Rationed Care is in the Recovery Bill

[sahuaro]

Hidden among the provisions of this complicated legislation is the creation of the National Coordinator of Health Information Technology to review our computerized medical records and determine not whether medical care is necessary but if it is cost-effective: doctors will be expected to comply with this new bureaucracy's decisions and essentially patients will be told to suck it up and accept pain and suffering.

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[johnb]

This legislation will have consequences that are important and far reaching for everyone. I'm already very educated about my health. According to my primary care doc, much more educated than his average patient. It is time to take responsibility for our health. If heart disease, diabetes, etc run in your family, then it's time to recognize that and become proactive. How much of our anual expenditures would be unnecessary if we made better life style choices?

On the otherside, their are doctors that are milking our system. I've seen it with my own eyes. The spine surgery I had was very expensive compared to what I needed, a decompressive surgery. I didn't need an expensive set of plastic, cord, and screws (I have 6 screws on my desk and are the most expensive paperweights insurance money can be wasted on). This was the opinion of two surgeons that had no financial stake in my treatment. I wasn't a candidate for ADR either which is what I would have had if my insurance had approved it.

I'll give you another example. My mother, who is 75, had some blockage discovered in her vascular system in her neck 5 years ago. Not high numbers, but something to keep an eye on via yearly exams. Instead of going to her vascular doctor last year, she had the exam done at a clinic closer by as she doesn't like to drive on the interstate. This clinic has been adding services under its unbrella and is close to a one stop shop so you can be referred to whatever specialist you need under their "umbrella". Her doctor told her the test pointed to severe blockage and immediately referred her to their vascular surgeon for surgery consult. My mom was worried and in horrible shape emotionally. I told her to hold on, I would take her to her regular vascular surgeon. Medicare will only pay for one exam per year but her regular surgeon looked at the report and questioned some of the interpretations. He advised her to relax and follow up with him next year. Well, it's a year later, my mom had her exam with her regular vascular surgeon and her vascular system is okay. That surgery that they were setting my mom up for carries a 50% chance of stroke according to my mom's regular vascular surgeon. This made me angry.

That old cliche about a few bad apples ruining the barrel can be applied here. However, I think it is more than a few bad apples. I'm glad we folks like Justin entering the field. My own personal experience has shaken my faith in the current state of affairs in our medical system.

John

[sahuaro]

Yes, there are patients and doctors who milk the system. But to be denied care because you're old anyway is very scary. For doctors to have to conform to computer programs about treatment is to deny them the ability to think and to treat patients as individuals. This is a very bad time for good doctors like Justin to be entering the field.

[Maria]

There has been such a move in health care towards regulating the amount of care via cost that if one has had to utilize an insurance that had any kind of restrictions and/or costs to it a graph of where this has all been heading would likely have been a diagonal line going from the top left chart to the bottom right chart over the last 30 years. Doctors have been losing control of what they are able to do literally to a great degree and insurance companies are making more and more decisions. A physican has so much more paperwork and hoops to jump thru now in terms of trying to get not only optimal care for patients let alone just adequate care.

And when money is concerned and the patient cannot pay they are often left in the dust to make their own choices on what is more important in life. Eating or medicines. There will be much more of this no doubt.

[Justin]

Honestly, the text of the bill is far less evil than the reporter made it out to be. I'm very disappointed that the writer took such liberties with the information that is available and Bloomberg published it under "News" rather than "Editorials".

However, I will concede that the writer did synthesize a plausible future scenario if this position progresses to its logical conclusion, but that remains to be seen.

Incidentally, the government already maintains the largest integrated system of electronic health records in the country: the VA system.

Originally Posted by HR1 Sc. 9202

SEC. 9202. INVESTMENT IN HEALTH INFORMATION TECHNOLOGY.

(a) In General- The Secretary of Health and Human Services shall invest in the infrastructure necessary to allow for and promote the electronic exchange and use of health information for each individual in the United States consistent with the goals outlined in the Strategic Plan developed by the Office of the National Coordinator for Health Information Technology. Such investment shall include investment in at least the following:

(1) Health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner, including connecting health information exchanges, and which may include updating and implementing the infrastructure necessary within different agencies of the Department of Health and Human Services to support the electronic use and exchange of health information.

(2) Integration of health information technology, including electronic medical records, into the initial and ongoing training of health professionals and others in the healthcare industry who would be instrumental to improving the quality of healthcare through the smooth and accurate electronic use and exchange of health information as determined by the Secretary.

(3) Training on and dissemination of information on best practices to integrate health information technology, including electronic records, into a provider's delivery of care, including community health centers receiving assistance under section 330 of the Public Health Service Act and providers participating in one or more of the programs under titles XVIII, XIX, and XXI of the Social Security Act (relating to Medicare, Medicaid, and the State Children's Health Insurance Program).

