By J.C., on August 12th, 2008
The hot topic for many physician practices is the creation of electronic medical records and charts. While these are great for making medical practices more efficient, one overlooked reason for using medical records and charts is for digital storage. One costly part of a physician’s practice is the storage of records. There are laws that vary according to state about how long records must be kept. However, in general, medical records must be kept for as long as possible. From a medicolegal perspective, failure to keep appropriate records and documentation of a visit or treatment that later becomes a patient grievance is a recipe for disaster. Thus most physicians archive and store their paper charts in storage facilities for an eternity. As you can image, these storage fees can add up over the practice of a physician.
Most physician’s store their electronic records in storage facilities that run several hundred dollars per month. Depending on the volume and size of records of a practice, this amounts to several thousand dollars per year. Digitizing these records does have a cost. However, once these files are digitized they are easily accessible by computer. They do not have to be physically stored nor does anybody have to physically go and retrieve the charts.
For those contemplating going digital, I’ll do a hypothetical calculation of the cost savings for a physician practice that has 12,000 charts costing $200 per month to store. Under that scenario a physician must spend $2400 per year or $24,000 per decade. Digitizaton of these charts is not cheap but in the long run can save good money. For example, for about $2000 you can get a high quality scanner and software. Scanning the charts is what costs the most as it probably takes 5 minutes to scan a chart. Thus it takes about one hour to scan 12 charts. Thus about 1000 hours is needed to scan 12,000 charts. Hiring someone $20 per hour would cost about $20,000, which is a lot of money but less than the $24,000 the practice spends per decade in storage.
By Jennifer Bunn, on July 29th, 2008
Medical tourism may be defined as seeking healthcare outside one’s own country. This is becoming more common as people search for affordable healthcare. In the U.S., patients travel to countries that perform the procedure they need for a fraction of the cost of the same procedure done domestically. In Canada, where healthcare is essentially free but where wait times may be unacceptably long, people are choosing to go to places that can perform the necessary procedure on the same day of arrival if desired. Some patients like to kill two birds with one stone and combine surgery with a holiday in an exotic locale.
What are the advantages for patients/consumers? As mentioned, costs may be considerably lower in other countries, allowing patients to combine a holiday with their procedure. Having surgery in another country can also cut down considerably on wait times for those patients who come from countries such as Canada, where wait times for elective surgery may be months. For example, wait time for a hip replacement may be longer than a year in Britain and Canada. In the U.S., restrictions on the patient’s choice of facility, surgeon, and the type of prosthetic used may be factors in patients choosing to receive medical care out-of-country. Additionally, many international hospitals have improved their facilities and standards of care to attract international patients. Many international hospitals have become JCI-accredited, which makes them even more attractive to foreign patients.
What are the disadvantages for patients/consumers? One disadvantage is that patients traveling to foreign countries for healthcare may actually expose themselves to infectious diseases to which their immune system has had no experience in dealing with (i.e. TB, malaria, hepatitis). Also, travel after some surgeries may not be recommended for some time and may be very uncomfortable. Post-operative care may not be to the same standard that some patients are used to, although many foreign hospitals are striving to remedy this.
Other considerations concern legal issues. Patients who are dissatisfied with their surgery results, or who have an adverse outcome, may have little recourse in other countries. Doctors in other countries may not have to adhere to the same insurance and malpractice standards as physicians in countries such as Canada and the U.S. Patients who suffer a poor outcome may have a difficult time finding a doctor in the U.S. who is willing to take on their care.
It seems the trend of medical tourism is here to stay. Patients who are considering receiving their care in a foreign country should thoroughly research the doctor and hospital where they will be receiving their care. They should also research insurance options for themselves before departure. Lastly, choosing a facility that has been JCI-accredited may provide some reassurance that the hospital they have chosen is maintaining basic standards of care.
Reference:
Health News Today, July 10, 2008. Washington Post, Wall Street Journal Examine Issue of Medical Tourism. http://www.medicalnewstoday.com/articles/114520.php.
By Jennifer Bunn, on July 23rd, 2008
The use of electronic medical records has been touted as an enormous economic benefit in terms of cost savings as well as a boon to increasing patient safety. So why aren’t more doctors using them?
Although many doctors employed by larger medical entities are making use of EMRs because the costs of implementing the system are covered, smaller practices with few doctors are unable to afford the $5,000-$50,000 start-up costs, not to mention the approximately $1,000-a-month maintenance fee.
There is also the issue of time lost and decreased productivity during the implementation of the system. It takes a lot of time to enter data on each individual patient into the system. Once the system is fully functional, doctors report that much of their time is still eaten up during clinic visits entering data into the system.
While larger medical centers are willing to pay these costs and train staff to use them, it is just not feasible for smaller practices with fewer resources. Additionally, there is little incentive from the government and insurance companies, although they receive most of the benefit from the use of EMRs.
Another reason for doctors’ worries are that there are many different models of EMRs, some of which are not compatible with each other and are unable to share the very information they were designed for.
So what can be done to encourage smaller practices to purchase an EMR system? Very few doctors report receiving financial subsidies to help mitigate the cost of implementing the system, according to a Texas Medical Association survey. If these systems will save the amount of money that they are predicted to and save as many lives as the companies who make them claim they can do, perhaps the government needs to help smaller practices implement these systems by paying for a substantial amount of the start-up costs.
By J.C., on July 12th, 2008
These are exciting times for all of us given the increasing interest in healthcare during a presidential election. One key theme in the transformation of our medical system has been whether universal healthcare is something we want, something we can afford, and something we want to make happen.
