A lack of creativity clogs up our doctors' offices

STLtoday.com ^ | 1-19-04 | Dale Dauten - Corporate Curmudgeon

[FairWitness]

There is a huge opportunity to improve costs and care during routine patient visits.

"When the guy who was making the first drawing board got it wrong, what did he go back to?"

Play along with me here. Picture a 1950s television set. Next, a 1950s shopping center. Now the old 1950s computer, the Univac. Picture a '50s telephone in its "phone niche," then an old grocery store. Quaint, no? OK, now for the point: Picture a 1950s doctor's office.

[FairWitness]

- - - say you go to a dermatologist to have a mole checked out. What if several moles were scheduled together? You'd get to learn a lot about what requires a visit and what doesn't.

Logical, but - - . Everybody here who has a mole somewhere they would not care to "bare" in a group of strangers, raise your hand.

[FairWitness]

- - - the most obvious way to improve doctor efficiency is to do less doctoring, which results in more medical problems and, thus, less long-term efficiency.

This article caught my eye since I have been spending a lot of time in doctor's offices lately - both for myself and with my son who is going through a laborious process of proving, via a series of doctor's visits, that his carpal tunnel syndrome is work related. I don't actually think that the "group visit" idea would help that much, except for the "educational" part which could be done in groups.

[Phaedrus]

Bump ...

[Restorer]

The major difference in medical offices in the last half-century is the camp of forms-processers behind the receptionist.

He blows right by this as unimportant, but over half the time of medical office staff is spent processing forms or talking to HMOs on the phone. Some offices now give a 50%+ discount to those who pay cash.

This undoubtedly increases medicals costs by 1/3 (?).

[livius]

LOL! Yes, I agree, the group visit thing may not work out. But the author is right about a lack of creativity in dealing with health care.

Unfortunately, I suspect that at least some of it has to do with the insurance company (or government payee), which is reluctant to let doctors change their way of doing things because then the insurers themselves would have to make changes.

[Taliesan]

The reason the delivery of office visits hasn't changed since the 1950's is because the supply is constrained by huge barriers to entry, the demand keeps increasing, and the legal exposure and regulatory burden on the transaction keeps increasing.

There is simply no incentive to do it "better".

Group visits have a very limited usefulness.

There are fads in every discipline. The writer is probably not in healthcare. Other businesses' fads always look more viable than your own.

[truthkeeper]

bttt

[Z.Hobbs]

Some of these group sessions would be a great idea, but neww HIPAA regulations protecting patient privacy will eliminate any discussion of anyones existing condition in a group setting. Hence all you can have are infomercials that do not involve actual patient care or the identification of audience members as needing a specific type of care.

[FairWitness]

The major difference in medical offices in the last half-century is the camp of forms-processers behind the receptionist.

He blows right by this as unimportant, - -

I agree that's important, but I suspect the author assumed it was not something the doctor could directly affect, whereas "mass production" (if accepted by patients) is within the doctor's control.

[utahagen]

Group medical visits? Give me a break. I'd happily pay three times as much to spend a chunk of time one-on-one with my doctor.

[FairWitness]

The reason the delivery of office visits hasn't changed since the 1950's is because the supply is constrained by huge barriers to entry, - - -

One of the things that seems new (to me, at least) is the increasing use of "nurse practitioners" to handle some of the cases in our doctor's office. This is a way to increase the supply of medical care, though it doesn't necessarily go down well with some of the patients I've talked to.

[FairWitness]

Some of these group sessions would be a great idea, but new HIPAA regulations protecting patient privacy will eliminate any discussion of anyones existing condition in a group setting.

Good point - does the law allow for a "waiver" to be signed by the patient to get around this?

[Taliesan]

Yes, mid-level providers are society's solution to the supply shortage. It is a very sensible solution, since it does not require an MD to do the 50-80% of office care which is more routine.

Nurse Practitioners are generally better liked by their patients, because they have a fraction of the economic pressure on them and can therefore spend more time with the patient.

[FormerACLUmember]

Some of these group sessions would be a great idea, but new HIPAA regulations protecting patient privacy will eliminate any discussion of anyones existing condition in a group setting. Hence all you can have are infomercials that do not involve actual patient care or the identification of audience members as needing a specific type of care.

Absolutely correct.

Any doctor doing what is suggested in this article would be tossed into jail ASAP plus vast be given fines. Thanks to congressional incompetent micromanaging via the vile new HIPAA massive federal bureaucracy and laws.

[Blue Screen of Death]

...Annals of Internal Medicine.

I don't spell well enough to try that line.

[Taliesan]

It doesn't matter whether the law has a waiver or not. The legal exposure is still there, since a plaintiff can claim they simply didn't understand the waiver.

There is huge legal exposure in a group visit, and not just from privacy concerns. Can you imagine 10 patients talking at once?

Now imagine one of them comes down with a malignancy a year later, and claims he mentioned that nagging cough in the group setting but it must have gone unnoticed in the hubbub.

You think this is far-fetched? Not at all. Think like a trial lawyer. I manage physicians. They will do group visits over my dead body.

[FormerACLUmember]

It doesn't matter whether the law has a waiver or not. The legal exposure is still there, since a plaintiff can claim they simply didn't understand the waiver. There is huge legal exposure in a group visit, and not just from privacy concerns. Can you imagine 10 patients talking at once? Now imagine one of them comes down with a malignancy a year later, and claims he mentioned that nagging cough in the group setting but it must have gone unnoticed in the hubbub. You think this is far-fetched? Not at all. Think like a trial lawyer. I manage physicians. They will do group visits over my dead body.

Beyond the horrific HIPAA criminalization of medical practice, your points regarding the Trial Lawyer, Inc. abuse of these group visits is completely on the mark as well. What passes for "law" in this country makes these recommendations de facto and de jure illegal.

[Born Conservative]

You'd get to see others being examined, get to learn about which ones needed to come to the ER and which didn't, and get some general health education.

I guess this guy never heard of HIPAA. I can see it now: "OK everyone, since there are 10 of you at the same appointment, you'll each need to sign this form allowing us to discuss your protected health information in front of the others".

And while we criticize HMO's for their cost cutting and lack of services to patients, the HMO I belong to and work for has nurse specialists who meet with patients in high risk groups (diabetics, asthmatics, etc.) to monitor their health conditions on a regular basis and act as a laison with the physician. It's a highly effective program that's good for both the patient, who gets personalized attention as well as close surveillance of their condition, and for the HMO, which is able to curb it's costs as related to uncontrolled disease conditions (keeping a patient's disease under control is much more cost effective in the long run).

[twigs]

Nurse Practitioners are generally better liked by their patients, because they have a fraction of the economic pressure on them and can therefore spend more time with the patient.

Not in the practice I go to. Several of our doctors are simply excellent diagnosticians and I would not forego their opinion for anything. OTOH, we've been misdiagnosed by the NPs, who cost as much to see as the doctors. The receptionist always try to get us to see them. We find that this does nothing to improve our relationship with the office.

[VOA]

bump