It’s another busy day at the hospital and as I dictate yet another consult note, I find I am repeating myself: “Patient has a history of diabetes, high blood pressure, and heart disease …,” and then on the next patient, “heart disease, breast cancer and emphysema…,” and the next one, “dementia, diabetes, arthritis, and colon cancer.”
What’s making us ill and even killing us Americans is not acute illnesses like a hip fracture or a urinary infection, rather it is chronic illnesses like diabetes, heart disease and cancer. In fact, two of three Medicare recipients have two or more chronic illnesses.
However, our entire health care system is built around treatment of acute illnesses, especially the payment system for doctors. Medicare and most insurance companies pay doctors for only treating patients when they are sick, and do not pay doctors for keeping patients healthy and well.
Starting this January, this payment system is about to change. Medicare will begin paying $42 per month to doctors for coordinating and caring for chronic illnesses; this will be on top of the usual payment for treating acute illness.
In return, doctors will have to change the way they practice in a number of ways:
Doctors must have electronic medical records in their office. Still 52 percent of doctors do not use computers for tracking patient records in their office.
Doctors must ensure patients are taking medications. More often than not, patients get admitted or readmitted to the hospital because they are not taking their medicine correctly or not managing their blood pressure or blood sugars. With simple health management reminders, a doctor’s office can nudge patients to do the right thing.
Doctors must assess the medical, psychological and social needs of patients and make a comprehensive care plan. Often, patients do not have a clear road map of their health status, where it is heading and what is expected of them, their family members and caregivers.
And most important of all, doctors must be available, that is patients must have easy access to a doctor or a doctor’s staff 24-7 for “urgent chronic care needs.” Our present outpatient — nonemergency room health system assumes that illnesses occur only from 9 to 5 on weekdays or patients only wish to address their problems at this time.
I am not sure if additional payment to doctors for chronic disease management will save Medicare money, however it will most certainly keep patients healthier and make primary care practices more responsive to patient needs. So if you are in the traditional Medicare fee-for-service plan and have two or more chronic illnesses, ask your doctor for a chronic disease management plan.
All these changes in payment make me wonder why weren’t doctors making a greater effort to manage the chronic illness and coordinate care in the first place?
I don’t want to sound defensive, but doctors like most professional are busy, which is apparent by the wait times in the doctor’s office or the lack of availability of primary care doctors, especially for Medicare patients.
In the midst of day-to-day “putting out fires” mode, doctors often emphasize the acute management of illness and not the chronic disease or preventive care management, such as getting an eye exam for a diabetic patient or a flu shot for the elderly.
So, to change health providers’ behavior, the government has taken on a new strategy: aligning payment to performance. Hospitals get paid more if the hospital infection rates and readmission rates are lower. Nursing homes get higher reimbursement if they have a higher satisfaction score.
While pay for performance for health providers is not the panacea for our health care system, it moves us in the right direction.
Source: Commercial Appeal