Monday, September 21, 2015

In Health Care A Little Imagination Can Go A Long Way. Three Why Not Solutions.

You see things and say, "Why?" But I dream things that never were; and I say, "Why not?"

George Bernard Shaw (1856-1950)

In writing my Medinnovation and Health Reform blog, I am always on the lookout for imaginative ways to cut costs and circumvent obstacles.

Here are examples:

One, Health Leads, a Boston-based nonprofit, founded by Rebecca Onie, a Harvard-trained lawyer, after working alongside physicians in Boston, spotted a problem. Physicians could prescribe precisely what poor patients needed, but they could not prescribe what poor patients needed once they left the office - heat, food, jobs, transportation, and home care. It dawned on Onie what patients needed was a connection with community resources that could supply these needs. Why not, she imagined, recruit idealist , computer –savvy, college student volunteers bent on health care careers , have them set up a desk at medical clinics and physician offices, and have these volunteers use their skills to help them poor gain access to community resources. And why not make it possible for physicians to prescribe these community resources? Onie has recruited hundreds of college volunteers; set up volunteer desks in scores of clinics, physician practices, and hospitals in multiple cities; and raised $30 million from organizations like the Physicians Foundation, the Commonwealth Fund, Robert Wood Johnson Foundation, and the Skoll Foundation to expand to multiple cities. Finally, Onie asked, why not make access to community resources a standard part of health care? Health coverage and subsidies can only go so far. Patients also need information on where to find help for basic needs like food, heat, work, and basic home care medical advice.

Two, although it is seldom mentioned, health care middlemen – like government and insurers and hospitals - add a great deal of cost for medical services. These middlemen offer essential services but they are not needed for all health care transactions. Consider such routine ambulatory surgical procedures – like biopsies, endoscopic gallbladder removal, cataracts, or a host of minor orthopedic, GI, cosmetic repairs. These procedures can be performed safely on an outpatient ambulatory basis without an overnight stay. The Surgical Center of Oklahoma, in Oklahoma City, using the services of 52 surgeons, has performed thousands of these procedures, the cost of which is announced online and includes bundled costs of nurses, anesthesiologists, and post-op care. Costs are as low as ½ to 1/6 those charged by hospitals and can be done with short waiting times at surgeons’ and patients’ convenience. The transactions are not covered by insurance but their low cost and convenience make them ideal for self-funded corporations seeking to lower costs and for patients who desire no-frill convenient ambulatory surgeries with documented results comparable to hospital procedures.

Three, here I shall be brief. The VA health system is notorious for its long waits. Many of these long waits are due to a VA prescription policy that says a VA physician must OK any prescription written by a private physician. Why not, simply fill the prescription automatically rather than have patients sit for hours or days in waiting rooms waiting for an overly busy VA physician to OK the prescription?