Thursday, August 16, 2007

'bureaucratic nightmare'....8/28

An article in Modern Healthcare caught my eye as it related to HIPAA.

For many years I was a chief information officer. Time passed and I became a chief executive officer. The whole Health Insurance Portability and Accountability Act discussion has for years fascinated me. First of all, the database maintained by the insurance industry has for many decades violated patient privacy. Any person with private insurance—life and health—gave employers and insurers the right to view one's clinical history, drugs ordered, diagnoses and other personal data. HIPAA has done nothing to change that. When you sign the application form for the insurance, you allow this to occur.

HIPAA was passed in the 1990s and became a so-called privacy protection. Instead I think it has become a bureaucratic nightmare.

For four years I was the CEO of a hospital in Monterrey, Mexico, and am now CEO of a division to put primary-care clinics in supermarkets. Imagine this scenario. A person wants to know his cholesterol. He appears at one of our clinics and requests that a specimen be drawn for the tests. He is charged our retail rate for the test. With his receipt is a password. When he gets home, he dials into our Web site, logs on and enters his password. He sees his result. If he wants to consult a physician, he can return to the clinic and see a doctor. This person did not have to make an appointment in a doctor's office and therefore did not have to pay that fee before the test. He can appear at his convenience. There is free parking at the market. Another possibility is his physician ordered a number of tests. Again the patient comes to the clinic in the supermarket and has specimens drawn. He can see his own results, as can his doctor. None of this is possible in the U.S., and part of the reason is the HIPAA law.

What about quality? Our chief of pathology was named national pathologist of the year. We are in the process of seeking accreditation from the Joint Commission and the College of American Pathologists.

As a longtime healthcare worker in the U.S., I began as a chemist. I always felt every system, technology and service was superior. When I saw the quality in Mexico and then understood the costs, I was truly surprised. I think the reason people are seeking care in other countries is based on price. However, without quality, this trend would surely die. I think an exploration and comparison of morbidity and mortality figures would amaze the American public. Disparaging other countries in the long run will not work. If healthcare in the U.S. represents 16% of the gross national product, and it is half of that in Japan with better outcomes, something must change. One of those things is the ridiculous HIPAA law.
David Libenson

Santa Engracia Hospital

Mexico

28 comments:

Anonymous said...

I admit the bureauracy of the US healthcare is ridiculous. However, some of it is for a good reason, but most of the mess is from our lawsuit-happy society. I don't see an immediate solution to the problem, alas.

Julie Flatt said...

I Had A Theory Recently About A Solution. It Is A Half-Breed Between Privatized And Socialized Medicine. If We Could Set Up A Government-Run System, Similar To The VA System, To Care For The Portion Of The Population That Cant Afford Insurance-we (meaning The Government) Would Be Able To Control Costs At Every Step. Medicaid And Such Are Draining The System Because We Are At The Mercy Of Ever Escalating CO$T$ In The Civilian Sector. The Problem Is That There Is Little $$$ To Be Made In Socialized Medicine Causing A Lack Of Highly Trained And Motivated Physicians And A Stale Environment. But We Could Stem This By Allowing Privatized Health Care In The Population Able To Afford Insurance. Just As In Military Medicine, The Private Sector Could Handle The Overflow Patients And Those Needing Specialized Care. Please Tell Me What You All Think.

Anonymous said...

Hello, Hillary? Hillary, is that you? Bark twice if you're in Milwaukee... Is this Wilt Chamberlain? Have the decency to say something.

Anonymous said...

Yeah, the VA. That's a model of efficiency and service.

Puh-leeze.

Julie Flatt said...

I Didnt Say That They Would Get First Class Care-but How Can You Justify The Poor And Infirm Getting B E T T E R Care Than Is Afforded To Our Armed Forces? If It Is Good Enough for Our Bravest And Best, Then How Can We Turn People With Absolutely No Healthcare Away From It. It Would Be An Incentive To Move To Middle Class And Thus Be Able To Get Better Health Care. 50 Million People Uninsured Is Quite A Crisis, Military Care Would Be Better Than No Care At All. Private Care Is Too Expensive For Taxpayers To Afford For That Many People. Think That All The Way Through And Tell Me A Better Way If You See One.

Anonymous said...

In re: the VA as a model of a healthcare system for those who can't afford care, I remember the words of one P. J. O'Rourke, who said:

If you think healthcare is expensive now, wait until you see how much it costs when it's free.

Putting government in charge of ther nation's healthcare service is akin to hiring the fox to be chief of security for the henhouse.

Anonymous said...

He governs best who governs least. The problems with our healthcare system are many and complex.

