Healthcare Reform: Things they should teach our doctors in med school.

 

Foreword: This article was kept back for quite some time until today for the reason that it might cause a stir among many of our business partners, affiliates and a handful of close friends. I do not intend to discredit the medical profession in general nor embarrass anyone. My sole intention is to let them know that they should put people first above all before themselves.

 

Quality healthcare is one of the very basic benefit every Filipino should and always have. Yet, even those who have and can afford, cannot truly appreciate health care in its true sense of the word. I'd say, much of the problems in service delivery  lies entirely not our government or the system but from the principal drivers of health care - the doctors.

I have listed some common and very annoying habits that doctors do or doesn't do in the practice of their profession and what med schools should teach to our young graduates.

 

1. Respect other people's time.

Have you ever seen a doctor who came in for work on time? Probably there are but in my experience 9 out of 10 doctors never make it on time. What's even more disheartening is the fact that people graciously accept doctors' tardiness. No one expresses anger or disappointment whenever the doctor come in late for work. Instead, they are greeted with respect and reverence much like greeting a priest in a confessional. Also, our chronically tardy doctors were given 'safe passes' or 'blanket' acceptance for such socially unacceptable behavior. It's high time that we should express to our doctors that our time is equally important as their time and that there are no excuse good enough for disrespecting our covenant of properly keeping time.

 

2. Always consider patient's financial capacity.

The cost of health care including diagnostic tests and medicines are steep these days most specially with the advancement of very modern medical technology. Ever wonder why doctors prescribe too many lab tests and not even ask if we can afford to pay for it? In retrospect, doctors should always qualify the financial capacity of the patient to pay for medical bills and that procedures should be conservative and given in accordance to patients' economic status. In other words, before an expensive procedure is to be given to a patient, a low cost alternative must first be considered unless extremely necessary.

If it may help to understand, doctors get as much as 15% to 30% percent (commission) for every laboratory referrals they make to private laboratories. The more referrals they make, the more income they generate - that is how the 'game' is played. Sad but true, there are no prevailing health care standards placed by our Government to better monitor and manage medical practice, much like an ISO for the manufacturing industry, and so doctors are left to do basically anything they want without being accountable for anything.

 

3. Give what is due to the Government.

Doctors make poor businessmen. A dishonest businessmen at that. In fact, they don't consider their practice a business at all; probably another excuse not to give official receipts and being chronically tardy. Doctors don't declare how much patients and money they earn for medical consultations. Doctors don't declare their commissions or referral fees they get from private laboratories and hospitals. Doctors don't declare cash gifts and bonuses. And, doctor's refuse to deduct taxes from services rendered to insurance holders. Well, if there is anything these doctors want to deduct from, it probably is their obligation of service and charity to their countrymen.

 

4. Stop asking favors.

We are in the business of health care and, part from being that, we hire doctors to manage our clinics. If there is truth to what our medical director once said that: "doctors need medical reps for conference sponsorships". Is it really a need or just merely a want? I pity the medical reps these days for they are reduced by these doctors to become their personal sponsors for conferences and even their dinner parties. This is one major reason why our medicines are among the most expensive in Asia because of the representation costs incurred by drug companies to these doctors. Yes, your doctor is the reason why they are expensive.

 

5. Work with the system.

Many doctors always seems to feel that they are always a cut above the rest. This probably stemmed from long and expensive education that they feel they should be given special treatment. Thus, being socially placed above the pedestal, they feel that they can work their best if there are less rules to follow. Rules that particularly govern their professional practice.

I can vividly remember when we first installed our first medical director to our chain of medical clinics and discussed on house rules and policies, they (the doctors) started feeling very uncomfortable.

 

The practice of medicine has changed dramatically over the years most specially with the advent of modern medical technology. We were able to probe deeper and understand primary causes of diseases and how we can protect ourselves from them. But, despite all the advancements, some basic yet very important things hasn't changed and that is how our modern shamans (doctors) practice their profession for the sake of science?

Physician House Calls : Reviving an Old Practice to Modern Communities.

When was the last time you remembered a doctor visiting you in your home and see how you are doing? I was fortunate enough to have such personal care when I was still a young lad, that kind doctor was our neighbor. From that time forward, going to the doctor's office was really somewhat a luxury. It is since I don't have much time to spend and wait in line for doctors that always come in late for work .

In cases of medical conditions where you need to urgently see a doctor at wee hours of the night, where do you go? I cannot go to OPD section since they close at night. So I am left with no choice but to endure the steep cost of medical care in the Emergency Room, even if my case isn't an emergency.

We in the health care insurance business recognize the this serious flaw in the delivery of health care services to our countrymen. More often than not, the HMOs shoulder most of these unnecessary expenses incurred thereby increasing their utilization.

