Enabling Healthy Decisions

“It has become increasingly apparent that doctors have to work with other people and share the care of patients with other professions, whether they are nutritionists, pharmacists, or nurse practitioners.  You’ve got to be more collaborative, work as a team.  There’s a different mind-set.”  (Michael Dacey, SVP for Medical Affairs and CHMO, Kent Hospital)

I think this quote a recent article in Health Leaders (In Search of the Team Player, Feb 2012) makes a great point.  Healthcare is changing.  While I think we are seeing the pendulum swing back towards being more physician centric, the new model will be very different with quality measures and new technologies and the empowered patient.

The article shares some survey data that I found interesting.  For example, while only 10% of physicians blame themselves for the “healthcare industry mess”, 30% of them believe they are the ones that will save healthcare.  Certainly, physicians by themselves can’t change the model.  We need payment reform and many other constituents with different agendas involved.

The article also shared a data point that 58% of physicians had ordered a test or procedure in the past year for purely defensive medicine reasons which is a sad reality.  At the same time, I know that many of us when faced with those tough decisions for ourselves want to jump through hoops to do everything possible even if it doesn’t offer a good ROI. 

The issue of the impending physician shortage (see Washington Post blog) can be mitigated by engaging these other professions in a care team strategy, but will physician’s embrace this.  26% of physicians surveyed thought that increasing the scope of care for nurses would worsen the quality of care and 13% say that abuse or disrespect of nurses is common.  Fortunately, everyone wants the same thing which is cost-effective care that improves outcomes and the quality of life.  The challenge is finding a solution to do that.

I don’t know about you, but this seems a little surprising to me. We know that it’s hard to figure everything out in the 8-15 minutes we have with the physician so perhaps a deep focus on key claims and key procedures is a necessary process. But, I think many of us worry that our physician will think we don’t trust them.

“Someone who has your best interest in mind will welcome that conversation.” Is what Dr. Jeffrey Cain, president-elect of the American Academy of Family Physicians says about telling your physician that you’re getting a second opinion

So, according to an article in Money Magazine, here’s what you do:

1. Check your coverage. You may be covered if you get a second opinion. If not, you might be able to appeal that decision.
2. Find the right doctor. The article suggests getting multiple names and finding MDs that work at different hospitals (to avoid group think).
3. Get your documents together. Make sure the physician has all the documentation before you go or bring it with you.

(Get More From A Second Opinion by Anne Lee)

I thought this was a nice summary which Money shared based on CMS data. It shows you what percentage of cost for your prescriptions you pay based on total dollars spent on prescriptions during that calendar year.

• For the first $320, you pay 100% of the costs.
• For the next $2,610, you pay 25% of the costs.
• For the next $3,727 (the donut hole), you pay 50% of the costs for the brand drugs and 86% of the costs of the generic drugs.
• For everything above $6,658, you pay 5% of the costs.