Healthcare_Problems

Major Problems with Healthcare Quality The major problems with healthcare in the United States can actually be summed up with one statement: Most Americans feel they have the best healthcare in the world but the system which delivers it is the worst. Why is this, and where or with whom does the blame lie' That answer is not so simple because one could argue the blame lies in every aspect of healthcare delivery from physicians feeling forced to practice defensive medicine and therefore ordering unnecessary treatments and procedures simply to ‘cover’ themselves to hospitals and other healthcare delivery services with no discernable accountability over-charging the private insurance and private consumers to make up deficits caused by capped government payments, and the list goes on. The question of basic quality is always in question. For decades Americans have heard healthcare horror stories of the wrong patient being operated on or a patient being admitted for minor surgery developing a major infection which leads to death. Consequently, consumers have become more savvy regarding healthcare and hospitals, physicians and other healthcare services are forced to become more transparent, they are demanding higher more expertise and higher quality. “Quality typically means different things to different people, and definitions of quality can incorporate various perspectives, depending on what individuals value most. Over the years in health care, we have become more precise in defining quality.” (Curran, C., & Totten, M. (2011). Since the passage of the Healthcare Reform Law, healthcare agencies will now be accountable to a higher standard of care and if they fail, monetary fines will be imposed. Healthcare Reform Americans are scared and confused about the new Healthcare Reform Law, it is far too complex for laymen comprehension and no one, from the President on down has explained it in an understandable way. “More than 2,100 adults were given a list of 18 reform items and asked to identify what’s included and what’s not included in the law. Only four items were correctly identified by the majority of those polled” (Anonymous, U.S. Newswire, 2010). Unfortunately, in the United States, the majority of the population does not read their news. They watch it on television and if people are affiliated with a certain political party, they may watch Fox News, if they identify with the other party; they may watch the programs on MSNBC. These news organizations are so radicalized that every story or “news item” regarding healthcare reform is imbued with that particular parties’ politics. Even people who do read their news get the same marginalized reporting depending on which news organization is doing the reporting “The level of ignorance and misinformation is astounding. It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don’t actually know what is or is not in the actual legislation.” (Anonymous, U.S. Newswire, 2010). Another problem of healthcare in the United States is defining and then achieving quality in the most efficient manner. The Centers for Medicare & Medicaid Services (“CMS”) is an agency that most American adults have heard of but does not fully understand. In addition to dispensing Medicare and Medicaid dollars to individuals, another role of CMS is to survey and investigate all healthcare agencies which receive Medicare/Medicaid funding. “When patient and families complain about nursing care, medication errors, poor infection prevention, or patient rights violations, the Center for Medicare & Medicaid Services (CMS) and state agencies are expected to investigate the validity of those complaints.: (Elzer, R.. (2010). State agencies are the first line of investigation and, often, the Federal Government will conduct a “look behind” investigation of the state agency to make certain the state’s findings are correct. It is part of a system of checks and balances utilized in the United States. While necessary, these agencies employee thousands and this is a major contributing factor to the high cost of healthcare. Every healthcare organization that accepts federal and state funding must comply with the survey process or the organization will risk losing that funding. In Long Term Care surveys are scheduled on at least an annual basis. The healthcare facility never knows when the survey will occur; it is generally every 12 to 15 months. Facilities are required to place survey results in a public area within the facility and post a notice to the general public with directions where to find this information. In addition, the survey results are posted on the internet, usually the state agency website. CMS rates the facilities based upon the survey results using the star system as a rating tool. A “5 Star rating” is considered excellent, a “1 Star rating” is considered deficient on many levels. The rating system utilizes many factors which include, staffing ratios, medication error rate, cleanliness of the building, adherence to life safety code, interview of patient/resident and family members, the number of deficiencies the facility has received and many other factors. CMS has devised standards for compliance and failure to meet these standards result in deficiencies. The deficiencies are given weight according to scope and severity. The more often a surveyor witnesses a deficient practice affects the scope and the magnitude of the infraction affects the severity. “When surveyors can substantiate the issues or complaints, on the basis of detailed information provided by observation, investigation, and family complaints, condition and standard level violations rise, bringing more hospitals or nursing