Sunday, October 18, 2009

How dire is our healthcare crisis?

Reader responses: How dire is our healthcare crisis?

In a recent issue of the Credentialing Resource Center Connection email newsletter we asked MSPs to share with us their thoughts about our nation’s so-called broken healthcare system.
Here are a few of the anonymous responses from in-the-trenches MSPs. Feel free to leave your own opinion in the comment box at the end of the post.
“If all I did in my position at the hospital were my duties as Medical Staff Coordinator, I would probably wonder what kind of “crisis” is being discussed.
However, I also work in risk management and am the first person contacted by patients with concerns and complaints. I find from my many conversations with patients, that many have really poor and confusing insurance coverage, that many are putting off vital healthcare due to the expense, and that our ED is becoming a substitute for the PCP’s office. I speak daily with tearful and frightened individuals who feel they have nowhere to turn, and who are fearful of ever-mounting personal medical debt.
Our hospital is located in a rural environment. We have many Medicare patients, and a good percentage of the younger ones are uninsured or under-insured, as we do not have many large employers in our community that provide employee health insurance coverage. If we are at all typical, we do indeed have a “crisis”.”
“Our credentialing database feeds a file that goes to 30 different payers each month as our managed care organization is delegated for credentialing approximately 3,500 practitioners. We need to maintain not only approved practitioners, but each address at which they are approved by contract to provide service. In some cases, such as radiologists or pathologists, this is over 100 addresses per practitioner. The payers review each claim against this information for payment, and then the terms of the contract to see how much is covered, generate and send the statements to the biller and the patient, and handle the claims wrangling that ensues. And this is above and beyond all the paperwork required by physician offices and hospitals in getting the bills coded and sent to primary and secondary payers, and then billing the patient. What a monumental waste of effort that would not be required in a single payer health care system.
Second, two-thirds of people who claim bankruptcy in the US cite medical expenses as the main cause. Of those, three-quarters have health insurance. Our co-pays, deductibles, uncovered expenses and maximum limits causes thousands of families over the brink into financial ruin. Meanwhile, in other industrial countries with government supported healthcare systems, no one goes into bankruptcy for health care expenses because it is all covered.”
“I personally find that we are so regulated that is hard to find time to give good patient care. We spend large portion of our shifts doing paper work to conform to regulatory needs that it leaves not enough time to give to our patients the one-on-one time they require. I work in an acute care rehabilitation hospital. I know that regulations are necessary. But I think it would help to combine some agencies and unify how Medicare, medical and the CMS along with the joint commission do their surveys. There are so many different processes to comply with that we stress out the thin staff that are giving the care.”
“I have worked in many areas of administration for the healthcare industry. I know first hand that both the physician and patients are getting the short end of the revenue stick. Patient care has diminished, because physician patient loads are unmanageable. Physicians are constantly being prodded by insurance carriers to give the least expensive patient care to avoid jeopardizing their reimbursements. Which acquire the patients being treated for cause and effect symptoms only. Physicians have abandoned the prevention care plans to keep their patients healthy. Insurance companies for the most part outsource their customer service to [overseas], where patients and physicians are not able to communicate much less get any resolutions to their issues. When we think that in the United States, we can figure out how send people to the moon – but can’t solve healthcare something is dead wrong. In my opinion the healthcare industry is long overdue for an overhaul and there should be no sacred cows!”
“Government taking over healthcare is a grave concern of mine. I do not believe that “control” is the answer. Abuse and neglect are the issues that need to be addressed. We need to research the control that insurance companies and medical supply and medication companies have on healthcare. The role of our government and elected officials is to enforce the law, not make the law as they see appropriate. We the people need to stand up and take back control of our government and quit allowing elected officials to run us. I’m willing to be involved [in this issue] outside of my work environment as this will be something that affects my children and grandchildren in the future.”
“The broken system is multifaceted but socializing medicine, i.e. having a government run program, is not the answer. Look how well Medicare has done. Giving people a choice between government run or private insurance is not the answer either. Managed care plans manage not to give patient’s care, manage not to pay doctors, and manage not to save money.
Forcing Electronic Medical Records on physicians is not an answer either. It will create a logistical nightmare and the cost is prohibitive for most practices. Ah, but wait, the government will give you a credit, and that will not begin to cover the cost. Not only is there the cost of the software, but there will be additional hardware and storage costs. It also does not increase “accuracy” as garbage in, garbage out – only if the data inputted is accurate and on the right person. Reimbursements are spiraling downward and expenses are going up. On some drugs with Medicare and Medicaid, we pay more than the reimbursement. I don’t know what the answers are, but I do know that more government involvement equals a more fractured system.”
“Yes, I do believe that health care is as broken as they say it is and part of it is their issue, but only a small part of it. The cost of healthcare has outstripped many employers’ ability to provide satisfactory health care coverage and in many cases they can no longer afford health care coverage. Pharmaceutical companies are charging for medication at an exorbitant rate. The American public is being charged for [research and development] on drugs that have long since had the expense paid for, while other countries, to whom the drugs are being sold, receive a discounted price. I understand that revenue is needed to develop newer, better drugs, but how about leveling the playing field and charging all customers the same price. Hospitals, physicians, and radiology companies have also played a large part in inflating costs. If they had taken care of the garden and not fertilized the weeds, we would be in much better shape. Anytime a radiologist gets a salary of $250,000 a year and only works 6 months, there is something seriously wrong with the system. The fact that the average length of stay in hospitals in the eastern half of the United States is almost double in the western half is unacceptable. The west has done its best to keep with reducing length of stay while the east is supplemented for over utilization. What about the medical supply companies? A simple item is priced much higher as the same item in another line of service, just because it has the term hospital or health care attached to it. Many physicians are treating the patient with every possibility of care because they can, not because it is truly beneficial to the patient. Though no one wants socialized medicine, I am afraid it is the only way we are going to get cost under control and provide health care coverage to the citizens of our country. We have too long taken advantage of the system and it is our own fault.