1. The government makes a mess of things the more they try to fix things.
2. Greed. Not just docs and hospitals, but pharmicutical companies and medical supply companies.
3. Greed from patients suing for everything under the sun. Yes some are legitimate suits but most of nuisance claims that cost ALL of us.
4. Abuse of the system by patients. A lot of folks go to a doc/hospital when they're sick or injured. Some have to be drug there nearly too late. Others like to pop in every other week or so to get a drug/attention fix. They screw it up for ALL of us.

Trust me, getting the government involved in healthcare is the last thing we need. It'll be another cluster**** like when they started medicare/medicaid with no limitations and or guidelines. Doh! No wonder people took advantage of it!

Anonymous said...

To Julie Flatt:

You said "If It Is Good Enough for Our Bravest And Best, Then How Can We Turn People With Absolutely No Healthcare Away From It."

That's just it. It's not good enough for our military personnel. In fact, it is a paltry immitation of real medical care. It is a bureaucratic sink-hole, swallowing up everything that comes close.

Socialized medicine is just that, socialistic. Why would you want anything but first-rate care? Why, if you knew a system would be sorely lacking, and mired in red tape would you want someone to be forced to submit to it? Socialism is socialism, regardless of whether it is in breadlines or health care.

Let me ask you a question Julie. Where is the money for this socialistic healthcare going to come from? Are you in favor of raising taxes to achieve this lofty goal of us relying on the government for one more thing now? Well I'm not. And I am irritated that someone wants to use my hard-earned dollars to fund another ill-conceived, bloated government program.

BTW, there's no need to cap the first letter of each word. It's distracting.

Julie said...

Make A Better Suggestion Then.

Anonymous said...

I was applying for a job with the VA in Chicago years ago. I had filled out all the paperwork and was waiting to get a determination on my grade, when I toured one of the VAs. I swore that I would never work in a place like that.

Being treated by a facility that was under VA management would scare me to death.

Have you seen the news on the VA system? This isn't the latest, but this link should point you in the right direction.

You also realize that retired and active duty military are not treated by the VA except under special circumstances. The VA treats vets without benefits.

With Valor Healthcare recruiting staff, I would say that we're going to have a VA contract clinic here soon. How does that affect Dr. Gulde who has the V.A. contract?

frank

(Pardon my clean-up of the comment and setting the link.)

julie said...

Yes, Thank U For Clearing That Up For Nonmilitary People (But I Am Prior And Current Military-and Yes That Does Make Me Well-versed In It's [military Med] Sinkholes). Now Back To Socialism At Large..... Just What Are U Proposing? Top Of The Line Healthcare For A L L 300 Million Americans Without Your Tax Dollars... Not Possible. And I Didnt Hear An Alternate Suggestion Yet. BTW, I Post From My Phone So Its Exceedingly Difficult Changing Case Every Word.... do u prefer this? ugh, im getting carpal tunnel!

Anonymous said...

Julie,

You are right, in a way. Socialized medicine is not working, and private medicine leaves lots to be desired.

Insurance cost more than my house payments per month, and Thank God, I'm not on any routine medications.

If you look at Scottish Rite, or St. Jude hospitals, maybe there is an answer. Look at what they do for so many. If you step into one of those hospitals, it is just amazing. Everyone from the janitor to the Doctor goes out of their way to help you.

Dr.'s make money, nurses make money, CEO's make money.

Are they for profit hospitals?

Do they get community support?

Churches raise money for these organizations, many organizations raise money for these hospitals.

I know it sounds impossible with the current situation, but it must be possible, because they are doing it.

I personally feel that for profit hospitals has led to the increased costs, and breakdown of our healthcare system.

If the community profits from the excess, aren't they more inclined to contribute, knowing that the money stays here?

The churches will raise money, and different organizations will raise money for individuals needing help paying for hospital costs, but they aren't going to raise money for a hospital that is going to keep the profit.

Anyway, its just my humble opinion.

Anonymous said...

Well, the VA is bogged down with bureaucracy that' for sure, but in some cases they are cutting edge. I recently was offered a job with them. I was interviewed on July 16, and my start date will not be until Oct. 29th. So a bit of a lag in the hiring process, but the pay is about 25% more than the private sector. They are completely paperless when it comes to patient care. No paper charts, no paper MARS, all patient armbands are bar-coded to prevent med errors. and the system works, and they are doing it a head of the 2010 deadline!

Anonymous said...

Julie said...
Make A Better Suggestion Then.

My better suggestion is for people to quit defaulting to government instrusion into our lives everytime some candidate for public office tells them there is a crisis in America. Hillary Care has to be paid for. That money comes out of the pockets of people who pay taxes, not those who don't. The care that would be provided would be substandard and mired in litigation ad infinitum. Bureaucratic red tape and back-logged cases, and a tax burden that is in a word, confiscatory.

