How do you fight your way upstream when
everyone is heading downstream? Still this doctor is saying it can
be done. He also declares that his way will save money and quality
of life for the elderly will be preserved. I think this doctor is
correct, but with the current mindset of today's medical community,
they would rather practice healthcare rationing than even allow
physicians and others to make house calls. There are a few that
believe this may be possible, but it would be difficult to find many.
Although I don't doubt we will also see
some medical euthanasia, healthcare rationing will be the weapon of
choice. I am already seeing this at a hospital near here. I have
already been told not to come back. I know I am supposed to take
this as they don't want a readmission, but when I am told to see
other medical people and other hospitals were mentioned, what am I
supposed to think.
Why are doctors so into medical
rationing? First, medical supplies are not inexhaustible, we cannot
continue to do more and more, and true doctors are becoming a rarity.
I know most will agree with the first two points, but I know there
are some raised brows on the third point. I say this with all
sincerity and am finding this true more each day. I have several
friends that have been dismissed by their doctors and guess what the
reason was. They did not have living wills and do not resuscitate
orders (DNR) on file with the doctor's office. Another friend was
told to find another doctor because he was living too dangerously.
Now what is going on? First, most doctors are starting to insist on
living wills and DNR's by age 50.
I could be a little more understanding
if they were saying at age 65 or 70, but at 50 seems a little crass.
Well, now I know why. They know that people that young generally
will not put these in place and this is one way they can weed out
people they do not want as patients. Oh yes, doctors are using many
excuses to tell patients that they are no longer wanted as part of
their practice. Even more surprising are the number of doctors that
don't want to see durable medical powers of attorney. The reason
given was that they weren't going to make calls to have those listed
come in if needed.
Back to house calls, you will have to
excuse me for getting off track.
As the proportion of the elderly continues to
increase, so will the number of people with chronic diseases. Mainly
cited are diabetes, high blood pressure and heart disease. Since the
largest and fastest-growing contributor to rising healthcare cost in
chronic disease, this needs to be addressed. The author is very
specific about U.S. Healthcare being based on a false premise. He
feels that home healthcare is doing exactly what’s most needed. He
says that there is more evidence that health care delivered at home
enables patients to live not only longer lives, but also better
lives.
In his analysis of home health care he
lists two studies, Avalere
Health study and this one, a
2009 study. These are both in PDF files so you
know what to expect in clicking on the link. The first study showed
a savings of $2.8 billion among patients with diabetes, congestive
heart failure and COPD. Indeed, expanding access to home health care
for chronic-disease patients could save a projected $30 billion the
author states. Yet the value of home care remains under recognized.
As a result, vast needs are still going unmet.
He is very sure of his data and lays
out the following for what needs to be done. I will quote his
points.
“Define the discipline better.
The medical community, including physicians, medical schools, and
hospital administrators must better describe what home care does and
why it matters in order to bring it to life for policymakers and
family caregivers.
Get in sync. Primary
care physicians particularly, but also nurses, therapists, social
workers and others, must align better with home-care clinicians to
coordinate care, especially during and immediately after the
transition from hospital to home.
Physician, educate thyself.
Physicians should learn about home-care options and discuss them with
patients who could benefit.
Adopt new technologies.
More companies in the home-care business should use innovative
technology to coordinate care in real time, including point-of-care
laptops, telemonitoring devices, and Internet portals for physicians
that allow all providers to share a patients’ information.
Remove policy obstacles.
Reimbursements from Medicare and private insurers should reflect the
true value of home care. But the payment system now in place sees
home care, quite mistakenly, as merely an add-on with little clinical
benefit. Policymakers should create a payment model that aligns
providers’ clinical and economic interests, assigning proper value
to good outcomes and recognizing that home care is pivotal to
success.
Health care at home is
patient-centered, outcomes-driven and truly collaborative, making it
a microcosm of how the health care system should function across the
board. Only by embracing home care can we truly reform the health
care system.”
Another article on house calls and the
need may be read here.
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