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Archives : specialty care
Specialization in health care means more cost to the system
It’s the unfortunate reality that while increased specialization of labor in health care can result in better care, it most certainly results in more expensive care. This is going to be an issue until we find a way to pay more for “brain time” or “cognitive medicine.”
From, the NY Times: Let Doctors Bid for Medicare Business
Researchers have observed that having one additional specialist (per 100,000 people) in a region leads to about $13 more in health care spending per Medicare patient. New York City, for instance, has 186 specialists for every 100,000 residents, which is twice as many as Albany’s 93. Accordingly, Medicare spends $12,114 a year treating each patient in New York City, but only $5,950 in Albany.
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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
There is a downside to specialization of labor in medical care
Specialization of labor helps to improve quality, efficiency, and profitability. In health care however, there is a downside – it can come at the cost of the quality of the continuum of care that patients need and deserve.
This is one of the worst examples of patient abandonment I can imagine. Surgeons are paid a bundled fee to provide surgical care for a 90 day period. I’m pretty sure CMS would like to hear about this surgeon’s policy of not providing their agreed upon service contract with the federal government.
See more from A Happy Hospitalist: Is it OK For A Surgeon To Stop Seeing Their Hospitalized Patient?
The business of referrals in medicine
In any industry, new business is required for growth, but it’s naturally much harder to come by. This has an impact on health care.
The New York Times published an essay titled, “Referral System Turns Patients Into Commodities” recently, and it provides stellar insight into the behind-the-scenes business relationships that are driving supply and demand of both patients and specialty care.
Logic says that a referral should depend only on a patient’s needs and the reputation and skill of the physician to which the patient is referred. But medicine is a business too, so that isn’t how it always works in practice.
_________________
Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
Doctors aren’t paid to think
If you read this blog regularly, this won’t be the first time you’ve read a post about the growing trend in medicine that favors reimbursement for procedures over time spent with patients, regardless of how important or necessary that time is to the overall plan of care. As the leader of many trends in medicine, Medicare is the driving force behind this direction our reimbursement system is taking, and there isn’t an immediate end in sight. This article from the Wall Street Journal explains how this trend is reducing the availability of needed specialty care in the United States by providing a disincentive for medical students to pursue specialty areas that rely on cognition rather than procedural expertise.
A discipline built on spending time with patients to gather clues for a diagnosis, neuro-ophthalmology could become another casualty of a medical payment system that favors high-tech procedures over low-tech exams. The median income of a neuro-ophthalmologist at a teaching hospital is $200,000, according to the North American Neuro-Ophthalmology Society. That’s a third less than most general ophthalmologists, who undergo less training but can see more patients, and do more pricey procedures, in a given day.
Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country’s most highly trained specialties as well.
Endocrinologists, rheumatologists and pulmonologists — specialties that also don’t involve performing many procedures — face acute shortages. Many of the severest deficits affect children. Though nearly 300,000 children in the U.S. are diagnosed annually with juvenile arthritis, lupus or other complex rheumatic diseases, there are fewer than 200 pediatric rheumatologists to take care of them, according to the U.S. government’s Health Resources and Services Administration.
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