Will Disease Management Really Reduce Health Care Costs? A Guest Post From Dr. Kirkwood.
When the New York Times reported that an experiment in disease management had failed to save Medicare any money. Dr Garth Kirkwood was among those who were not surprised. Here are his thoughts:
A recent article in the New York Times reports the likely failure of an ambitious three-year experiment undertaken in an effort to save money in our Medicare system. (Link: "Medicare Finds How Hard It Is To Save Money" by Reed Abelson, NYT April 7, 2008)
In this experiment, nurses working for "Disease Management" companies make telephone calls to patients, unknown to them, with chronic conditions such as congestive heart failure and diabetes to check whether they are taking their drugs and seeing the right doctors. The idea is that keeping people healthier can help patients avoid costly complications, such as expensive hospitalizations, thereby saving Medicare money. Of course, the disease management companies, also known as contractors, receive significant fees for the service, i.e., the phone calls.
The utter nonsense of the thinking that underlies this experiment is so glaring that it makes me cringe. Medicare officials, health policy "experts," and the directors of these companies somehow have all arrived at two conclusions: 1) That keeping people with chronic conditions healthier will lead to a reduction in the frequency of expensive hospitalizations. 2) That telephone calls from nurses working for disease management companies is the key to keeping people healthier.
Admitting patients to the hospital, long before their condition deteriorates to the point of urgency, for the purpose of gaining control over the myriad of their problems, often with the help of several specialists, helps to maintain the state of being as healthy as possible. The use of the hospital and specialists on an ongoing basis is an important tool for keeping chronically ill patients in as good a shape as possible.
How is it that Medicare officials, health policy experts, and the directors of disease mangement companies through telephone nurses place themselves in the position of managing the care of the chronically ill? Just the term, "disease management companies," is an oxymoronic whopper. None of these people, despite their self-serving presumptions, are in a position of being able to manage the care of a chronically ill patient. Well, Who is? Doctors and only doctors occupy that position, and they perform this service through the mutually developed trust known as the doctor—-patient relationship, which also happens to be the foundation of all medical care. Why is it that the people, who promote the thinking that underlies this type experiment, insert themselves into doctor—-patient relationships with which they have no connection? It seems that they wish to put the doctor and patient asunder. Perhaps the doctor and patient are already asunder, and their thinking is designed to take advantage of this for their own gain. A less severe interpretation is that they designed the experiment to ameliorate the regrettable and well-recognized decline in sound, ongoing doctor—-patient relationships in America, the reasons for which are multiple and the consequences of which are profound.
My solutions? First, mandate that the occurrence of sound, ongoing doctor—-patient relationships for every patient living in America is the primary, overriding goal of health care policy. Second, recognize that beneficial change in the status of doctor—-patient relationships relies heavily on the performance of the doctors and patients themselves and must begin there. Third, demand that health care businesses operate with the primary goal of support for the existence of sound, ongoing doctor—-patient relationships for everyone living in America, even though this means a reduction in their dollar profit. Fourth, demand that our politicians cease making business-driven policy that places the dollar bill at the core of our health care system, i.e., that demands that changes in health care, the functioning of the doctor—-patient relationship, occur to support the dollar bill. The abject failure of this policy ethos is amply demonstrated by both this "experiment" and the overall mess that our health care system has become. Fifth, demand that our politicians create healthcare-driven policy, which requires that change in the administrative payment mechanism occur so that clear and equal access to sound, ongoing doctor—-patient relationships for everyone living in America can occur.
R. Garth Kirkwood MD
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
In this experiment, nurses working for "Disease Management" companies make telephone calls to patients, unknown to them, with chronic conditions such as congestive heart failure and diabetes to check whether they are taking their drugs and seeing the right doctors. The idea is that keeping people healthier can help patients avoid costly complications, such as expensive hospitalizations, thereby saving Medicare money. Of course, the disease management companies, also known as contractors, receive significant fees for the service, i.e., the phone calls.
The utter nonsense of the thinking that underlies this experiment is so glaring that it makes me cringe. Medicare officials, health policy "experts," and the directors of these companies somehow have all arrived at two conclusions: 1) That keeping people with chronic conditions healthier will lead to a reduction in the frequency of expensive hospitalizations. 2) That telephone calls from nurses working for disease management companies is the key to keeping people healthier.
Admitting patients to the hospital, long before their condition deteriorates to the point of urgency, for the purpose of gaining control over the myriad of their problems, often with the help of several specialists, helps to maintain the state of being as healthy as possible. The use of the hospital and specialists on an ongoing basis is an important tool for keeping chronically ill patients in as good a shape as possible.
How is it that Medicare officials, health policy experts, and the directors of disease mangement companies through telephone nurses place themselves in the position of managing the care of the chronically ill? Just the term, "disease management companies," is an oxymoronic whopper. None of these people, despite their self-serving presumptions, are in a position of being able to manage the care of a chronically ill patient. Well, Who is? Doctors and only doctors occupy that position, and they perform this service through the mutually developed trust known as the doctor—-patient relationship, which also happens to be the foundation of all medical care. Why is it that the people, who promote the thinking that underlies this type experiment, insert themselves into doctor—-patient relationships with which they have no connection? It seems that they wish to put the doctor and patient asunder. Perhaps the doctor and patient are already asunder, and their thinking is designed to take advantage of this for their own gain. A less severe interpretation is that they designed the experiment to ameliorate the regrettable and well-recognized decline in sound, ongoing doctor—-patient relationships in America, the reasons for which are multiple and the consequences of which are profound.
My solutions? First, mandate that the occurrence of sound, ongoing doctor—-patient relationships for every patient living in America is the primary, overriding goal of health care policy. Second, recognize that beneficial change in the status of doctor—-patient relationships relies heavily on the performance of the doctors and patients themselves and must begin there. Third, demand that health care businesses operate with the primary goal of support for the existence of sound, ongoing doctor—-patient relationships for everyone living in America, even though this means a reduction in their dollar profit. Fourth, demand that our politicians cease making business-driven policy that places the dollar bill at the core of our health care system, i.e., that demands that changes in health care, the functioning of the doctor—-patient relationship, occur to support the dollar bill. The abject failure of this policy ethos is amply demonstrated by both this "experiment" and the overall mess that our health care system has become. Fifth, demand that our politicians create healthcare-driven policy, which requires that change in the administrative payment mechanism occur so that clear and equal access to sound, ongoing doctor—-patient relationships for everyone living in America can occur.
R. Garth Kirkwood MD
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
Comments