First, I would not want to be the health czar. I like my current position. Still, it is fun to provide advice from the sidelines.
Our job is to consider health care costs and which are unnecessary. I have some candidate categories for potential health care savings.
Our biggest hurdle remains the privacy issue. We could save considerable money in duplicated testing if we had a national medical record repository. As I have experienced through the VA electronic medical record, I can save time and unnecessary testing through access to all VA records.
Too often I see patients have expensive testing repeated when they move from one hospital to another. Too often the physicians at the new hospital do not “trust” the physicians or the technology at the first hospital. Radiologists often do not want to read the images from the first hospital.
Too often we do not have access to old ECGs. We do not have a master file of prescriptions. Often we do not have records of previous surgeries.
Any hospitalist will tell you the knowing old lab tests improves decision making. Having access to old films and other imaging can save unnecessary repetition.
So my first major strategy would focus on making information available to all physicians. The privacy concerns would require some consideration, but I believe the improvement in health care delivery and decrease in unnecessary repeat testing would trump those privacy issues.
The second major concern is over use of technology in the emergency department. Ask any practicing physician about testing in the ED. Patients have too many imaging studies. I think we all understand why those studies are done, but a significant percentage are clearly unnecessary.
Now clearly, ER physicians have a high exposure to malpractice claims. When in doubt, they image. The emergency department is often overwhelmed with patients, so technology trumps the history and physical examination. We need a multispecialty panel to develop reasonable standards for technology use in the ED.
The thrid concern is unnecessary use of newer more expensive drugs. I am a big fan of comparative effectiveness research. I want to choose appropriate drugs based on data rather than hype. Unless we fund comparative effectiveness research, we really do not know how and when to use the latest entry into the pharmaceutical market.
My fourth concern is pharmacological education. We need to do a better job of minimizing the number of medications each patient takes. So often I see patients admitted to the hospital with >10 prescriptions. Usually, we can decrease the number of meds.
As the number of medications increases, so does the chance of interactions, side effects and decreased adherence. We are not teaching pharmacology properly during the first two years of medical school, and we rarely focus on pruning medical lists during clinical training.
Today’s last concern is palliative care. We should increase funding for palliative care training and delivery. We spend too many unnecessary dollars during the last hospitalization. Too often we cause unnecessary suffering for patients and their families. We could do a much better job of treating patients rather than diseases during the terminal phase of illness. We sometimes use ICU resources unnecessarily, because we do not have a palliative care mindset, and we just have not discussed these issues with the patient and the family.
I am certain that my outstanding readers have other suggests for the czar. Please comment and I will respond. Perhaps we could even develop a health care bloggers guide to decreasing health care costs!
