Some points on receiving medical treatment

The way we receive health care today is changing in many ways.
+ On the provider side we see lots of consolidation, which often results in higher fees.
+ The way treatment is covered by our medical benefit plans has been evolving for a few years. Implementation of federal health reform, beginning in Jan 2014, has had a big impact on increasing the cost sharing individuals have to pay.

A couple recent news posts related to these changes caught my eye:

The first is connected to the way we receive healthcare and I believe it is very important - Getting fully involved in your medical treatment.

Jennifer Thew, RN., the Senior Nursing Editor, for HealthLeaders Media brought out some points in her May 19, 2015 article, which I want to share.

I have followed the way medical treatment is delivered and have seen MDs indicating better treatment outcomes can often be gained if there is transparency on the details of a medical treatment session between the MD and patient. One part of improving this transparency, which is not always easy to implement, is to get individuals more involved in their care.

The article reported on a group of Primary Care MDs who are making the results of their visits available to patients online. She indicated in part:
“ - - - a year long study to explore how sharing clinician's notes affected care. The results found that patients frequently accessed visit notes, reported a greater sense of control and understanding of their medical issues, had improved recall of care plans, and adhered better to medication regimens.”

The study was based on a program, which is expanding, called OpenNotes. This effort will be an important step toward people receiving improved health care since in much of today’s treatment not a lot of information is available to the individual. Because of this there can be a negative impact on patients. She shared an example where the lack of information following a person’s first treatment resulted in a complicated medical situation when the situation was later found.

She also brought out a point another professional made on why it is important to get people involved:

"Another really important part of patients reading their notes is the fact that they can contribute to safety monitoring," says Jan Walker, MBA, RN, co-director of OpenNotes and assistant professor at Harvard Medical School. "Care is really complicated, we're all human, we all forget things, and having another set of eyes on what's going on can probably help people avoid errors."

Bottom line – this article provides examples on why it is so important for everyone to talk with their MDs during treatment sessions and to ask for a copy of the notes, which the MD made following the visit.

The second article was connected to to a point I communicate to client employees – A procedure performed by a high volume surgeon has advantages for them.

Cheryl Clark, senior quality editor for HealthLeaders Media reported in a May 21st article 20 hospitals have announced the "Take the Volume Pledge" campaign. Its focus, according to John Birkmeyer, MD, a surgeon, outcomes researcher, and executive vice president for enterprise support services at the Dartmouth-Hitchcock hospital, is to “reduce complications”. He indicated:

"What we're trying to do is minimize the number of patients who wind up getting their care by so-called 'hobbyists,' surgeons and hospitals that seldom do these procedures, certainly not enough to attain a high level of honed proficiency."

Cheryl Clark’s article also reported another point from Dr. Birkmeyer:

“hospitals and surgeons who perform certain procedures infrequently aren't always doing them just because it's lucrative, which it can for smaller organizations.”

"It's less because of the survival instinct and economics of high revenue surgeries. Instead, they're just accommodating the pride and professional autonomy that surgeons believe is their due. What hospitals do care about is running afoul of their surgeons and ultimately losing those surgeons who would go somewhere else."

My sense, in reviewing the article, is outcomes information on surgeries in low volume vs high volume hospitals will be developed in the future. Information and data to determine quality and outcomes is however difficult to gather and report.

In employee meetings, when discussing suggestions for doctor visits, I usually indicate when an MD says the recommended treatment for this situation is surgery it’s very important to get a second opinion. When doing this they should also seek out a surgeon that does lots of procedures like the one you are considering.

Goings on with medical treatment and what these costs mean to medical benefit costs.

The healthcare industry, both on the delivery and financing side, is way behind others such as banking in the use of technology. Many have made statements like this over recent years so let’s take a look at what is going on today.

The June 2013 issue of the HealthLeaders magazine includes an article “Seeking the Strategic Sweet Spot” and brings out some steps providers are now or need to take to reform the way they operate. I want to share some points from the article on what this means for the way primary care will be provided:

● A team of people with varied talents working toward the same goal – management of populations

● Physicians working with high risk patients and funneling low-risk, low-acuty patients to physician assistants and nurse practitioners.

● A big move to telemedicine among younger patients.

● “About 80% of the office visits done right now by primary care can be done by midlevel providers and 80% of what the midlevels do can be done over the telephone”.

I found this last one of considerable interest. It represents one of the important steps for employers – to help employees understand the best way to deal with medical related situations.

Another factor, which is affecting providers, is the continuing trend of more and more consolidation among physicians and hospitals. A point was made on why this is happening:

● In narrow operating margin industries, which healthcare is destined to become, because of cost pressures “you need economies of scale and scope”.

We also find across the U.S. and here in Connecticut medical treatment costs, which some say are increasing at more than twice the rate of normal inflation. One part of this, which is having a very big impact, is the use of expensive medications.

What does all this mean for employee medical benefits? Increasing treatment costs result in higher plan premiums, which has a direct impact on an employer’s business and on the amount employees are asked to contribute as their share of plan costs. In addition, to increasing treatment costs medical benefit plan costs will face higher costs as federal health reform is implemented in the coming months.

Some steps employers are using to offset the ever increasing cost of the medical benefit plan:

● Working to help employees understand how lifestyle choices result in higher costs for them and the firm. They are also providing incentives for employees to work for better health.

● Encouraging, through employee contributions, the selection of cost effective health plans.

● Introducing a defined contribution approach as a step to control future costs.

Please contact if any questions on what these issues mean to individuals and employers here in Connecticut.

John C Parker, RHU, LTCP – (860) 451-9793

http://parkerhealth.com/