I Want To Be A Vigilante

I want to be a vigilante. More than anything. I tried to keep this blog from becoming an outlet for my rants and raves, but yesterday, after meeting yet again more victims disabled unnecessarily by U.S. Health Care, I’m outraged.

I’m outraged hearing that a person who isn’t outwardly bleeding is made to wait 17 hours in agony in the ER only to be sent home and return two days later with a ruptured appendix.

I’m outraged hearing about a person enduring multiple hospitalizations to no avail until a surgeon overheard physicians discussing the hospitalized patient’s x-rays and upon viewing the radiographs, informed them that the patient needed a gallbladder operation.

I’m outraged that a female colleague had to have her uniformed and armed policeman husband accompany her to a repeat doctor’s visit in order to get the medicine she needed for her epilepsy and migraine headaches.

These are no longer anomalies. They have become commonplace, accepted occurrences in our society. And I’ve seen nothing in any proposed health care reform legislation that will change such accepted behavior that embodies the essence of wasteful spending.

What really got my goat, however, was an article on a respected patient advocate’s website attempting to justify why physicians don’t spend more time reading and analyzing a patient’s test results. The reason she gave was that physicians aren’t paid by the insurance companies to spend time reading and analyzing test results. There’s no code for this, she said.

The article explains that doctors are paid by insurance for every patient they see according to CPT codes, which are developed, maintained and copyrighted by the American Medical Association (AMA). Development and maintenance of these codes and the publication of all the software, books and manuals needed by those who use them brings an estimated $70 million in income to the AMA each year.

The article goes on to explain that the doctor’s compensation is tied to the amount of money the doctor negotiated with the insurance company for each CPT code procedure regardless of the amount of time it takes the doctor to complete. And the logical progression concludes that because there is no code for reading and analyzing test results, the physicians are justified in not spending their time doing such.

I ask, isn’t reading and analyzing test results implicit in being able to derive a diagnosis, which is required for insurance payments?

Is it now acceptable for doctors to simply order tests and not review results? If so, how do they decide which of the many disease/condition codes to circle on the insurance form? Do they throw darts? Is this decided by where the doctor’s finger lands when he closes his eyes and points to the paper?

I assume the physicians’ contracts with the insurance companies has language that refutes this notion.

Yet we, as an enterprising nation with capitalistic ideals, have come to view “follow the money” as an acceptable mantra to justify nearly every health care foible. That’s the way it is. Accept. Forget. Go about your business as usual. It doesn’t concern you. Turn a blind eye.

To me, private enterprise’s ethics sound more like the totalitarian “Big Brother” regime portrayed in George Orwell’s novel, 1984, than any views emanating from our government about health care reform — a government that appears to have gone AWOL when it comes to enforcing regulations.

This is no new revelation. In fact, if you read Holding Health Care Accountable by E. Haavi Morreim, you’ll find that it is a well known and documented fact that the average insured U.S. citizen has less than a 50/50 chance of receiving an accurate diagnosis and proper treatment under our present health care system.

Would you risk your life savings deliberately in Las Vegas with those odds? I think not — at least most of us probably wouldn’t. Yet, without realizing it, based on the status quo, we’re doing so daily not only with our wealth, but also with our lives.

My conscious mind keeps telling me that I’m barking up a tree with no chance of catching the squirrel. Being concerned and speaking out on such matters — even caring — is probably ruining my health even more than it’s already destroyed. I have to admit, the picture of the state of our present health care system gets my blood boiling. But my subconscious tells me something different, and I’m still not convinced getting heated isn’t a good thing given my low body temperature and blood pressure.

~ by doctorblue on May 27, 2009.