Lehigh County Health & Medicine Winter 2019 - 12

FEATURE

60% since 2000. Physician care cost has
increased by 23% since 2000. The healthcare sector overtook the retail sector as the
nation's largest employer. The medical CPI
has increased 1000% since 2009 while the
general CPI for all items increased 250%
since 2009; both are higher than is good for
the nation. Researchers attribute this to more
tax-sheltered employee insurance coverage,
and middleman expenses. Consolidation of
providers led to price discrepancy between
areas with less competition. For example,
lower limb MRI costs 24% more in some
markets and knee replacement 16% more.
Finally, in 2017 health-care companies
spent $550 million lobbying 532 members
of Congress or $1.0 million per person
member. (1) (2)
Although healthcare expenditure increased
exponentially in the USA, life expectancy,
infant mortality, cancer deaths per 100,000
population and Respiratory disease outcomes
are no better than in other developed nations.
Diabetes rates are higher.

The 2010
ACA Bill is
the law of
the land and
primary care
physicians
using
technology
are the
clearing
house of
healthcare.

We are inching toward identifying increasing healthcare costs and politicians challenge would disappear, and the politics
are moving toward a type of "Medicare for would be mute. Do the math. Either spend
All" (MFA) type of National Healthcare an additional $3.3 billion or more per year
plan. On average 49% of Americans are for on MFA or eliminate $900 billion per year of
and 49% are against MFA. George Mason present unnecessary drugs, ancillary testing,
University calculates that the price tag for elective surgery and fraud. The estimated
MFA will be $330 billion over ten years or $900 billion savings would provide 420
$3.3 billion per year, 70% of the present billion to insure 27 million uninsured
Federal budget. This calculation includes a Americans and provide $300 billion per year
projected 40% decrease in reimbursements for half the USA military budget. For the
compared to the present Private, Medicare remaining 5.4% or 180 billion per year of
and Medicaid Healthcare. When Americans the cost for MFA, childhood poverty could
were told that that MFA would increase be reduced to zero in America and free K-8
taxes the approval fell to 32% and when education for the poor in the form of grants
told that it would lead to delays in care it that include one nutritious meal a day would
fell to 26%. Most Americans want care on be possible. (4)
demand at any cost. (3) In my opinion, if
MFA becomes law costs will rise and delay
The 2010 ACA Bill is the law of the land
in elective care will occur but emergency and primary care physicians using technolcare will not be affected.
ogy including telemedicine are the clearing
house of healthcare. A strong primary care
An alternative option would cut the 900 system is an essential precondition for an
billion dollars per year of waste, fraud and affordable healthcare system. (5) Primary
abuse and all unnecessary healthcare. If $900 Care physicians and healthcare teams can
billion of existing "inefficient" healthcare care for the poor and elderly, the disabled
were eliminated per year, the healthcare and the mentally ill. The silent elephant in
12 Lehigh County Health & Medicine | WINTER 2019

the room is the greater than $900 billion
per year of healthcare "inefficiencies." (6)
We can do better.
The principles of patient safety are known.
We have been taught to take an accurate
and comprehensive history. If we are unsure,
repeat the history until we have narrowed
the diagnosis. Then order medical-based
studies to add data to make the best diagnosis.
Finally, avoid any procedure deemed unsafe.
Forty-five percent of hospitals use electronic
"record alerts." (7) Medicine is adapting
and adopting business models to improve
patient safety. Assembly line like pre-op
checks for patient identification, correct
side surgery and correct equipment in the
operating suite are the best practice. "If the
attending surgeon's gender differed from
that of the majority of other personnel in
the OR, cooperation was significantly more
common." Female surgical teams with male
leaders and male teams with female leaders
are more co-operative. Male surgical teams
with male leaders had 50.6% conflicts and
conflictive behavior jeopardizes patient
safety. (8)
How are we doing? Some studies say better,
but no randomized data exist from the World
Health Organization. Electronic Medical
Records use default settings to stop unsafe
events and guide best practice. Examples
are automatic referrals for post myocardial
infarct patients, limiting opioids to 10
pills per prescription and readable printed
prescriptions forms. (9). The Environmental
Protection Agency reports that nursing
homes across the country toss out about
740 tons of medications each year. Add to
that the "left over" and costly prescription
medications that fill our medicine cabinets.
(10) We can do better.
In 2016 10,200 women with breast cancer
were assessed with genomic testing. After
nine years, 83.3% were cancer free with
hormonal therapy alone and 84.3% were
cancer free when chemotherapy was added.
"Less is more" and side effects and costs were
decreased. (11) Another costly inefficiency
is the manner in which electronic data is
shared among, doctors, insurers, hospitals,

Lehigh County Health & Medicine Winter 2019

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Winter 2019