Guest Post by Kumar Yogesh, MD
Yesterday we attended Attended Gathering in Nashville and met Dr. Carson. What a great guy !!
I believe time is short and we the physicians need to come up with a short, to the point and precise plan the general public can understand and other fellow physicians can support.
This is what I propose
- Kill the CPT-based payment system and get the AMA dictatorship out of our lives. The board of each society in medicine such as ACS, ACP, ACC, ACCP, ACOS, etc should get together and come up with payment schedule that best fits their expertise.
- RVU can be used as base unit.For example, as a pulmonologist, I would be happy with setting 1 RVU for basic visit, 2 RVU for moderate visit, 3 RVU for a complex visit. For procedures, setting 2.5 RVU for bronchoscopy, 1.5 RVU for pulmonary functions, 0.5 RVU for chest xray, etc.Similarly, surgeons can assign “X” RVU for appendectomy, “Y” for cholecystectomy, and so on.Payment rate per RVU can be determined based on the level of training and experience of the physician. For example, a mid-level provider, a new physician with three years of training, a senior physician with five years of specialty training and 10 years of experience, all these groups can have different payment rates according to their expertise.
- RVU can be calculated at the time of service by a built in software program and payment rendered when patient leaves. I have discussed the possibility of this with a number of software engineer friends and this is doable. If this program is implemented, 10% of cost for billing/chasing insurance companies (which is becoming a very dirty and corrupt game) is gone for all clinics and entire healthcare system!! Savings of billions of dollars!!
- Let patients be the owners of their charts. Digital chart can be put on iPhone or any Smartphone, USB, or such device owned by patient. Such devices will be password protected and HIPPA compliant. This can be done virus free and HIPPA compliant according to the software engineers and consultants I have spoken with. This will save at least 10% of cost for the entire healthcare system. It seems that my nurses are making endless copies for other doctors or hospitals all the time or having to spend hours of time on the phone with either machines or nonmedical people who have no idea about patient care. This process not only consumes tremendous amount of human time and resources but it also severely distracts/strains very good nurses and doctors from their primary task which is “patient care “. This entire process will be unnecessary if we let patients own and carry their charts with them. All the information will be available instantly wherever the patient is. When doctor renders his services, he types his own note in his computer. At the end of the visit, physician can transfer his note to patient’s is digital chart device. This way, physician will always be in the possession of the original record. If the physician makes any additional notes later, it can be transferred to patient’s chart electronically. This will eliminate tremendous amount of absolute mental torture, worthless repeated paper work and redundancy that patients and medical staff have to deal with on a daily basis under current system. This will save A LOT of time, money, mundane paper work and best of all restore the sanity for the healthcare workers and doctors who are absolutely going insane by these tortuous process imposed upon us —all Wins for all sides. Again, savings of billions of dollars!! Much more simple and efficient system at a lower cost.
- Most of these savings worth billions of dollars should be passed to patients lowering out of pocket cost and premiums for all. Bottom-line for providers income will not be affected since overhead will come down significantly. In fact physician income may rise modestly since efficiency and morale of entire team will improve. Win-win for all.
- Kill CMS and its dictatorship. President can appoint an independent board that may consist of 6 to 7 reputable medical centers across the country and ask them to develop medical decision making and treatment protocols based on state of the art current evidence based guidelines. When a physician is evaluating patient, treating patient, performing a procedure on patient, ordering imaging or other studies, this physician has to follow one of the guidelines/protocol. Physician needs to do this in front of patient in real-time with the use of Internet and monitors. Once the medical decision and plan is made, physician can answer all questions of patient/family/guardian according to review of guidelines as discussed above. Final Orders are entered into patient’s digital chart.
This should be the end of the story of a patient visit. Once this happens, there should be no need for prior authorization, denial by any insurance or government agency, no need for waste of our nursing/staff spending endless time on phone or talking to machines. Simply put, we physicians should be done at this time as we have completed our service. Any problems that arise afterwards will be dealt by patient and insurance since these are the two entities that hold agreement with each other.