Merry Christmas, Mr. President

Kerry Willis, MD, www.aihinc.com

Dear Mr. President,

It’s me again. I realize you ignored my advice on the Sustainable Group Rate (SGR) fix, but I thought maybe if I kept writing that someone might read my letter and start thinking about healthcare issues in a rational manner. I wanted to take a moment to discuss the primary care shortage we have in our country and ways to improve the amount of care available to be provided quickly and without a massive new government program. I still realize that I’m an humble country doctor who is unwise in the ways of the world and I really need to join a think tank if I want to be taken seriously. However, that would take me out of practice and I really enjoy my patients and view medicine as my calling in life.

Out here in the real world we have a shortage of doctors who work and see patients. Some have chosen academic careers. Some have moved into the myriad of opportunities in administrative positions that have been created by the massive government programs. Combined with an aging population and a lack of new medical schools except primarily new DO schools, we have less doctors and more new patients who require care.

I have a suggestion. Let me return to taking care of patients and eliminate and streamline the paperwork needed largely for government programs. While I have grown efficient at filling out the four or five forms required to get CPAP or oxygen for a patient, I would think that one form would be enough. Recent studies have shown that up to 25% of a physicians' time is spent on uncompensated paperwork to help patients get the care they need. If we cut this in half, we could free up a lot of time that could be used more productively to see patients or do something mundane like eat lunch outside your office while signing forms and refills.

I look at our government and realize there are too many moving parts to fix when there are problems. For several years I have wondered why a tax code that is enough words in its volumes to fill up a large room is tolerated. I have considered the irony of a tax code that forces me to pay someone to tell me how much I owe the government and realize that our system has gotten way too complicated. It would seem to me that the purpose of a tax code is to raise money to fund the government. The purpose of our tax code seems to be to elicit bribes from lobbyists to contribute funds to the re-election campaigns of our politicians.

Is it any wonder that healthcare has been twisted by the same problems as special interest groups? They have moved us from providing care to making a quick buck on the system. We have too many moving parts and every solution is a bizarre collection of new programs and rules designed to replace the last mistake that was made by our government. If I express that I have little faith that the current experiments will provide improvement in a system that expends large amounts of money to provide care, would you call me cynical?

Recently I became enamored with the idea of examining the costs of our current system. I found that we spend billions of dollars to train people to become physicians like me. I also found that on average I spend 25% of my time on tasks that have nothing to do with taking care of patients.  They are usually related to the pipedreams of a somewhere MBA. Mr. President, it seems that you need more data which I should provide without compensation for the costs or has convinced someone that your plan to control my behavior would result in a savings in healthcare expense. Funny thing, I’m smart enough to get into medical school but can easily be manipulated by a clerk with a 6-week training course in prior approvals. I like to think I’m smarter and more dedicated to my patients than those folks seem to think I am but then I digress. I provide these examples as background to the following thought: Healthcare is in need of proven models and the end of grand experiments and a close examination of the costs and motivations for care to be provided.

We do have proven models that have demonstrated a cost savings while increasing the quality of care provided. It’s called the Patient Centered Medical Home (PCMH). We can reward practices for moving to this model and save money and improve the quality at the same time. We have trials, data and savings demonstrated everywhere the model has been tried. It’s portable, accessible and easy to understand and implement. And it’s being ignored in favor of ACOs where we have no data and no savings and no one is quite sure what they are or how they work. Why...because the powers that are the Center for Medicare and Medicaid Services didn’t think of PCMH.

Healthcare is in need of a dramatic simplification. We have too much expense tied up in claims processing and administrative tasks to properly restructure the system. The over-reliance on claims processing and large insurance systems/companies along with a lack of leadership for fixing the problems that exist have brought us to this place. Happily abandoning claims expense in favor of quality reporting from PCMH and leadership that demands real solutions to actually fix abuses of these system will lead us out of this place. All that is needed is the resolve to change.

Finally Mr President, I hope that you will demand Congress sign a bill to stop the SGR cut from taking place and stop the games that are endangering the access to care for millions of our citizens who depend on the Medicare system. You already have my thoughts on the matter in my last letter, but I will note that eliminating bad debt by the hospitals and implementing a single pay schedule for physician compensation as proposed by the Republicans seem to be fair and reasonable ideas to fill the gap while developing a permanent solution to end this problem.  Respectfully, continuing to kick the can further down the road shouldn’t be an option for solving the problem.

If I can be of further help to you with ideas for fixing these problems feel free to let me know. I tend to like fixing small problems without massive new programs needed to solve the problems. This approach is one the country can afford when we wind up with better care for the same or less money. At the end of the day, that shouldn’t be a bad idea. I am quite certain that someone will disagree.

Merry Christmas, Mr President. It’s been a rough year for you, and I suspect the next will be challenging as well. I do believe that solving some of the problems instead of quibbling over them would improve the public view of you and your administration.

Dr. Willis is a practicing family physician in Beaufort, NC, where he founded East Carteret Family Medicine. He currently serves as Chairman and CEO of the largest and oldest self-sustaining physician-led network in NC, The Beacon Company, and Chief Operating Officer of Atlantic Integrated Health (AIH). A true believer in the need for healthcare reform, Dr. Willis believes that the best solutions will be community-based and provider-directed and are aimed at improving the affordability and accessibility of medical care by reforming the healthcare delivery. The need to consider new models that are patient-centered and eliminate many of the moving parts that cause waste are the driving goal for Dr. Willis and his organization.

Comments

[Jonena Relth]

Dear Mr. President,
Dr Willis is a smart guy who knows how to treat his patients. He and his staff also know how they could help simplify the documentation now required by congress.

I too would like to ask why you think our healthcare paperwork has to be so long, detailed and convoluted, thus making it time-wasting, untenable drudgery for doctors?

My business is to simply procedures and documentation and my customers have been quite satisfied by how we have simplified their workflows and paperwork over the last 20 years.

I'd be happy to do the same for you. Just give me a buzz, (I'm guessing you know everyone's phone number) or have someone email me.

At your service! Jonena
jonena.relth at tbd consulting.com

[Kerry Willis]

I'm not sure why we need the paperwork and why most of it isn't standardized. If Medicare needs a Rx for diabetic supplies then use the same one for everyone. ditto prior authorization forms and credentialing.