Sorry, "Government Run System" could be translated "Inefficient Bureacracy That Is A Drain On Americans' Pocket-books".

Socialistic healthcare looks good on paper to some and it makes for a good sound-byte for political candidates, but it has to be paid for by someone.

I'm thinking you've never really been exposed to a system like the one you've suggested, at least from the administrative side. If you had, you would see how unrealistic it is.

Anonymous said...

I think it is absolutely wonderful the job that charity hospitals are doing, but I also think it is infinitely easier to coaxe money out of people to treat a dying child than it would be to pay for a hernia operation for joe-bob down at the trailer park or shaquisha's 8th childbirth. The infommertials just wouldnt be near as lucrative without the sick kids. I mean no stereotyphic disrespect, I only cite these as possibilities of people in need of free healthcare.

Julie said...

So if bureacracy is the problem with the health care industry, maybe the poster commenting on charity systems is on to something. How would a government "sponsered" program that is administered and run by the (obviously competant) folks now running Scottish Rite's (or equivalent) institution sound? Possible? I Am Still Looking For The Best Solution, And I Will Continue To Do So Until One Is Found.

Anonymous said...

We already have socialixed medicine. It's called medicaid. You want to see the result up close and personal. Go to any ER. At least 90% of er patients are nonemergency patients with government funded healthcare. I wonder why that is. Oh yeah people that actually pay for insurance have copays while there is not one with medicaid. That means people with insurance are inclined to go to a doctor's office or a minor care center where services are cheaper and their copay is less. However, if the government is footing the bill you just go down to your local ER for your stubbed toe because you don't pay anything. Good idea lets get everyone to do this. Plain and simple if you arent paying for insurance you don't respect it. Emergency Rooms are the most expensive place to get healthcare and they are supposed to be for TRUE emergencies. You want a solution julie. Start by changing the socialized system we have. Something like physician screening of all ER patients for emergencies. If you don't have a TRUE EMERGENCY then HIT THE BRICKS. Second if you have socialized American healthcare (medicaid) you get a urine drug screen every time you go to the doctor. Pop positive ONE TIME for something not prescribed to you and you forfeit ALL government assistance for life. Make the recipients of our current socialized systems use the cheapest appropriate means for their care (Dr. office, clinic, etc...). That is as fair as you can make it for those of us that actually work and pay the taxes to GIVE them the care that so many of them abuse. I don't mind my tax dollars helping those in need, but when I help people that don't appreciate it and abuse it How can I be expected to have empathy for them?

Anonymous said...

11:46 pm post -- You are exactly right! It's hard to have compassion for someone when we prioritize and struggle to pay our insurance premiums, and then see many medicaid recipients (including illegal aliens) get better free care without giving up their cigarettes, their big-screen TV's and cable, and other high cost unnecessary items. Many people who "can't afford" insurance actually can -- they just don't have their priorities straight. I believe your drug-screening suggestion would weed out a bunch! When you get ready to run for office, sign me up on your campaign team.

Anonymous said...

11:46

I don't know how much it would cost the government, but the drug testing for medical or any other government assistance is a good idea. Most in the working community must have a urine drug screen, on hire, and random, and in the case of an accident. Why not for government assistance?

But, when you think of the ecology surrounding a knee jerk like that one, it would scare you.

Take away government assistance due to drug use:

1. What would happen to the person's children's access to healthcare, and food supply?

2. Would CPS be required to investigate for all of these positive urine drug screens, taking away government assistance?

3. If so, what would happen to all of the drug endangered children?

Anonymous said...

julie here's the solution. Stop looking for a GOVERNMENT SPONSORED program. Let us start holding people responsible for themselves. It is not the American taxpayers responsibility to give free healthcare to anyone that doesn't have it. I don't mind giving a hand up to those in need. I do have a problem giving a hand out to many that are just plain lazy. Like 1146pm pointed out; when you give something away for free people are going to abuse it and have no incentive to seek cost appropriate care. Then again maybe you are right. We can give it to everyone, Totally destroy our healthcare system due to abuse, and everyone will have worse care. It would be equal then right.

Anonymous said...

"Natural selection is the process by which favorable traits that are heritable become more common in successive generations of a population of reproducing organisms, and unfavorable traits that are heritable become less common."

Gotta love Charles Darwin.

Anonymous said...

Response to 11:46


"1. What would happen to the person's children's access to healthcare, and food supply?"

They lose their childern. We are all products of our environment. In other words we are not born who we are; we are made into who we are. Do you want these kids seeing mom/dad living off the government dime, doing drugs, and learning that it is ok? That is part of what has gotten us into the fix that we are in. Place their kids in foster care, orphanages, etc... as protection for the children. Are you suggesting that we leave kids in a household where their is known drug abuse.

