Let’s Get Back To
Basics
Daily Observer
The latest fad is
the assumption that increased medical costs are bad for the country. As a
result we have organizations like the PSERO Professional Review Organizations)
and hospital cost containment legislation, aimed at rationing health care. An
editorial in the
The health care system is
one of the nation’s largest employers, a dependable source of jobs. Health care
is a low energy industry and its energy consumption would be lower still were
the nation to construct a proper transportation system. The cost/benefit ratios
cannot be determined in health care, because they deal with philosophic
imponderables such as the value of life itself.
The doctor’s contract is
with the patient. The doctor is supposed to solve the problem of the patient
and not those of the community. The fact that the economy has been mismanaged
should be the major concern of the parsimonious social scientists. A
well-managed economy can afford patient care. Doctors have been brainwashed
into caring about costs, when all we should be caring about is patients. Every
regulation and plan that evolves to save medical dollars somehow cuts back on
patient care.
There are about seven
thousand hospitals in the nation. Seven thousand then is our multiplier. If
each hospital eliminated its public relations department (average cost probably
about $100,000 yearly for each hospital spread out on the per diem hospital
costs) would save about $700,000 million dollars.
If the JCAH (Joint
Commission for the Accreditation of Hospitals) would relax its requirements on
the medical records section of each hospital probably another billion dollars
could be saved annually. (More
attention is paid to patient records than to patients)
The cost/benefit
ration of medical records is zilch (zero). It is mainly for lawyers. Proper
admission and discharge notes on the charts are all that are needed since
laboratory results, x-ray reports kegs etc are automatically placed on the
chars and copies kept in their respective departments. I would rather than
several signatures were omitted on a chart than a calcium or phosphorus on a
lab sheet. Despite the fact that the “patient worth” of the latter is
negligible at least when normal, it rules out a category of disease and
eliminates uncertainty. A forgotten signature on a chart does no harm, and a
signature added after discharge does no good. In fact the entire chart is
tidied up after the patient leaves the hospital. This is known a covering up or
plugging leaks and the price is exorbitant. (Doctors forced back to record room to tidy up the chart)
Another
extravagance that should be mention and considered is the hidden cost entailed
in the “semi-private” hospital room. First it is not semi-private, it is
semi-public. Secondly it necessitates the transfer of patients from room to
room matching males and females, youngsters and the dying etc. The actuarial
cost of each transfer in an average hospital is $50. Even in small hospitals
there are about 30 moves a day ($1500 x 365). For 7000 hospitals this adds up
to 3.5 billion annually which appears on per diem charges.
Hospitals composed
mainly of private rooms and wards (“units” is the current euphemism) would
eliminate this expense. Thus proper hospital planning and reduction of
unnecessary services could save the nation six or seven billion annually and
make the new technologies affordable.
We should be
concentrating on patient care, but somehow our heads have been turned. Our
attention has been diverted from the immediate care of patients to the costs of
that care. I think its time to get back to basics.