When people think of universal healthcare, they often look at the rosy view – that every person should have access to healthcare. This is an ideological change from the previous view that healthcare was a privilege and a fringe benefit. For those of you who don’t know, the health insurance industry really came about for the need for companies to recruit great workers. Many of these potential workers were war veterans and needed medical care. Thus, medical “benefits” was indeed a fringe benefit that was only previously afforded by the elite or those with good jobs. Interestingly, if you think about it, every one has “access” to medical care these days. There are no barriers from anybody walking into a doctor’s office or a hospital. Whether you can pay for it is a different story. Thus when we say “access to care” we really mean “care that is paid for by someone else”!
In this day and age, many people are viewing healthcare as a right. Thus, in other words, people expect to receive medical care that is paid for by someone else; simply because you exist in this world, you have the right for healthcare. That “someone else” happens to be the government, which passes on the cost to every person in the United States via some tax somewhere.
But one of the consequences of universal care, which I view as somewhat of a socialist concept, is that all care will be the same. In other countries where universal care is in place, you do not get a “choice” to go to the doctor you think is better than the other. What you get is the right to see the doctor who you see.
We Americans are truly a spoiled lot when it comes to consumerism – the medical industry is not spared. We want to go to the best doctor possible. We want choice, and we will pay for choice. If there is a special procedure, we want it done. What we do not realize is that those choices and tiers of medicine are only availed through a profit-driven capitalist medical industry. Where do we think all of those drug and device discoveries are coming from? From the company that spent billions of dollars researching it and who sells it at a handsome profit and whose stock is listed in the public markets!
Are we ready to give up choice to establish a “standard” of care from which no patient receives anything different? I really don’t think so. I really think we love the idea of “fairness,” but when it comes to ourselves and our bodies and our health, we want the best even if it is what others cannot afford.
By Jennifer Bunn, on July 11th, 2008
The cost of healthcare is always a major concern in the U.S. With approximately 47 million uninsured people and soaring costs, the already-beleaguered healthcare system has been a major topic of debate in this, an election year.
In “Options for Slowing the Growth of Health Care Costs” from the April 2008 issue of the New England Journal of Medicine, the authors present several options that they see as potentially cost-saving. Their “top three” picks that they believe have the greatest potential are capitation, strengthening reviews for new drugs and technology, and electronic health records.
Capitation, in which providers of care are paid a fixed amount of money to provide for the healthcare needs of a patient population, has been tried and found wanting. Providers of care have balked against caps placed on their provision of service, and patients have been dissatisfied with being unable to freely choose their own physicians. Given that it is an unpopular choice for many physicians and patients, an effort to expand capitation to more healthcare sectors will likely be an unpopular choice that will meet much opposition.
The idea of a national oversight committee to provide more effective and stringent reviews for new drugs and technology and which would be required before reimbursement was made is a sound idea in theory. However, as the authors point out, “concern about this approach comes from members of industry, who worry about the possible effects of such reviews on the time and costs associated with getting products to market.” This may be a valid point: tying up new drugs and technologies in bureaucratic red tape might unnecessarily lengthen the time it takes to get them to patients who need them. This could be a drawback if the new products have the potential to save money in the long run in terms of making patients well faster.
The authors believe that use of electronic health records can be a cost-saving strategy. “We believe the greatest cost-reducing effect of electronic health records will result from improved coordination among health-care providers and from decision support that improves clinician’s use of tests and treatments.” The major drawbacks mentioned by the authors in this study are the costs involved in implementing electronic health records into practice and, perhaps more importantly, physician’s potentially negative attitudes towards using computers to tell them how to practice medicine.
The authors suggest several potential cures for what ails the U.S. healthcare system, but will anyone be able to agree on which, if any, methods to use.
By J.C., on July 6th, 2008
One of the reasons that the costs of medical care continue to escalate is the litigious society we live in. Physicians, leery of the litigious patient, must practice medicine in a defensive manner. Oftentimes, they must prescribe medications or order expensive tests to cover all bases. These expensive routine workups are a primary reason why hospital bills can be so expensive.
For example, the patient who complains of chest pain while in the hospital for some other minor reason will typically get a battery of tests such as an electrocardiogram, cardiac enzymes, electrolytes, pulse oximetry, and a chest x-ray even if he or she does clinically look like he is having a heart attack. If the physician fails to do all these things and the patient does indeed have a heart attack, the physician may be on the hook for that event.
Thus in such a litigious environment, every physician should obtain malpractice insurance. In many specialties, such as obstetrics, these costs can be prohibitively expensive in certain states, driving physicians out of those states. However, some states, such as Texas, have addressed tort reform. Texas has enacted a law several years ago that caps noneconomic damages at $250,000. This sort of policy limits liability for the physician and drives down the cost of malpractice insurance significantly. It is interesting to note that since the law went into effect, the number of physicians applying for medical licenses in Texas has increased every year.
Tort reform and capping of damages obviously has the significant benefit of allowing physicians to practice medicine with limited liability. Thus, it is significantly pro-physician and is cost-effective. However, from the patient’s perspective, putting a number on a possible outcome from malpractice may not be palatable. After all, we live in a society where people can successfully sue others for millions of dollars from other types of accidents.
Thus, malpractice will continue to be an issue at the forefront of the health economic and policy debate. From my perspective, the medical industry is regulated in almost every other area. It might as well regulate malpractice and make the health economy more financially viable.
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