October 2017 Edition. Volume XVII

restaurants  Why do people chose one restaurant over another?  Why do some restaurants succeed while others fail?  The answer typically relates to quality, service, price, and other high levels of client satisfaction.

What if restaurants were required to identify all of their dishes by standardized code numbers and relative value indices were assigned to each code and if the establishment had to charge their clients exactly the same price for each identifier?

Would anyone be surprised if restaurant owners, under such a system, would give up on innovation and creativity?  Would there be any incentive for restaurant owners to work hard and be diligent and creative?

So why does government demand this of medical physicians?  There are now 10,000+ ICD-9 codes, related Diagnosis Related Groups (DRGs) and a Relative Value Index (RVI) in medicine.

On health care consultant James Orlikoff pointed out that the typical (economically unproductive) physician response to a decrease in their reimbursement by working harder and seeing more patients.  While economists recognize that losing money on each encounter is not alleviated by increasing volume it must also, in the opinion of Burton Report®, be pointed out that the greatest strength of medical practice is the inherent bent of physicians to work hard and be diligent.

There is a movement afoot to consider medical services as packaged and uniform (much like pork bellies) and to “lobotomize” physicians to provide these uniform and measurable services.

Someone has apparently forgotten the “restaurant principle” of quality, service, and patient satisfaction.  Yes, it would be great for the United States Internal Revenue Service (IRS) if everyone were an “employee” subject to uniform monitoring of earnings and taxation and the government would like to see physicians in this situation.  As the cost of health care increases there is any alternative to managed or socialized care?

The majority of all Americans are presently enrolled in some form of managed health care (most common being HMOs).  Is it possible to maintain lower health care costs and not “lobotomize” the medical profession in the process?

Of course it is, but the paradigm has to change.  First of all the patient has to become the “gatekeeper’ and the “shareholder” for their health destiny rather than abrogating this to a third party uninterested in their welfare.  If Independent Health Maintenance Programs (such as Medical Savings Accounts) were more prevalent and patients basically spent their own money on choices they made quality, service, and patient satisfactionwould become bywords.

Why not encourage medical centers of excellence and continuing physician industry and diligence?  It’s not hard to do.  Why not have every patient, at the completion of their treatment fill out, and submit to an uninterested third party, a questionnaire (such as the Prolo and Oswestry scoring systems) as determinants of patient outcomes and patient satisfaction.  What else really matters?  Trust patients to seek out the best physicians and hospitals as they do restaurants.

Regina Hertzlinger has pointed out that we can improve this picture with a consumer-driven health care system that rewards productivity by empowering providers and consumers.  Providers could price and design services, absent insurer and government micromanagement; consumers could choose from a wide choice of insurance plans, offered by their employers along with excellent information to support their decision-making.  The resulting market-driven competition is much more likely to create the efficiencies that can broaden access to health care.”

P.S. If you were a restaurateur and your clients decided that the service was not to their liking and paid only 35-50% of their bills would you find this disturbing?  Would you accept this as most physicians presently have to do?  How, then exactly, would you respond?

Burton Report is an independent and non-commercial internet journal which was first published on January 1, 2000 and is dedicated to the principle that health care and the health care process MUST reflect truth and integrity as well as the best interests of the patient.

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