Being fully aware of this situation, KAINOS Health Management, Inc (our company) has come up with a simple plan that isn't really new at all; but a long gone practice - physician house call.

Yes, we believe that genuine health care should be patient centric and that, a personal and convenient approach is necessary at all times - even at night. Providing house calls is a very welcome convenience most specially for parents who have not enough resources to visit the nearest hospital or can't wait until morning to consult a very tardy doctor.

Visit our new program on our company website at www.kainoshealth.net to learn more.

JCAHO: The "Big Brother" of Medical Practice

I remembered a few months back when my brother told me that one of the major hospital in the city here in Cebu was threatened by an immediate drop in hospital admissions. Something very unusual for them since they are always flooded with patients at any given time. All of a sudden, as what my brother described the phenomenon, the emergency receiving area became a "ghost town". Orderlies are lining up outside waiting for patients!

What brought about this phenomenon? As it turns out, many of their hospital doctors has somewhat "unionized" and started referring their patients to other hospitals of their affiliation. What sparked the sudden outrage of these doctors was due to the hospital's initiative to adopt JCAHO practices. As a consequence, other hospitals within the city suddenly had an unexpected surge of patients while the said hospital had very few. So what is JCAHO? Why are doctors in that hospital intimidated and even caused outrage to move their patients out?

 

What is JCAHO?

JCAHO is an independent, not-for-profit organization, The Joint Commission accredits and certifies more than 15,000 health care organizations and programs in the United States alone. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

What is JCAHO's Mission?

To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

What is the scope of JCAHO?

The accreditation programs of JCAHO includes: Ambulatory Care, Assisted Living, Behavioral Healthcare, Critical Access Hospitals, Home Care, Hospitals, Laboratory Services, Long Term Care, Networks, and Office-Based Surgery.

 

Isn't this good for all of us?

The answer is a resounding yes! However, (in my opinion) doctors are threatened because of the following reasons:

1. Standards: When doctors work in a JCAHO accredited hospitals, part of the policies that they are expected to adhere is the set standards by JCAHO. This means that doctors cannot just confine patients, request lab workups or procedures unnecessarily. Thereby, controlling healthcare cost incurred by he patients. This significantly controls the doctor from having malicious agenda of giving so many procedures and confining them unnecessarily just to earn more. This is true and this is rampant.

2. Peer Review: This time around, doctors practices are meticulously reviewed for proper patient management. They are under a watchful eye of hospital appointed committee (like the "Big Brother") and reprimand if any violations are made, be it procedurally or behaviorally.

3. Performance Evaluation: With our current healthcare practice, who determines if the doctor is effective in patient management? Does the doctor himself even know he/she is efficient and effective in delivering healthcare? I bet he doesn't. We consider doctors as modern day Shamans and would want to remain that way! JCAHO has toolkit for medical practitioners in the form of performance indicators. It is performance metrics program where all their patient management activities are measured, quantified and analyzed. The output of the report provides a grade. Just like how hospitals under JCAHO are graded from 0 to 100.

4. Full disclosure: Doctors are also expected to fully inform and disclose all activities that will be done to the patient, its outcome, and medical errors (if any) - blag! Doctors are human and they commit mistakes but they are not honest enough to tell you they made a mistake for fear of litigation.

My thoughts:

We don't anymore live in the middle ages where the Shamans are the only people in the know and not even question their authority. Doctors have enjoyed that position for a long time and at most at the expense of patient safety. JCAHO's basic tenet is patient's safety. Nothing more and there are no hidden agenda to this. Bottom line here is, doctors don't want to be controlled or a "big brother" watching over their shoulders. It just annoys them to think that they can be kicked-out of the JCAHO accredited hospitals or worse, sued for medical errors by their patients.

KAINOS’ Managed Care Rules, Rights, and Responsibilities

Knowing your plan’s rules – and your rights and responsibilities under those rules – can help you make the best use of your KAINOS Healthcare Plan. It also can save you money and help you get the right care you need.

You get a lot of information about your managed care plan when you enroll. The member handbook explain the benefits – the kinds of treatments and services your plan pays for. Keep this material handy so you can refer to them when you have questions. Read the plan newsletter or our blogs, like this one. It keeps you up to date on any changes in your plan.

A health plan contract provides a legal definition of plan benefits. If you are in a managed care plan through your job, the contract may be between your employer and the health plan. You may need this if you have a serious problem with the care or services you get from your health plan.

The Rules

Your membership materials provide information about:

• Costs and Benefits

Find out which benefits your plan pays for and which it will not. Find out how much you need to pay (on programs requiring co-payment) for each doctor visit, for prescription drugs, and for medical equipment.

