Why the Affordable Care Act can do Nothing to Improve Health Care

 

  1. The problem is not access.  For the vast majority of Americans, access to health care isn’t the issue.  The issue is quality of care.  Because the average quality of care is so poor in American medical offices, few patients are accurately diagnosed and fewer still are healed.  Typically, at best they have their symptoms managed.  Why is quality of care so poor?
    1. `Medical appointments are too short.  The insurance industry reimburses so poorly that the typical primary care appointment is less than 10 minutes long.  In my profession you are lucky to have 25-30 minutes of face-to-face time with your physical therapist.  The insurance industry documentation requirements for reimbursement leads to more and more mouse clicking and “key phrase” typing which steals more minutes from actual patient interaction.   The vast majority of documentation requirements lend little/no value to the patient interaction or even to follow-on care appointments.
    2. Medical professional skill level.  Fewer and fewer medical appointments are conducted by actual physicians.  More and more care is provided by physician extenders (Physician Assistants and Nurse Practitioners) and ancillary medical professionals (CNA’s and MA’s).  These medical assistants to physicians are doing their best, but they have less training, less time and more documentation requirements.  The deck is stacked against them.  I’m a firm believer in direct access for physical therapists for musculoskeletal pain.  We have more training and evaluation appointment time than any PCP (Primary Care Provider and if anything, insurance companies should mandate that their beneficiaries be required to see a physical therapist BEFORE seeing a PCP.  Physical Therapists are more qualified to make follow on consultations and radiographic orders (X-rays, CT scans, MRI’s, etc).   This system has already been in place and extremely successful in all branches of the U.S. military.   
    3. Quantity:  Number of trained medical professionals.  Our profession has a vast shortage of trained medical professionals and I’ve said many times that if the government wants to get involved improving healthcare it should create more scholarship opportunities for Americans to attend various medical schools (ranked based on need assessments).  I’m also a firm believer in reinstating a medical internship program.  Right now if you have all the intangibles to be the best physician in the history of the United States, but can’t pass the MCAT, you will never enter the profession.  I believe that with a 3-5 year internship interspersed with select college course work, writing assignments and a LOT of 1:1 mentorship by experienced clinicians (>10 years in field), that we would be able to field another group of highly skilled medical professionals who would improve both quality and quantity deficits.  

2.   Little to no focus on prevention.  There is no money to be made in the field of prevention, all the money is in pharmaceuticals and surgery once illness or injury has progressed.  I’m sure you don’t have to believe in conspiracy theories to imagine the big pharmaceutical companies might be lining the pockets of politicians and government employees to allow the status quo.  This is far from my area of expertise, but imagine the effect of pollution, pesticides, “food” additives, fertilizers, artificial food dyes, artificial sweeteners…many of the above are banned in some or all of other modern countries, but not the United States.  Don’t underestimate the effect of a stationary lifestyle where Americans sit far too much hunched over a laptop or cell phone.  What if insurance companies rewarded fitness with cash rebates to their beneficiaries?  What if our government rewarded agriculture and food industry for producing “clean” food?  What if insurance companies rewarded individual practitioners for best results and healing rates?

 

If the average American were healthier he/she would need fewer appointments and access to healthcare and cost of medical care would both improve.  

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