This week I decided to read a section in the newspaper I don't ordinarily have time for and came across an article that described all the wonderful technology and social media that is being applied to the science of getting people to, into, and out of the shopping mall parking lot-especially during this season of holiday joy.
There appear to be several premises driving parking lot technology. Among them: 1) get them to the parking lot. If the lot is too full, maybe having them come later might be customer-friendly. You know, build mall parking lot loyalty and all that stuff through serving the customer (remember that thought). 2) Once they get to the lot, get them to the closest parking spot which is what everyone wants. (Except me. I like to park far away and tote up the steps on my pedometer. My wife is not a fan of that strategy.) 3) Provide them valet services that work, including having the car ready and waiting for you when you set back to the front door laden with packages by using beepers that can signal the valet you are on your way.
There are other aspects of this wondrous technology, including special lights that show you where there was an available place just for you, social media apps that transmit this information to your smart phone, big signs that tell you the same thing so you don't have to be distracted from driving looking at your smart phone while you are trying to find a parking spot.
As I said, fascinating stuff. But what could this possibly have to do with health care?
Maybe we should have a contest to see who comes up with the best answer to the question about why technology and social media for the parking lot is more important than saving lives and treating people?
One cynical response would be that a big chunk of the economy is driven by the consumer, so it would be natural that we would want to make their shopping experience more pleasant with less exertion or worry. That might be a winner, until you figure out that health care isn't exactly a small chunk of the economy. And right now it's growing a lot faster than consumer spending.
Here is the bottom line: we can get you a space in a parking lot, but we can't get a system in place to avoid you having to fill out the pesky paper patient information forms every time you go to a new doctor-and even periodically when you are going to the same doctor. We can't have your medical records in a single place, such that you don't have to repeat every test every time. We can't figure out how to routinely take the sophisticated lab test or x-ray you had in one place come up in another place. Ditto on pathology slides, genetic tests, even routine blood tests.
And then there is the business side of the house.
I am becoming more and more convinced that there are literally armies of clerks sitting behind telephones prepared to confuse you and your doctor and deny you medical care for no reasonable reason (promise you, we had a situation like that in our family this past year, and my wife-an ob/gyn-faces bizarre situations like this regularly). Oh, yes, there are indications for various tests and procedures, but your doctor has to call in first. And if the clerk doesn't understand the test or procedure-or it doesn't fit a neat algorithm sitting in front of her or him-it gets bumped up another level and then another level. Eventually it may get to a doctor or nurse who may be trained to understand the particular issue, but then that doctor or nurse has to talk to your doctor or nurse who may be busy doing something else like brain surgery when the insurance doctor or nurse demands to talk to them (actually, that little scenario is based on a true story from a major cancer center. Maybe we should have all the doctors and nurses who are busy taking care of patients during the day call the insurance doctors and nurses at the same time, like 3AM in the morning.).
There is fraud and waste in medicine. We agree. But the burden of this oversight process on the typical patient and doctor's office is getting beyond ridiculous. There are not enough people in the world to make this work, and make it work economically.
Again, back to the parking lot question: You don't think if they really wanted to the insurers couldn't streamline this process electronically? You don't think they could focus on the outliers as opposed to trying to tease apart almost every single decision made between doctors and patients to determine if it is medically necessary? Do you think this has done a lot to bring down or control medical costs (has your insurance decreased recently???? Do you think we have improved the health care system while all this is going on? Are we really giving more effective and appropriate care?). Do you think it is possible-just possible-that creating a simple, information based electronic system to handle this nonsense might help streamline this system for doctors, patients and insurers? Is every doctor a thief mistreating their patients? I don't think so, but it is appearing more and more that that is the philosophy driving this system, and that is not good.
And now the reason why I am writing this blog in the first place.
There is a battle going on in Washington having to do directly with the questions I raised above. And the American Cancer Society has been quoted extensively this past week raising the flag on this particular issue.
Whether or not you are a fan of the Affordable Care Act, it is the law and barring some event over the next 12 months (or perhaps later), we are going to be subject to that law. And when you have a law, there is the need to write regulations. And those regulations for the ACA are being fought over and written write now. If we don't pay attention today, then we will find ourselves in a not-so-good place later on when the Act actually has most of its major provisions go into effect.
One of those provisions deal with medical loss ratios. Medical loss ratios in human terms means the amount of money actually spent on true patient care vs administrative expenses.
Guess what? The insurers are supposed to spend 80% of their dollars on actual medical care and 20% max on administrative expenses under the new law. So what is a medical expense and what is an administrative expense becomes a very important topic.
So a prize goes to the person who gets this question right: You are an insurer, and you have an army of people reviewing everything your doctor or other health professional does to the people you insure, every test, every x-ray, every hospital admission, every surgery, etc. etc. In short you have an army of approvers sitting at your desks doing their deeds. It's a lot of money.
Now, which bucket do you think you want those expenses to fall in? The 80% bucket that provides for medical care or the 20% bucket that pays for administrative expenses? As an insurer if they go in to the larger bucket, you win. If it goes into the 20% bucket you lose. You lose because what you have created is expensive, cumbersome, and is not focused on the places where you really have a problem. It just gums up the works, makes people angry, and doesn't do much to save lives most of the time. You may actually have to reduce some salaries and stock options if you have to squeeze the money to pay for all of this nonsense from the 20% bucket. You may actually have to deliver on the promise of developing effective, electronic simple to use medical approval processes. You may actually have to streamline an arcane, obtuse and incredibly expensive and inefficient system.
So there is this big argument going on in Washington as to where the money is going to go, and ultimately it will impact the amount of real medical care you will receive. I don't think people are of the impression that someone sitting on a phone in a distant place responding to your questions in a dull tone, or our doctors and their offices spending scads of time doing the same thing really counts as medical care. I think patients would rather have their doctors and their staff spending time taking care of them.
Which brings us back to the parking lot. If we can automate the parking lot, why can't we automate medical practice? The answer is: we can, if we wanted to. And if the insurers wanted to, they could get the job done instead of finding all sorts of excuses to plod on like Luddites in the wilderness.
Will we ever see the day of true efficiency in medical care? Maybe. And getting these gobs of administrative expenses into the right bucket-as a true administrative expense, as if there is any question-may just be the catalyst this bizarre situation requires.