(4) Infrastructure and tools for the promotion of telemedicine, including coordination among Federal agencies in the promotion of telemedicine.

(5) Promotion of the interoperability of clinical data repositories or registries.

The Secretary shall implement paragraph (3) in coordination with State agencies administering the Medicaid program and the State Children's Health Insurance Program.

(b) Limitation- None of the funds appropriated to carry out this section may be used to make significant investments in, or provide significant funds for, the acquisition of hardware or software or for the use of an electronic health or medical record, or significant components thereof, unless such investments or funds are for certified products that would permit the full and accurate electronic exchange and use of health information in a medical record, including standards for security, privacy, and quality improvement functions adopted by the Office of the National Coordinator for Health Information Technology.

(c) Report- The Secretary shall annually report to the Committees on Energy and Commerce, on Ways and Means, on Science and Technology, and on Appropriations of the House of Representatives and the Committees on Finance, on Health, Education, Labor, and Pensions, and on Appropriations of the Senate on the uses of these funds and their impact on the infrastructure for the electronic exchange and use of health information.

Keep in mind that this Office was established 5 years ago:

Health Information Technology

Also, here's the language of the bill that this lady seems to be referencing:
SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY.

"(a) Establishment-- There is established within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology (referred to in this section as the 'Office'). The Office shall be headed by a National Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary.

"(b) Purpose-- The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that--

"(1) ensures that each patient's health information is secure and protected, in accordance with applicable law;

"(2) improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care;

"(3) reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information;

"(4) provides appropriate information to help guide medical decisions at the time and place of care;

"(5) ensures the inclusion of meaningful public input in such development of such infrastructure;

"(6) improves the coordination of care and information among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information;

"(7) improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks;

"(8) facilitates health and clinical research and health care quality;

"(9) promotes prevention of chronic diseases;

"(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and

"(11) improves efforts to reduce health disparities.

It seems clear to me that the "help guide medical decisions" part refers not to the Office's role as an omniscient final arbiter of all medical decisions, but rather just as part of a list of the benefits of standardized medical records (the contents of which will, presumably, "help guide" the decisions of doctors).

[runner]

All of this does not surprise me.
Our health care is heading toward a regulated/electronic state.
Just last year, I went to a nursing conference where they had the tele robots that have a screen where the doctor can "see" you in the hospital and therefore treat you.
That kind of bothered me because I don't think I would like talking to my doctor on a monitor screen. These robots followed us around and it was weird. We are told this is the coming face of medicine. Some of it is good and beneficial and other parts are not.

It is true the VA system has electronic medical records and is ahead of most hospitals in my area, but at least 2 years ago, I was told that the VA system of having to bar scan intravenous bags was coming and then some of it did.
It is good to be safe but I have heard horror stories from nurses where in an emergency they could not get medications from their hospital pharmacy because the patient wasn't admitted in the computer yet. And there was no emergency override. This really happened at a hospital in northern California.

As we move towards more of this, we are moving toward loosing the human touch.

About the rationed-care idea, that idea is already in effect with the insurance companies being the gate keepers, and denying care. The government might do better than insurance companies because our insurance companies are only hoping to increase their bottom line and could care less of us as patients.

I am all for having the power of decision placed back in the physicians' hands. That is where medicine needs to go back to. I support a nationalized health care system because our system is hurting people and people are dying because they cannot afford care or care is denied as "investigational" or "experimental".

I just got an EOB (evidence of benefits) from Blue Cross (Anthem/Wellpoint) and they are holding payment to my pain doc for my facet block because they want more information. I am thinking, "What the heck. I had to wait three-four days for them to get a pre-authorization and now, they don't have enough information? But I have gotten at least 30 calls from them for some out-reach program they want me to enroll in."
No kidding, at least five calls this week after I had already told them to send the information in the mail. This company is totally nuts and there is no way I want medical information from them for my asthma.

There's a bill in Congress right now for a medicare-like universal health care system. I am not going to advertise it here, but people need to wake up and see what a mess our health care system is. One of the web sites to find info is Guaranteed Healthcare | We Don't Need Insurance, We Need.

runner

[Justin]

Kimmers,

Thanks for your thoughtful reply. I know a wave of change is headed to medicine, but I'm an eternal optimist deep down--I'm keeping my fingers crossed about the future.

I was talking with a friend the other day and he brought up an interesting point regarding medicine: doctors unionizing.

It seems with insurance dictating care, decreased reimbursements from insurance companies, patients not willing to pay their medical bills, and student loans exponentially on the rise that this might inevitably happen.

This is a very interesting topic that will directly impact me in the future. BTW, sahuaro and johnb thank you for your kind words.

I'll chime back in later...great discussion!