Dental health care has also gone awry. Dentists often refuse to bill insurers. Dentists and physicians often opt out of Medicare or Medicaid, leaving many people unable to pay and attain the services they need.
Just to let you know how my opinions have developed. I have been in health care for 44 years of which the last 18 has been as a MSP. I have attempted to receive a degree in nursing and worked as a nurse aid for 23 years all the while observing and experiencing many of these issues. I have staffed a hospital, and worked as a ward clerk and a member of an ethics committee. If you keep your eyes open and your ear to the ground you can easily come to the same conclusion.”
“After working 30+ years in healthcare from physician office practices to Quality/Risk Management/UR, to home care, and now in the medical staff office, it is difficult for me to give a perspective only from the MSP viewpoint. I don’t necessarily think the US healthcare system is “broken”, but I do believe there is so much that can be done to improve it. I don’t believe that national or universal healthcare is necessarily bad; just look at the WHO outcome statistics from other countries who have universal healthcare and the U.S. does not fare well in comparison. I could go on and on, but at this point, will only focus on a couple of things I think are of major importance.
First, I think the pharmaceutical industry needs to be regulated. They are making millions of dollars each year on the backs of poor and middle class people who have no insurance and/or who cannot pay for astronomical high priced medications, most which are necessary to keep chronic diseases such as hypertension and diabetes, under control.
Patients stop or cut back on these medications that they cannot afford which many times result in hospitalization. Major cost savings and improved patient care could result with lower drug costs. The government controls milk prices but not medication prices…why doesn’t this make sense??
Second, regarding universal health care, my fear is that our government will formulate universal health care without involving appropriate healthcare people. I’m not talking about physicians who sit on healthcare boards and haven’t seen a real patient for years, but frontline healthcare workers who know and see what the real issues are. This should include more than just physicians, but also nurses, quality people, CEO’s, CFO’s, and even some MSP’s sitting around the table when this is discussed.
I certainly don’t have all the answers, but I know there are a lot of questions. Regarding my current role, I feel there are still too many “substandard” physicians practicing that can go from state to state and that the NPDB is not an effective mechanism for detecting who they are.”
“We have the most advanced healthcare system in the world providing services to individuals who pay for their care, via health insurance or private pay, and those who do not. Businesses and the employed workforce pay hefty taxes to fund Medicare, Medicaid and other programs to provided care for those who can not pay. And we should do those things – no one wants a child to suffer for lack of healthcare. But to believe that some of the people can provide for all of the people – via government run healthcare – is not realistic. It is comparable to the US Postal Service One Flat Rate Priority Delivery. It’s a great pitch, great idea in theory, but fails in delivery – you never know when your package will arrive at its destination.”
“Yes, our healthcare system is wildly out of control. As a 51-year-old, taxpaying American citizen and as a 30-year (and counting!) career healthcare professional, I have come to believe the following things.
1.) We made a mistake long ago to divorce the patient (also known as “the customer” and the “end-user”) from the decision making process about healthcare. The entire Medicare program as well as employer-paid health insurance alone account for most of this distortion. By taking personal responsibility, final decision making and fiscal responsibility away from patients, we opened the door to out-of-control costs and a healthcare philosophy based around illness rather than on wellness and quality of life. Solution: a.) Do away with Medicare and place responsibility for basic care of infirm elderly and disabled individuals in the hands of the States and the local community charities; b.) Do away with employer-paid health insurance. People can make their own decisions about these things. Let’s concentrate on public education about being responsible for taking care of our bodies and our families. Require folks to take charge of the process by either paying as they go or by purchasing their own insurance. This will ultimately result in a more balanced and sensible use of healthcare services by patients, and it will result in prices re-stabilizing naturally, all by themselves, without regulation. (Imagine that!) It will also result in all of us learning about the consequences of our own behavior.
2.) We have “villainized” physicians for a long time, and we ask of them what we would not dare to ask of any other professional in terms of responsibility. All the while, we as a society and as an industry have been dictating to them more and more about how to do their work, without taking much of the responsibility for the outcomes onto ourselves. Solution: a.) Reform the legal system, state by state. Currently, we allow patients to victimize physicians. Most of the law suits that I have ever read were about bad luck, unfortunate genetics, foolish behavior, hurt feelings or unrealistic expectations on the part of a patient. Many were also about poor quality communication between patients and physicians – a two-way street and a joint responsibility. I have rarely seen suits that were truly about malpractice by a physician. Yes, malfeasant physicians do exist, as do criminals from all walks of life. They are the exception and not the rule. We do not need to build our world around them. A few good laws and the National Practitioner Data Bank suffice. b.) Reform the hospital accreditation system. Period. More is not better. I think the public would be outraged if they understood the cost of the paper chase we indulge ourselves in. c.) Support the transition to coordinated electronic health records and do away once and for all with the expense and the dangers of disjointed, illegible records. This is the true way to coordinate care and engender patient safety.
3.) We have gotten silly, as a culture and a society, about what we think we need or deserve or have a right to. Solution: Get back to basics: the Bill of Rights, the Declaration of Independence, the Golden Rule, the Ten Commandments. Simple guidelines for just, self-reliant and compassionate people.
4.) We have gotten cowardly, undignified and unreasonable about acceptance of death, dying and aging. Solution: Take a longer view. We are all meant to come and go. In the end, each one of us is fleeting. There is no dignity in trying to defy death or nature.”

