Accountable Care or The Accountants That Took Out Windows To Improve GM Cars?

OBAMACARE /ACCOUNTABLE CARE:  A doctor with years of success and experience told me that “Accountable Care,” the center piece of ObamaCare, is a name created by congressmen who sit live in palatial royalty while their constituents clamor for crumbs! Is that true? The elderly doctor reminded me that theories of healthcare management are nothing but, dreams and hype to sell at election time!  He reminded me to follow the money trail and notice that it paid off those who elected the congressmen, the insurance accountable-care-organizations-lights-cameras-article-3759companies. It did so by putting all the “financial risk” of the experiment on doctors while guarantying the financial rewards to ‘insurance companies.” It was,  he said,  “like legalized gambling in a Casino that rigged the tables.”   It ruined many nights of my sleep because I knew this man and he had credibilty.

CHANGE AS OF 2014: As of the year 2014, a large percentage of ObamaCare is affecting medical practices of all types. The majority of doctors are no longer writing on paper but using EHR (Electronic Health Records).  Tedious, often slow and unreliable for now, it is quickly becoming the legally required standard.  If a doctor doesn’t  use it they will certainly not get paid easily for insurance claims, if at all!  Is this the dreamed of efficiency that saves us money?  Most doctors surveyed said it made their exams 30% slower. They were clearly less efficient!

RUSHING INTO DATA EXCHANGE, THE NEXT PHASE?:   The imagined economy of ObamaCare is an  exchange of data that prevents the current very real duplication of testing that at times exists in medical care.  Not a bad “idea;”  but,  is it likely to work?   Since I am an eye doctor in addition to being a writer, I chose to look at my profession and get a view from my colleagues eyes.  It was not encouraging, at least at this point in time.  Why? It is simple to explain.

EHRs do not contain the full information of complex testing and technology print outs, they currently contain the summaries. So much data of importance is lacking.  On the other hand,  they are bloated with  miles of garbage produced to satisfy the demands of courts and lawyers rather than patient needs!

If a patient has a test that produces many pages of data with images (such as repeat vision fields, which is a tedious and somewhat unreliable test for Glaucoma),  all the pages are almost never stored in EHR records.  Much is stored in the testing machines memory. Furthermore the quality of the  test (as with many tests) may frequently be questioned as the patient may have a bad day,  the technician may have been preoccupied with other issues, and the doctor may have missed something in reading them (they too are human).  If ONE test is the requirement and its detailed pages,  test environment, other related events are not available,  is the currently available “essence” of this whole process all we need to share? Will this create better out comes or more frequent law suits?

There are many other tests used by eye doctors that meet this criteria for failure such as:  OCT (Optical coherence tomography),  HRT (Heidelberg Retina Tomography) all complex imaging tests. Even simpler tests such as: An extended opthalmoscopy,  Biomicroscopy, or Fundus photography! Almost never is the full data store in EHR. As a result, sharing the data between doctors means sharing and duplicating and error becomes highly probable!

ACO AimIn the future as data storage and retrieval becomes more encompassing this significant challenge may be overcome, but for now, rushing into data exchange is only likely to be unreliable and dangerous to doctors and patients!

EXAMPLES FROM A REAL WORLD:  Years ago accountants told GM to take out the operable rear window in their passenger cars and make its opening an “option.” GM mindlessly did this and it cost them a significant bit of their reputation.  Just recently a patient in my office, told me a story of Government Vision and Success!  I was excited to hear this as I felt landing the moon over 40 years ago with no progress of significance since was what I expected of our government.  He told me our congressmen had spent BILLIONS of dollars creating a water treatment plant for NYC.  He told me it would create the best quality water the world had ever seen!  He was enthusiastic about the technology they employed and the excellence his workers had provided in building it.  I was amazed! He then said, “there is one caveat doctor.  After we take this water and make it into the most pristine water the world has ever seen,  it flows out into an open pond on its was to NYC,  where birds shit in it each day.”  Now this is something I can believe comes out of congressmen whose financial liability is nothing like that of private business. They don’t worry about if it works;  but,  they do concern themselves with  who gets paid off!  Does anything work for data exchange?  Sure!  For now if you have the same software in the same facility, yes; with the caveat that you have access to off-line storage in the same machine (that is not on ehr).  So, if you are a hospital or a large medical group, your doctors could exchange some data and get the rest of machines they can access.

What about doctors not in the same group or in a hospital?  Well faxed reports are still viable and work!  When an eye doctor faxes a report to a pcp regarding diabetes or atherosclerosis that information can be incorporated in the PCPs records. This provides better management and better fees as it meets the needs of HEDIS scoring.  It provides better care possibly and in this case the specialist’s input is all the PCP really wants.  Should doctors rush into data exchange software?

Just imagine all the bugs in a doctors EHR software and the I would tell a  doctor, ” ask yourself  two questions:   1) Do you need more bugs and more complexity?   2) If you are in a ACO that will bet its medical outcomes to be enhanced by data exchange, would you tie your financial future into this for 3 years?  Remember capitation?  ACOs are really capitation with not just the very scary dangerous 1 year contracts that doctors dropped like a hot potato years ago  but a much longer 3 year contracts that could do more than burn your fingers!”   The lesson may be:  Don’t rush into anything congress has just blessed or someone is peddling for profit!  Let it prove itself first before you Literally bet your house on it!  We have enough people in bankruptcy in America today!

Janr Ssor.





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