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Is the government running our healthcare already?

Socialized medicine is already here. The Medicare system is a government program. The Medicare model sets the standards for how medicine is practiced in this country. Practitioners follow this model so they can get reimbursement for their services. Health care systems that rely primarily on Medicare reimbursement are under the thumb of these government standards. An example of this is Hospice, where most clients are of Medicare age.

Providers that accept Medicare are under the watch dog of the government. They are required to follow all the rules set forth by the government in order to get paid for their services. Some guidelines are necessary but the pendulum has swung away from quality of care.

The rules set forth do not always promote quality of care. Clinicians are burdened with more and more paperwork requirements that take time away from patient care. This has led to less individualized treatment which is necessary to improve the quality of care that the patient receives.

It appears that some of the rules are not prepared by clinicians in that particular field. They make no sense when it comes to quality of patient care but are focused on money and reimbursement. We have left the quality of our healthcare in the background and let money be in the forefront.

Physicians and other healthcare providers are forced to treat patients by what insurance covers, not what is necessary to achieve the best outcome. Generic medications are an example. They are ordered when the patient can only afford the $4.00 medication instead of a drug that may have better results. Only those that can afford the recommended treatment actually receive it.

The Medicare drug program is so confusing because each plan offers different drug coverage. These are private companies that have developed a list of covered drugs and have government approval. Our seniors have to sort through this bureaucracy. Why isn’t the list standard based on the most utilized drugs and quality? Without some drug coverage, some seniors can’t pay for necessary drugs to maintain health.

Private companies are hired by the government to oversee Medicare providers. These companies are highly paid to monitor healthcare providers. The companies perform audits of patient records. On paper they must show denials which in turn prove cost savings. The higher cost savings, the more likely that company will regain a contract with the government. The focus in on money and not the quality of care that patients receive.

In Arizona, the Medicaid program has cut the hospice benefit for all adults unless they are receiving the long term care benefit. This steers patients to seek more expensive treatment and decreases the quality of care for terminally ill patients. Patients with the long term care benefit are already receiving non medical home care assistance.

Health care reform is just around the corner. The cost is out of control because there is no focus on quality. The definition of quality in our government has changed from patient results to monetary gain. In my experience as a clinician for many years, quality of care is much more cost effective. Quality of care is based on a relationship between the healthcare provider and a patient. The patient works with the healthcare provider in improving his or her quality of life. The patient has personal goals and the healthcare provider has the knowledge to work with the patient to achieve these. It’s really very simple.  This doesn’t always mean that the patient may require expensive treatments but it does mean that the patient may need treatment that is not covered by his or her insurance.

Years ago, insurance companies took the abuse of being overcharged by healthcare providers. They paid whatever the provider charged. This led to the HMO industry to help curtail cost. Over many years the pendulum has swung in the opposite direction and insurance companies under underpaying providers, including our government Medicare program. This has led to decreased patient time and providers trying to keep reimbursement up by having to see volumes of patients. Healthcare providers are being underpaid but they desperately need the client referrals from insurance so they sign contracts that are way too conservative.

I believe it’s time that we enforce the concept of the government  that works for the people. We pay them to work for us but we have let them take over in making decisions for us that are not always in the best interest for the majority of people. Senators and congressmen are not clinicians, nor are they close to the challenges that we face in healthcare. We the people, are faced with limited insurance coverage and the monies to pay for what is not covered. We need to let the clinicians that specialize in their areas be the voice for our Medicare program so quality of care is the focus instead of monetary gain. Rules should be developed with documented input from the specialty providers and clinicians that have the experience to help make the best rules in the Medicare program.

Instead of paying billions of dollars to private companies who monitor Medicare, put the dollars into improving the reimbursement so quality of care is the goal. An example is Hospice care. It is intended per the government to be for patients with a life expectancy of six months or less. The Medicare program doesn’t let patients die in their own time or way. They use a standard of death and if the standard isn’t met the provider doesn’t get paid. Can’t we die in our own way? Why must we put a number on when to die or a guideline on what patients must go through to prove they are dying just to get care for terminally ill patients?

Bring quality back to our healthcare system by allowing healthcare providers to practice medicine as they were trained to do. Healthcare providers, as do patients, all have an obligation to help with costs by reducing waste in our system, the right care at the right time and place. Let us the people, define quality of medicine by our individual circumstances blended with statistical data to achieve the best outcomes. If we can’t have it all, let us at least be able to die in our own way, at our own pace, and leave this world with some dignity.

Louise Williams is the Director of Hospice of the Pines.

Note: Please mark your calendars to join us on Saturday, May 15, 2010 from 5-8pm for An Evening with Movie Classics at the Rose Restaurant. Watch for upcoming details. You may also This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call Louise Williams at 632.0111