Entry Information

Filed Under: healthcare news
Emily Berry About the Author: Emily Berry is an associate editor at HCPro in the credentialing market. In addition to managing information on CRC she writes the Briefings on Credentialing newsletter and the Credentialing Resource Center Connection weekly email newsletter. A native of Ohio, she graduated from Case Western Reserve University in Cleveland before moving east to attain her MS degree in journalism from Boston University. She’s always looking for new ideas for articles, so if you have any to share, please email her at

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  1. Don’t overlook the multiple free EHR’s that don’t require doctors to invest in expensive software. There are affordable solutions for electronic health records available if you know where to look. Wikipedia has a good comparison chart.
  2. Hey, you have a great blog here! I’m definitely going to bookmark you! Increasing your web traffic and page views Add, add your website in site, it’s pretty awesome too!
  3. I licensed medical professionals for many years, worked for the State government, and now credential medical professionals for a private hospital. I am appalled at the high cost of medical insurance, especially that which is paqrtially funded by employers. The cost is so high, many of my co-workers cannot afford it. When I worked for the State, an attempt was made to turn the statewide healthcare plan for welfare recipients into a type of HMO, where anyone can join and pay according to their income. This would have been an excellent plan and would have left NO ONE uncovered as welfare recipients would still be on it, but would pay nothing or very little. It would have encouraged preventive care. However, taxpayers voited AGAINST it, not understanding how it would have worked and now we are all paying the price as taxpayers have to cover the exorbitant costs of medical care for people who, if they had had insurance and preventive care, would not be hospitalized with majoe health problems and would most likely be enjoying good or fair health. Preventive care is much cheaper, yet taxpayers cannot comprehend that.
  4. I work for a large highly regarded healthcare system in Kansas City. I hear everyone complaining about the high cost of healthcare and how government control can “fix” it. Get real people!! I can name you any number of employees on our staff who have jobs BECAUSE of all the government regulations that we must meet. Recovery Audit Control, CMS, Joint Commission, to name a few. All expenses we have due to government regulations and we must pass these expenses along to our customers or close our doors. We do a huge amount of indigent care within our health system. So our customers including our health system employees are already paying for these uninsured folks to have healthcare, by our taxes, increased health insurance premiums, co-pays, and no raises. I too think the system needs fixing and feel a large part of the problem is government regulation and greedy insurance companies. However, I am not sure that a single payor system that cuts out competion in the marketplace is the answer and I AM SURE more government control is NOT the answer.
    A physician in our area has begun a clinic where he charges a set fee for everyone for various office calls, procedures, etc. He prints you an itemized receipt which you can turn in to your ins. co. if you so desire. However, he accepts no insurance of any kind. His overhead is minimal and his care is excellent because he does not have to focus on administrative, etc. duties. I applaud his courage and ingenuity. After all, these are the qualities of our forefathers that made this country great. Perhaps a little more inventiveness and less apathy and belly-aching on the part of John Q Public would get us back on track!!
  5. In you blog, you stated, “Second, two-thirds of people who claim bankruptcy in the US cite medical expenses as the main cause. Of those, three-quarters have health insurance”. I would like to use this in my report but I need sources. Is there any way you could e-mail me your sources, only for that statement, I seem to have most of the information I need with resources. I live in a very conservative area and have to have references for anything I say that goes against typical John Burch mentallity
  6. Emily Berry NOTE: Posted on behalf of L.H.
    In response to the question about the appalling correlation between health care costs and personal bankruptcy, I found information on this at the web site of the National Coalition on Health Care Costs. It cites a study reported on in the American Journal of Medicine regarding this.
    “A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance.9″
    9. Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.
    I hope this information helps.

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