!

President Obama signed forced spending cuts of $85 billion dollars last Friday. There has been a public outrage but it is already too late.

What does this mean for us? just $11 billion dollars spending cut for Medicare.

Yes Sir, Medicare is going to slash away $11 billion in payments to healthcare providers, this amounts to a 2% cut.

All Medicare providers including hospitals, doctors and other allied health services will get the brunt of this order.

It will also effect CDC, American Public health, FDA, Vaccination programs, education programs (HRSA) , substance abuse and Mental health services administration (SAMHSA) and community healthcare center patients.

Imagine this is only one sector, please go and search what is happening to your sector. 

PS: About the picture: Bend a slinky too many times and it will stop springing  back to its original shape.

Medicare Cost and Million Gazillion Dollars.

Recent new estimates from US government reported a 17.3% increase in health care spending as compared to the previous year. This is the largest jump in half a century. 2.5 trillion spent on healthcare was 134 billion more than last year. These are very huge numbers, beyond my comprehension. The way I see it they will continue to grow.

How we contribute to this cost, is best explained in the words of a patient I recently admitted.

ER called me regarding a patient who was unresponsive. She was in her late eighties. Patient had a comprehensive work up including labs, chest x-ray, EKG, cardiac enzymes and CT of the brain. These entire series of tests were predominantly negative.

When I saw her on the floor she struck me as all gray, her hair was all gray, skin ashen and face pale; like a flower dying slowly. She was still not responding to any commands, I saw that there was an order for a MRI of the brain and carotid ultrasound. After examining her I reviewed the records in the chart from the nursing home and among other things there was a DNR (Do Not Resuscitate) order in the chart.

I called the son and he asked me, what his mother was doing in the hospital. I told him about her grim status. He informed me that she was always good to him, he was her favorite.  She had started to deteriorate once dementia started to set it.   Now she had been non verbal for a year. She was like an empty shell. He decided to enroll her in hospice a year ago. I assured him that I will call hospice. Within few hours hospice saw the patient, I cancelled all pending labs and test and she was transferred to nursing home with hospice. 

Hospice patients just want to be comfortable, they do not want any heroic measures or any further diagnostic test. Even within twelve hours of her stay in the hospital, Medicare will be billed probably more then 15 grand, excluding bills from EMS etc. All of this could have been saved if someone had paid more attention to her code status at the nursing home, ER or on the floor.

The sad part is not just the cost of care but taking the opportunity away from some loved one to die in peace rather than dying with tubes coming in and out of you.

About the picture: I shot this at my backyard.

Medicare Cuts And My Plumber.

So there was a neurosurgeon who called a plumber for a house visit. The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said “Even I don’t charge this much after a surgery”. The plumber stood up, gave him a sly look and said,” well that is why I am a plumber now; I used to be a neurosurgeon”.

I mention this as I was talking to a cardiologist few days ago. He said we are one of the few professions where someone else comes in and informs you how much you will get paid, regardless of what you do. Next time when you have a plumber at your house. try telling him what you want to pay him but do not hold your breath. Unfortunately every year with Medicare cuts we are seeing more and more doctors changing the way they run their practices.

Now we can argue that physicians are still compensated well, but on the other hand they also do a phenomenal job in helping and saving lives. A bureaucrat sitting in his office can decide how much health care institutes and providers will be compensated. However, these bureaucrats do not get up in the middle of the night or drive 80 miles an hour to reach the hospital to save a life. Neither do they have to reach the hospital within 90 minutes because the sooner they perform the procedure, better the outcome. Nor do they perform a cardiac catheterization which literally saves lives. However one thing they will never be able to share, is the sweet feeling of contentment about making a difference in someone’s life. By the way this doctor after spending three hours will get a profligate check of $253.

A plumber was actually at my house this week. He charged me $50 for consultation and $260 for fixing a leak. He was out within an hour. On his way out I did ask him, “Hey were you a neurosurgeon before?”

About the picture: A billboard at 43rd and 7th, NY.