facilities close to CMS’s immediate jeopardy and could even result in Medicare termination” (Elzer, R.. (2010). Losing Medicare funding can cripple a healthcare facility irreparably so it is, understandably, in the healthcare facilities best interest to remain in compliance. With the new healthcare reform law, a compliance program is now mandated whereas in the past it was merely a good idea. Physician Services Another problem in American healthcare is the inconsistency with which healthcare is prescribed by physicians. The cost and quality of healthcare go hand in hand. “Too little care (underuse), incorrect care (misuse), and too much care (overuse) raise concerns about both the quality and the cost of care.” (Avraham, R. (2011). Underuse occurs when people cannot afford to carry health insurance. Maybe these people know about health maintenance and attempt to lead a healthy lifestyle but, more often, this is not the case. Too often in the United States the uninsured neglect healthcare maintenance until a condition arises which can no longer be ignored and only then will they seek healthcare. Often, by this time, the condition is in such an advanced state the cost of healthcare is astronomical and cannot be paid for. The uninsured person cannot pay and the healthcare facilities must then write-off the expense and attempt to pass this cost along. Misuse occurs when a patient is prescribed the wrong medication or the wrong treatment and as a consequence the patient must be hospitalized to reverse the condition. Misuse is often the result of physicians who may be exhausted from being on call too long and overly tired and as a result make mistakes or it could be something as simple as ineptitude or carelessness or incompetence. Overuse can happen for many reasons, physicians practicing ‘defensive medicine’ in an attempt to prevent malpractice claims. Or, perhaps the physician orders excessive tests to “pad” their reimbursement. Or, as often happens, physicians order procedures, labs, or tests with no idea of the cost. I personally see this practice on a daily basis, physicians often order whatever medication the pharmaceutical salesman recommended to them that morning never stopping to consider a lower cost alternative. American physicians have been elevated to ‘godlike’ status in our society for generations and because of this many conduct themselves as if the rules of economy which factor into any other business in a capitalist society do not apply to them. “Overuse can occur because of compassionate medicine, that is, excessive care provided because doctors compassionately opt to do the most they possibly can for a patient, especially when the patient is dying.” (Avraham, R. (2011). Overuse is of compassionate medicine is a noble gesture, we are taught as healthcare providers to exhaust every alternative to save lives, regardless of cost. With the recent, extended “healthcare debate” there was controversy over ‘death panels’ the idea behind the controversy was the government should not pay physicians to discuss end of life issues with patients. This was ridiculous, of course, because discussing “Advanced Directives” has been a part of the American healthcare system for decades. It simply provides each person the opportunity discuss their healthcare options and choices. Questions which are discussed include: “Have you designated a Medical Power of Attorney'”, “In the event it becomes necessary, do you wish live supportive measures be implemented to sustain life'” These types of questions are asked to every one of us prior to every hospital admission and have never been considered controversial until recently. Cost Why does U.S. healthcare cost so much more than any other industrialized country' From the CMS Office of the Actuary “U.S. health care spending growth decelerated in 2008, increasing 4.4 percent compared to 6.0 percent in 2007, as spending growth slowed for nearly all healthcare goods and services, particularly for hospitals. Health spending growth for state and local and private sources of funds also slowed while federal health spending growth accelerated in 2008. Total health expenditures reached $2.3 trillion in 2008, which translates to $7,681 per person and 16.2 percent of the nation’s Gross Domestic Product (GDP). Despite slower growth in overall health expenditures, the share of GDP devoted to health care increased from 15.9 percent in 2007”. (Healthcare Economist). Please see the CMS tables listed below of the National Health Expenditure Growth Rates: Type of Service/Product | 2008 | 2007 | Hospital | 4.5 | 5.9 | Physician and Clinical Services | 5.0 | 5.8 | Other Professional Services | 5.6 | 6.5 | Dental Services | 5.1 | 6.2 | Other Personal Health Care | 2.6 | 5.8 | Home Health | 9.0 | 11.8 | Nursing Homes | 4.8 | 5.8 | Prescription Drugs | 3.2 | 4.5 | Durable Medical Equipment | 4.1 | 3.3 | Other Non-Durable Medical Products | 4.2 | 5.9 | Source: www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf Payor | 2008 | 2007 | Medicare | 8.6 | 7.1 | Medicare FFS | 5.3 | 3.8 | Medicare Advantage | 21.3 | 22.1 | Part D | 10.0 | | Medicaid | 4.7 | 6.1 | Federal Medicaid expenditures | 8.4 | | State Medicaid expenditures | -0.1 | | Private Health Insurance | 3.1 | 4.4 | Out-of-Pocket | 2.8 | 6.0 | Source: www.com.