[Terry Allen Blackburn]

I have no qualms with the need to have an electronic medical record that is universal and accessible wherever I go. I just don't want to see it used to deny us care, insurance of any kind, or, possible disability if the need arises. The most important aspect of good medical care is still the relationship between doctor and patient but, the need for a record that helps eliminate human error is paramount. The other thing that this helps in is in becoming more efficient.

My therapists spend more time with their paperwork than in meeting clients. This is all for the purposes of satisfying Medicaid which is my lowest form of reimbursement to begin with and, the one that stands the biggest chance of landing me in prison for fraud, waste, and abuse. We routinely get audited, and have money retracted for the human errors that can occur with seeing way too many patients. If a therapist forgets to put in a time-out on the session, the entire session amount is retracted. This is why most clinics in the area do not accept any new Medicaid patients. They cannot afford to do this kind of medical practice with the most intensive documentation requirements and the lowest form of reimbursement.

I agree with Justin; this is not as bad as it appears. It is amazing how many patients die because of medication errors or other human factors. A universal record, that has the ready information about a patient, will help this substantially. It does need to be secure enough so that insurers cannot cherry pick their insured. There is a lot of potential for good and abuse with the universal electronic record. I am hoping that the medical ethics committees will sit down and hammer out these details so that this information is on a need to know basis. Unfortunately, insurers get access to this information, and use it to deny coverage on an on-going basis.

I also agree that we need to be more responsible for our own health.

Whether you believe that addiction is a disease or a choice is not as important as the ramifications of the unwillingness of insurers to fund the treatment for the condition. Addiction can be seen as a true brain disease due to the following factors:

The brain produces chemicals in the forms of neurotransmitters that elevate or decrease the production of differing brain chemicals called neurotransmitters. When you add drugs in to the mix, they over or under stimulate the production of these chemicals, setting up a chain reaction to literally hijack the brain. The one inescapable piece of personal responsibility, pops in to the picture, when you realize that all people take their first drink/drug of their own volition. This is unlike other psychiatric conditions such as schizophrenia, bi-polar, depression, etc., where the person is born with the condition. This issue of a person's volition has enabled insurers to deny addiction treatment for many years which has forced the taxpayer to become the biggest funding source of addiction treatment.

Now, imagine if you will, the universal application of this principle. "I'm sorry Mr. Smith but, we cannot pay for your heart disease, as you've had a pattern of eating in an unhealthy fashion for years, in spite of the public knowledge, that eating proper food will prevent the condition you have. Also, you have avoided exercise, as evidenced by your being well over your ideal body weight." This scenario could be applied to Type II Diabetes, Adult Hypertension, Asthma, or any other disease which has a behavioral component. If you are going to apply this to one disease with behavioral implications it should be universally applied. People wouldn't stand for it so it is easy to do this with a disenfranchised population to begin with.

But, in spite of the potential financial implications, we are all ultimately responsible for our own health. If everyone took care of some lifestyle choices we could save billions of dollars annually in health care.

Now, enough of my pulpit. Go eat a cheeseburger.

Terry Newton

[Justin]

Interesting video about author of the Bloomberg piece...

Clarity to healthcare concerns

[sahuaro]

Wow! Thanks, Justin for posting the MSN piece.

I do think that you are right, though, about these possibilities appearing in future proposed legislation.

I have already encountered what happens when "treatment" becomes a computerized program, in dealing with a HMO in which I had to tell the technician on the other end of the phone to get his head out of the computer and listen to what I was telling him about the patient! After a major letter campaign, including contacting the head of the major organization that was the patient's employer, I was able to obtain the care for the patient that truly was appropriate--and I still resigned from the provider panel. My fear is that we will have fewer opportunities to protest if this happens with nationalized health care.

[Justin]

Sahuaro,

No problem! This topic is very interesting to me and I've been trying to keep up-to-date and read everything I can regarding this. I'm trying to stay optimistic, as insurance companies now dictate patient care and patients pretty much have to mortgage their houses to afford healthcare in the US. If you find any other good articles, please continue to post them here.

I hope you are well.

Originally Posted by sahuaro

Wow! Thanks, Justin for posting the MSN piece.

I do think that you are right, though, about these possibilities appearing in future proposed legislation.

I have already encountered what happens when "treatment" becomes a computerized program, in dealing with a HMO in which I had to tell the technician on the other end of the phone to get his head out of the computer and listen to what I was telling him about the patient! After a major letter campaign, including contacting the head of the major organization that was the patient's employer, I was able to obtain the care for the patient that truly was appropriate--and I still resigned from the provider panel. My fear is that we will have fewer opportunities to protest if this happens with nationalized health care.

[sahuaro]

Looks like the preliminary steps were in fact included in the bill:

http://www.nytimes.com/2009/02/16/he...gewanted=print