A Still Noble Profession

I have been following health care polling by Rasmussen, CNN, and Gallup since March 23^rd, 2010, when President Obama signed the Affordable Care Act into law. Since 2018—before Covid, the general public’s feeling about the insurance system and health provider networks has become increasingly more negative.

https://www.cnn.com/2023/01/19/health/us-health-care-poll-gallup/index.html

Beginning early this year, the patients who have been responding to the polls have had an increasingly negative feeling about the clinical side of their experience, for the first time.

Yesterday I underwent a left total hip operation at St. Luke’s The entire pre-op and para-operative experience was incredible and I am so grateful to the doctors, nurses and technicians that took care of me. I think my pre-operative workup was more complete when compared to what I was able to provide for my patients 10 years ago. My anesthesiologist and orthopedic surgeon were excellent. The use of new MAKO Cat scan technology and equipment cut my OR time in half—”measure twice and cut once” is as true in surgery as it is in construction. I stopped operating at Luke’s in 2002 and stopped operating at Al’s in 2014 when I retired. I was surprised to find many of the OR team at Luke’s to have been old friends. They were all competent, professional, and compassionate. Thanks to everyone.

The problems Lynn and I encountered were on the business side of the engagement. Just like when a patient’s care is transferred from one “node” to another”, it has been well recognized that these transfers need to be mitigated because they are where complications occur. Transfers on the scheduling, billing, transcription, and coding sides have not caught up to clinical proficiencies and practices. This is surprising because of the new and very expensive medical records system that has been put in place with much of the investment funded by government transfer payments, grants, and subsidies—that have included many strings and bureaucratic hurdles causing patients and their families to be suspicious of the system. The public was given a look behind the curtain during Covid when hospital administrators and Public Health bureaucrats usurped the clinical decision-making power from clinicians. What we have come to understand today is that “experts” should have let the worker bees—the professional health care providers, call the shots

During my 6 hours stay in the hospital I noted that all the nurses (4) taking care of me were LOCUM TENUM (TRAVELING NURSES) and loved being in Boise. Where are all the Boise nurses? Doing “Locums” in other cities where they get paid more. The circulating nurse and nurse anesthetists were all professionals who I personally had worked with, some for almost 40 years while I practiced in Boise. Why the difference? I believe the members of the team that worked closest and most intimately with the patient were probably hand selected by each other doctors—nurses—scrub techs—the selection transaction goes in both directions. This provides for almost all of the efficiencies in the Operating room. One would think that by increasing efficiency on the front end there would be increased access and decreased prices. There is room for improvement in the business office and in IT.

My total hospital bill came to almost $40,000 including the $7500 doctors bill which is more than reasonable and nominally less than what an orthopedic surgeon would bill 10 years ago. When a hospital administrator was paid $18.5 million his last two years of “service” to the non-profit system, one has to wonder how the “fungible revenue pie” is being divvied up. Lots of in town providers—nurses, doctors and techs could be paid with that kind of money floating around! Maybe some of it goes to lobbyists—the IMA/IHA/IACI or campaign contributions We have inquired from the insurance carrier—United Health about their write off but have not been able to access that number.

In asking patients about their health care, it is always important to differentiate between those patients who have been in the hospital or had surgery over the past year and those who have not. In the mid-nineties 90% of Canadian Citizens polled said they were happy with their health care and only 70% of Americans responded favorably to the same question. When patients who had undergone surgery or been in the hospital for over three days were asked the same questions the numbers flipped. According to a Gallup Poll this year—referenced above, only 52% of Americans believe their health care to be “excellent or good”. 20% felt it was “poor”. The numbers for access were about the same. The numbers for cost showed a similar trend for people with private insurance, and even greater for those with Medicaid—remember the “sick patient rule”?

The problems with health care are not insular. They are a direct result of a collusive process between stakeholders and suppliers (hospitals and insurance companies) and not the buyers of health care (patients—taxpayers and those who pay for their own insurance or businesses). Customers and investors have little say when stakeholders control hospital boards.

The reasons for this are many, but the solution can be found in the policies that can put the power of the doctor—patient back in control Our State legislators have an opportunity to explore again the promise of “cost—quality—access”. If they chose to “nibble around the edges” we all lose.

Independent outside signed partners audits of the Idaho Department of Health and Welfare and all institutions that receive over $100million of transfer payments would be a start.

Let’s see who has the courage to step up to the plate.