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf “The growth in healthcare spending has outstripped economic growth regardless of the source of its funding. The major factor associated with that growth has been the development and increasing use of new medical technology. In the healthcare field, unlike in many sectors of the economy, technological advances have generally raised costs rather than lowered them” (Krugman, Wells 2006). Recently a television commercial for a major pharmaceutical company was advertising the new medication and during the commercial made the statement “we are often asked why our new medications are so expensive, the reason is simply because we are paying for the research and development of these new medications so they can be placed on the market and benefit the world sooner” I thought this was a pretty clever way to justify the exorbitant cost of the medication and Americans seem to be satisfied with that type of propaganda. The fact that we agree to pay the price allows these manufacturers to sell at this price. Little has caused as much debate as the new Healthcare Reform Law. It seems that most people are dissatisfied with it. One reason it is so unpopular is the individual mandate. Americans do not want to be told they must buy something and many believe the mandate is unconstitutional. I disagree. I have worked in the healthcare for almost 30 years and I can say with certainty that everyone will at some point in their lives utilize the healthcare system. Life is full of variables that are uncontrollable. It does not matter if you work out and hone your body into a perfect specimen of health some unforeseen accident will happen and you will find yourself in a hospital, it happens every day. Part of the rationale of mandating all Americans to purchase health insurance is to facilitate payment to those healthcare centers that formally did not receive payment for services rendered. “So why does US health care cost so much' Part of the answer is that doctors, like other highly skilled workers, are paid much more in the United States than in other advanced countries.” (Krugman, Wells (2006). A specialized physician in the United States such as a Cardiothoracic Surgeon can earn $400,000 after only four to five years practice while that same physician will only earn £72,000 in the United Kingdom throughout the course of his/her career. This variance is astonishing and many will argue that in a capitalist society everyone is entitled to make as much money as they are able, however, it cannot be denied this is a huge part of the reason why we in the US pay so much. We do not pay physicians according to the quality of care they provide. In the United Kingdom, 95% of the physicians are paid in accordance with the level of quality of care they provide. Naturally, this system incentivizes physicians to perform better. There is no such incentive in the United States. Good or bad physicians earn the same. And, despite these exorbitant wages, our Dr’s don’t listen to us. “Americans are the least likely to report that their doctors explain things in way they understand (though the spread on this question is rather small) or say doctors spend enough time with them (56% of us say they do, as compared to 70% of Germans” (Klein, E. (2007) How many of us have felt we were imposing on our physicians in their offices just by asking questions' Our physician rushes into the examination room barely peruses the medical record, perhaps not even sit down reinforcing the idea that they are simply too busy to see us and we are “holding them up”. “The main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance, reflected in the uniquely high US share of private health insurance, reflected in the uniquely high US share of private spending in total health care expenditure.” (Krugman, Wells (2006). Why does our health insurance cost so much' We want a company to pay for it or the government or anyone except us. We do not realize that paying for healthcare is a lifelong investment in our lifestyle and our health. We are an entitlement society. We want to eat what we want, when we want it, we do not want to exercise to keep healthy we would rather take a pill or have surgery to lose weight. We feel our jobs are sub-standard if 100% of our insurance benefit isn’t paid for. We are bombarded with images of what has recently been termed “American Exceptionalism” but I don’t think we really know what that term means. We mistake Exceptionalism with Entitlement. References Avraham, R. (2011). PRIVATE REGULATION. Harvard Journal of Law and Public Policy, 34(2), 543-638. Retrieved November 10, 2011, from Research Library. (Document ID: 2360266711). Many Americans Still Confused About New Healthcare Reform Law and its Provisions: Lack of understanding linked to rhetoric that preceded the final vote in March, and the complicated nature of existing health-care system. (29 July). Anonymous, U.S. Newswire, Retrieved November 6, 2011, from ProQuest Newsstand. (Document ID: 2242339021). Curran, C., & Totten, M. (2011). Governing for Improved Quality and Patient Safety. Nursing Economics, 29(1), 38-41. Retrieved November 10, 2011, from Research Library. (Document ID: 2268150491). Elzer, R. (2010). Guide to CMS Compliance. Journal of Healthcare Management, 55(2), 77-80. Retrieved November 6, 2011, from ABI/INFORM Global. (Document ID: 2011791331). Garson, Arthur, Jr. MD, MPH (2010) The US Healthcare System 2010 Problems, Principles, and Potential Solutions. http://healthcare-economist.com/2010/01/25/health-spending-climbs-to-16-2-of-gdp/ Klein, E. (2007) Ten Reasons Why American Health Care is so Bad The American Perspective, Vol.18 No.10. Krugman, P., Wells, R. The Health Care Crisis and What to Do About it. The New York Review of Books March, 2006. Noam N. Levey. (2011, October 5). Trying to heal a system's flaws; Amid partisan rancor, the chief of Medicare and Medicaid says errors and waste are what ail healthcare. Los Angeles Times. A.1. Retrieved November 10, 2011, from Los Angeles Times. (Document ID: 2475614271).