21 June 2013

Doctors Need to Return to Making House Calls

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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