Cost
Cutting Exercises Do Not Help The Patient
Why
is the cost of Medicare higher than anticipated? The most obvious reasons: health is open ended; medical advances
preserve lives that demand ever-increasing medical and nursing surveillance as
well as hospitalization; the elderly have complex system diseases so that each
patient demands the time facilities and money that for a younger population
could be expended on 10 patients.
But
the bill will escalate preposterously because of the watchdog systems that the
government is construction to police utilization of hospital beds.
Utilization
of beds must be surveyed continuously at two-week periods according to federal
law. The responsibility for this, with
the foolish encouragement of the American Medical Association, must be carried
out by the medical staffs of the hospitals as mandated by law.
To
properly determine whether or not a patient belongs in a hospital, a physician
must examine the chart with the deliberate scrutiny of a professional proofreader. The admission notes, the history and physical
examinations, the daily progress notes, the graphic sheets, the daily medical
orders, the daily laboratory reports, the radiology reports must be chronologically
arranged and scanned, each detail carded with a fine tooth comb, to determine
whether or not the patient has overstayed his welcome.
This
was always a difficult job, even when done less carefully, as a requirement for
the Joint Commission for the Accreditation of Hospitals. But now encoded into the law of our nation,
this screening cannot be performed casually because the law demands precision.
To
provide guidelines for the reviewed, the government has ordered that Medical
Audits be created for various disease entities.
This means that, for a specific disease, the Audit Committee must
describe the diagnosis and the methods of treatment. It is arranged like a game. If (a) occurs, go to (b). If (b) is not there, perform tasks (c) and
(d) and then pick the winner and jump three squares to (e). As if medicine were that simple, or could be
played according to the numbers. Be that
as it may, the Audit provides the guidelines for the utilization review and the
charts eventually will have to be examined with respect to the guidelines. No physician will then dare digress from the
guidelines. Tests will have to be
ordered that normally judgment would proscribe.
Bacterial cultures will be taken for every crack in the skin of a
patient, as if that would be of help to anyone.
The schemata for the guidelines and utilization review thus are complex
and the review exceedingly time-consuming to perform. It is a job for a keen sighted clerk with a
green eyeshade who has a retentive memory and nothing else to do with his time.
To
the initial screening, the hospitals through the nation will have to hire
anywhere from five to 50 medical records librarians, secretaries and clerk
typists to keep the Xeroxes rolling. The
cost, assuming $40,000 for small hospitals and $400,000 yearly for larger institutions,
will run to millions of dollars that could better be spent on patient care.
Medical
staffs, if they are wise, will require the hospital trustees to hire a team of
physicians who have nothing other to do, perhaps retirees, or administrative
types who will be glad to earn $50,000 yearly to perform this thankless,
wasteful task, which attacks the credibility of the medical profession. No medical staff has the personnel to do this
job properly if they still want to practice medicine.
The
job, of course, is unnecessary, just another bureaucratic pillow the contents
of which can feather bureaucratic nests.
The
millions of dollars that will be wasted on this perfidious “cost-cutting”
exercise, perpetrated in the guise of conserving the tax dollar might better be
spent in increased Medicare benefits and realistic remuneration to the patient
of medical costs. But instead, the cost
cutting will cut nothing but the throats of the consumers and may well cripple
the profession of medicine in the “bargain.”