"2. Would CPS be required to investigate for all of these positive urine drug screens, taking away government assistance?"

Why burden cps? You pop positive you lose your government assistance. PERIOD!!!

"3. If so, what would happen to all of the drug endangered children?"

See answer one

As far as the cost of drug testing. You can get a 10 panel test that checks for Cocaine, Amphetamines, Methamphetamines, Marijuana, Methadone , Opiates , Phencyclidine, Barbituates, Benzodiazepines, & Tricyclics Anti-Depresants in bulk for less than $2.00 each.

Anonymous said...

TO 9:12 AM

Darwin was right. Look back into our own history. In the time before our social(ism) programs people had to do whatever possible to care for themselves and their families. Not today now if you don't work it's alright we will give you welfare. Don' work thats ok we will give you medicaid or some other socialized healthcare program. Don't work you just sit at home and have as many kids as you can. Wait you cant support those kids. Don't worry we will pay for them too as long as they follow in you footsteps so that we can pay for them and their kids down the road. Looks like sitting at home living off the government dime is the favorable trait that is being passed down. I cant reproduce like they can to pass down anything. Im too busy working and paying for them to sit at home and have more kids.

Anonymous said...

11:29

I know what you are saying, and I agree. I do think that the drug endangered kids should be out of the home where drugs are being used.

I just think that the staggering numbers of these drug endangered kids would overwhelm many systems, such as CPS, law enforcement,foster care and orphanages.

Don't get me wrong. I'm all for drug testing in the welfare system. I just wonder why they haven't done it already, except for maybe those reasons.

Next question, say these persons who are on drugs, get their assistance taken away. They are still going to have health issues, and still flood the ER, and with EMTALA, they would still have to be seen.

Medicaid to a hospital is better than no money at all.

Maybe with physician triage we could only take true emergencies, but still, drug users have true emergencies too. Car Accidents, drug overdoses, mishaps due to incoherent thinking, etc...And that will be a lot of costs due to no insurance, due to drug use.

I know you are probably going to think that I'm a negative thinker.
I have been told that before.

Worse case scenerio has been a career long training that forces me to see what's coming next.

Personally, I would rather see, clear cut solutions with no apparent adverse effects. But I think that must only come with drug usage.

Somebody give me a pill so I can see sunshine and puppies! (just kidding)

Julie said...

I Am Absolutely in favor of drug testing for all government programs. i have seen people living off of welfare while spending every dime on drugs, in paris no less. i also completely agree with e.r. screening and can relate to spending a gaggle on health coverage. it took over a quarter of my husband's income for insurance thru his work (school teacher), 600 dollars a month for mediocre coverage. i now have ind. insurance, which sucks even worse. couldnt we take away the access to financial programs without taking healthcare for piss popping?also how about mandatory sterilization (or birth control of some sort) for all repeat unplanned baby boomers, say after three children paid for by the goverment? mandatory in the sense that if they dont submit to a procedure they will forfeit future assistance.

Anonymous said...

When the government stepped in to take over the role traditional to the nuclear family, it further fragmented it without establishing the traditional boundaries. This has created a bloat in social services and healthcare--as well as the waste associated with all government programs. It's time to set some boundaries.

1. If you're on government assistance for children, you have to be on depo shots (or some other type of reliable/monitorable birth control.)

Should you become pregnant while on assistance, the additional child does not qualify for any additional benefits.

The ACLU would scream about reproductive rights. Okay, they have the right to come off assistance if they want to reproduce.

2. Those on assistance for their children have to undergo manditory drug testing. Since we provide support for the environment that they live in, the environment must conform to established standards.

It may take a village, but there needs to be a new sheriff in town.

Anonymous said...

As much as I hate government paternalism, I must say I agree with 12:27.

Anonymous said...

response to 10:17

"Next question, say these persons who are on drugs, get their assistance taken away. They are still going to have health issues, and still flood the ER, and with EMTALA, they would still have to be seen."

Screened yes. Treated? Not if you are not having a true emergency. EMTALA doesn't say you have to treat everyone that walks into the ER. In a nutshell, EMTALA entitles you to three things: screening, EMERGENCY care and appropriate transfers. If you're not having an emergency, then the hospital emergency room does not have to treat you. If you do not have a true emergency the hospital can direct you to your own doctor, community health clinic, etc... All of this is 100% legal under EMTALA and many hospitals are already taking advantage of it. No emergency and youre out the door. This is why a physician, NP, or PA needs to be in triage. Screen em right at triage and either send em into the er to be treated or send em home.