From the New York Times, January 30, 2008:
"Two main causes of the system's ills are century-old business models, for the general hospital and the physician's practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy."
Reading this article you would think we are sitting in our offices with 2-3 week wait times for appointments trying to dream up ways to make patients come back for unnecessary visits. You would think we don't care if our patients are healthy. Yes, hospitals profit from full beds, but hospitals do not fill their own beds any more than airlines or hotels, which also profit from full occupancy, do. Doctors admit patients and hospitals are not allowed to pay them for referrals.
We don't need a financial incentive to keep people healthy. Although as a specialist in a very narrow field that doesn't fall into my particular type of practice, I still counsel patients about weight loss, managing diabetes, smoking cessation, etc, and the family docs in the area do a superb job on health maintenance.
No matter how hard we try, people are people and they don't always take care of themselves. Many engage in risky behavior, whether it's smoking, drinking to excess, eating Big Macs, or sexual promiscuity. We can only do so much. The uneasy feeling I get from this new theory of what's wrong with health care is that it looks like doctors are going to be held responsible for keeping patients healthy, which is a Sisyphean task. If your patient continues to smoke and has a BMI of 40, will your reimbursement drop? What do you think?
How do we keep health care costs down while we try to keep people healthy? That costs money too. If diet and exercise doesn't control hyperlipidemia then aren't we supposed to prescribe a statin? Are those pills free? Are recommended preventative health care measures like vaccinations, pap smears, colonoscopies and mammograms free?
If you read between the lines this is Destruction of Medicine Part II. The first wave was the transfer of income from physicians and hospitals to insurance companies. The coup de grace will come from the government with this new theory of health care, which is nothing less than yet another strategy to cut physician reimbursement.
MEANWHILE, Humana, the nation's second-largest health insurer, reported 18% revenue growth last year, but due to higher administrative costs and investment losses they had worse earnings. But Wall Street should not despair that Humana might have lower earnings going forward. We have this reassuring news:
"Last March, Humana warned that its 2008 results would suffer severely because the design of one of its Medicare drug plans led to steep costs. But it said the problems were correctable and that growth would bounce back this year. Humana was expected to shed such unprofitable members this year, and indeed projected a sharp decline this year of as much as 1.2 million enrollees in its Medicare plans that provide only prescription drug coverage." [emphasis added]
Don't you wish you could "shed" unprofitable patients? Just jack up the charges until they go away? Just kick them to the curb if they are a drag on you.
And for those pesky sick people who just won't go away, according to Bloomberg News Humana has a fix for that too:
"Humana said it expects to earn $5.90 to $6.10 a share this year, helped by a 64 percent increase in average premiums for its biggest U.S. Medicare-backed drug plans for the elderly." [emphasis added]
So while Congress tries to figure out how to screw us, the insurance companies are jacking up health care costs 64% for the elderly. This is a national disgrace. The bookies make all the money in health care, just like they do on Wall Street. There is more money to be made pushing paper from one side of the desk to the other than treating sick people - or keeping them well.