• Member Services

Find the telephone number for the member services department of your health plan. Call this number (1-800-1-888-6300) with questions about how to file a complaint, the health plan rules, costs, and benefits. Be sure to tell the member services department of any changes in your address, phone number, job or family life that may affect your coverage.

• Practice Protocols
  

See if your plan recommends doctors follow “practice protocols” or “treatment guidelines” for certain chronic diseases and other illnesses. These guidelines usually are based on standards of care set by medical experts. You are more likely to get good quality care if your doctor follows these guidelines.

• Out of Network Care
  

Know if and when your plan pays for visits to doctors and hospitals that are not part of your plan’s network. This is sometimes called going “outside the network.” You might need to pay all or a percentage of the doctor’s or hospital’s fee if you go out-of-network for care. Costs incurred during “outside the network” services are reimbursable only if it conforms to your subscribed healthcare plan.

Your Rights

If you know your rights, you can stand up for yourself and protect yourself from an unfair plan decision.

• Read through the plan materials for information about what you can do when your plan or your doctor makes a decision you don’t agree with.
• Talk with someone in the member services department to find out how to appeal a plan decision you feel is unfair. For example, how to appeal your plan’s decision to stop paying for your medical treatment.
• Your insurance/human resource department can tell you about laws that protect your right to health care in managed care plans. Your insurance/human resource department may help you file an appeal or reconsideration.

Your Responsibilities

People today take more responsibility for their health than they did 20 years ago. They are more active, eat better, and work as partners with their doctors. Taking responsibility for your health can mean a healthier and happier life. Here are some ways to do that:

• Learn healthy habits. You are responsible for what you eat, how much exercise you get, whether you smoke and following your doctor’s advice when you are healthy and when you are sick.
• Call any KAINOS affiliated doctors or your plan’s help line (1-800-1-888-6300) if you need advice about medical problems.
• Go to the nearest hospital emergency room if you have a life-threatening or very serious health problem. Be sure to call your health plan as soon as possible.
• Attend Health & Wellness Seminars sponsored by KAINOS. It’s a free service provided for members so take advantage of all the amenities available as much as possible.

Empowerment Through Information Sharing

Technology has dramatically advanced how people do things over the last century. From the inception of simple farming tools to electronic communications, our lifestyles changes to conform to this evolution. Much of these advancements are merited to people`s capacity to share knowledge and the pace of ones development depends on how fast people do. Many people mistake power with information monopoly and tries to withold as much as they can to obtain favors, wealth and influence when in fact it is the contrary.

KAINOS Health Management, a uniquely identified managed care company, strongly believes that empowerment begins through the spirit of sharing. Our company was firmly founded on that principle and will continue to influence others to follow suit beginning with the basic resources that we have - Information. KAINOS has been managing healthcare to companies of different sizes and industries and over the years we have garnered a good reputation on unwavering and excellent service towards our clientelle. On those years, health information were collected, processed, analyzed and secured in our database. Sound management and critical decisions were made based on these kept information.

Our situation of keeping information is never different from the rest of the healthcare institutions or the entire healthcare industry in the Philippines. Hospitals, privately-owned clinics, laboratories, pharmaceutical companies, insurance companies and brokers have their own electronic systems in place, managed and kept only for their own use. An enormous wealth of health information are kept in a vault of `steel and stone` which could have been shared to different entities in the healthcare industry. The entire local healthcare industry in itself is a cluster of unsynchronized subsystems focused almost entirely on profits generation than healthcare management. Structured information framework and information sharing takes a backseat as well.

KAINOS is separating from this mediocre and ‘old school’ practice and hopefully lead the pack towards healthcare information restructuring. Our goal is to empower people by implementing acceptable standards and sharing useful information among different entities within the entire healthcare industry. Doing this provides many advantages and the list below are just a few of them:

• Better health management through sustained monitoring.
  If your the type of person whovisits different doctors every so often like me, they will ask you the same questions about my medical history like: allergies, medications taken, previous operations, and after every consulations these records are kept in their big clunky cabinets for my next visit to them. Monitoring your health becomes a very tedious tasks for such a simple problem.
• Better decisions through comprehensive reports.
  There is really nothing like making sound decisions when all medical records are complete.health management is really about knowing history to understand present illnesses.
• Improved awareness through easy accessability of records.
  This simply means that medical records are portable and are readily accessible at their own convenient time. There will be no more lost drug prescriptions or laboratory results.

There are a host of advantages when you start empowering people by sharing. KAINOS is devicing a plan to approach this challenge and will soon be realized in the coming months. I will be discussing the overview in my next blog under Health Informatics category.