HomeFocus → Single specialty medical centers in the context of healthcare reform (part I)

Single specialty medical centers in the context of healthcare reform (part I) Print E-mail
Written by Alejandro Badia, MD, FACS   
Friday, 14 June 2013 17:11

Much debate is currently focused on healthcare reform, with emphasis on controlling costs, increasing access, while maintaining quality.  While a daunting challenge, it is clear that the basic premises currently recommended to achieve this are fundamentally flawed.  A very different approach may be necessary.

The following points run contrary to current goals yet seem to work on a small scale.  Why not expand this to a national, or even global, level?

For starters, the recent focus on increasing primary care medicine may actually be more costly.  While a necessary part of our medical infrastructure, the primary medical specialties need to work more closely with their subspecialized colleagues.  This will paradoxically decrease health care costs in the long run.

The exponential explosion of medical knowledge has clearly made it impossible for a physician to have even a cursory knowledge of all specialties, let alone subspecialties.  The result is that a general physician will often miss the diagnosis, and currently more relevant, will expend much greater resources in order to arrive at the diagnosis; let alone formulate the appropriate treatment plan.

For example: It is not uncommon that a patient presents to me, a hand specialist, with wrist pain.  While my experience and clinical acumen will often lead me to the diagnosis immediately by just listening to the patient's complaints, the patient who comes from a primary doctor may come see me with an MRI already performed, a battery of blood tests, and perhaps even a course of physical therapy already in progress.  The problem is that this patient may simply be suffering from DeQuervain's tendonitis, a very common condition responding to a single corticosteroid injection in 80% of cases as per the scientific literature.  I am so confident about the result that these patients are typically not even given a follow-up appointment.  Hence, the difference is clear: the subspecialist makes the diagnosis much faster, with superior resolution of the clinical problem and at much less cost, utilizing less testing and imaging studies.

The issue is that this same scenario applies in nearly all fields of medicine.  Even in other orthopedic areas, I as a hand surgeon would be completely out of my league if evaluating a patient presenting with something as common as intractable low back pain.  This diagnosis alone occurs in 65 million Americans and costs our society more than 100 billion a year!  If I feel ill prepared to manage this problem as an orthopedist, how can a general internist or perhaps even a chiropractor be sufficiently qualified to ensure that they are not missing spinal stenosis, a midline herniated disc, or perhaps a spinal cord tumor?  It is clear that each diagnosis, whether glaucoma, lymphoma or renal hypertension, should be managed by the appropriate specialist; from the outset and until symptom resolution/management.

A further problem is the intrusion of non-trained, essentially laypersons, into the fabric of American medicine.  This means that non-medical personnel are frequently interfering with care or serving as "cost-controllers" when they are really superfluous.  Do physicians really need a pencil-pusher "authorizing" care when their staff calls the insurance carrier to essentially ask permission to perform a procedure or order a test?

This layer of bureaucracy is redundant and not cost-effective.  It slows the process and adds cost to the system.  Are MDs not the best barometer of whether a test is needed?  Are physicians not subjected to the most arduous training and education of most any profession while, in most cases, maintaining a certain ethical standard dictated by a professional oath of conduct and enforced by medical societies?  The amount of money, and time, saved by avoiding this validation step would greatly offset the occasional physician overutilizer, or even unscrupulous provider.

Click HERE to read Part II

ABOUT THE AUTHOR:  Alejandro Badia, MD, FACS is a hand and upper extremity Surgeon at Badia Hand to Shoulder Center in Doral, Florida He is also Chief Medical Officer, OrthoNOW. To see Dr. Badia's BIO, click HERE.

Last Updated on Friday, 21 June 2013 09:23

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