What Would You Do to Fix the Failings of Healthcare Delivery ? - page 3

Suppose you have the authority to fix the failings of healthcare delivery in the US. Nothing is off limits, and you have the ability to implement change at any level. What would you do?... Read More

  1. by   T-Bird78
    Insurance companies need to let physicians make decisions, whether it's a prescription or imaging or hospital admission. If doc writes for drug X because it works, pt shouldn't have to try and fail drug A, B, and C for 30 days before pt can get the script that works. I'm appealing a pts MRI brain right now because insurance will only allow it for 5 certain diagnoses and pt doesn't have one of those, but does have a condition that requires MRI to rule out a tumor. Let doctors be doctors.

    Stop pt satisfaction scores as an indicator for reimbursement and bonuses. We didn't get our bonus this year because not enough people said "yes, definitely" to "would you recommend this practice" even though most did say "yes, somewhat."

    Make it possible for physicians to allow 30 minute appointment slots without losing income. Docs have to see more pts in a day and pts get mad at a short appointment or having to wait if a doctor does spend more time with a pt.
  2. by   twozer0
    Here is a really well written article about one of the elephants in the room. Cost.

    https://www.forbes.com/sites/realspi.../#7692ec5d7b9b
  3. by   NurseSpeedy
    Quote from T-Bird78
    Insurance companies need to let physicians make decisions, whether it's a prescription or imaging or hospital admission. If doc writes for drug X because it works, pt shouldn't have to try and fail drug A, B, and C for 30 days before pt can get the script that works. I'm appealing a pts MRI brain right now because insurance will only allow it for 5 certain diagnoses and pt doesn't have one of those, but does have a condition that requires MRI to rule out a tumor. Let doctors be doctors.
    Exactly. I remember working in an office where a patient needed some imaging done for her abdomen. It was so long ago that I can't remember if it was a CT or MRI but the request was originally denied. Then I had to go over the whole case with the insurance nurse who after I listed off a list of s/s not explained by labs and simple imaging and doctors progress notes stated to me, "but she doesn't have pain?". Well, no, the patient isn't reporting pain but isn't that more of a perception? Hell, I was in active labor with strong, frequent contractions. My water had broke. I was scheduled for a c section that morning. I felt NOTHING because the baby wasn't anywhere near my pelvis (too big). Not all medical issues warranting testing/surgery involve pain.

    This case was then escalated to the MD at the insurance review. Explained the whole thing again. And again, "but she has no pain?". Ready to beat my head into the wall. After this I just dropped the chart on the PCPs desk and said, "I think they want to see pain before they approve the test. It's your turn to call these idiots".

    Now, more recently I had my own wonderful experience. I had severe pain in my knee radiating down my leg. X-ray of knee normal but MD pretty sure it was a torn meniscus. Ordered an MRI of that knee and was scheduled in a couple weeks. Went home and a few days later went to get out of bed and the pain was so severe I literally fell upon rising. My 4 year old brought me my crutches from a previous surgery I had in the closet so I could get off the ground and drive her to school. The MRI was then changed that day, but I had to talk to the insurance company who wanted to let me know that I could get it cheaper at other locations. Um, no. My doc is at this location and my appointment is this afternoon after the scan. No.

    Turned out my knee had it's own problems but not the source of my pain. Doc thought it was my back. Sent me to the spine specialist (this one did ortho but not spine/foot/ankle-the group had other specialists for these). Put me on tramadol, which worked fine, while I waited a month to be given back X-rays. Of course nothing can be seen on the X-ray. So, PT 3x a week for 3 months and if that didn't work THEN I can get the MRI. I was an LPN working every weekend, going to RN school during the week online plus labs and clinicals, and I had a 4 year old to care for. I didn't have time for PT that often and I sure as hell didn't have the money for the co-pay each time I walked in the door. So, I did nothing and the pain got a little better.

    Fast forward two years and the pain is back but this time radiating into other areas of my upper back as well. I have a new primary because my insurance changed but I knew him from a hospital that I worked at for years in the past. He had found a loophole. He told me which radiology company to go to and to state that I am self pay. He said the cost is $200. Your insurance copay is $500 if you use them. Your insurance company is also going to reject it until you go to PT 3x week for three months and fail. This you can get done today and we will know what's wrong and how to treat it effectively. Three herniated discs (one really severe) and spinal stenosis (at age 35, probably been there for a while). While this news isn't what I wanted to hear, I knew why I hurt and what to avoid to keep it from getting worse. I also know what treatment options I have if I need to get more aggressive with my care. The insurance company would rather pay for months of PT, MD office visits, and meds than a simple MRI of my back to avoid possible back surgery. However, they didn't blink at the idea of an MRI of my knee...that's just completely messed up.

    Please excuse typos-sent from my iPhone.
  4. by   HalfBoiled
    I would also wish to have a increase budget for preventative medicine.
  5. by   mmc51264
    Things have changed a lot in my short tenure as a nurse. I have been a nurse for about 5 years, late in life. I was fortunate to have a lengthy orientation in my specialty. they have turn 180 degrees. I got 6 months of orientation. Now they are lucky if they get 12 weeks. The new nurses are just thrown in the pool to learn how to swim. I see them struggle. I think staffing is an issue. I live in an area that has a shortage. I wish they would increase the pay for CNAs. We can't find them to save our lives! Between the hosp, SNF, home health, the demand is great, but the pay sucks!
    I agree that there is a lot of waste in management. We have a clinical operations director that has 4 units to supervise! Two are ICU. My unit has a brand new clinical lead and no manager. we feel like we are limbo. There seems to be a lot of turnover (we are hosp saturated and a lot of "grass is greener" syndrome).
    There are many factors that go into what could make things better. I wish we didn't have the tail wagging the dog so much (patient satisfaction-driven evaluation-we saved your life but you're going to give us 3s because the food sucked???).
  6. by   gypsierose
    Quote from twozer0
    Here is a really well written article about one of the elephants in the room. Cost.

    https://www.forbes.com/sites/realspi.../#7692ec5d7b9b
    Nurses cost money- just cut staff! Seriously cost IS an issue, though. Good article.
    PS Its a small help but i would support home health, home care, and family caregivers to cut down on LTC cost .
  7. by   RRTNurse
    Staffing only comes when MBA's and greedy MD's stop putting profit ahead of patients. Humanity must return, and government regulators must get out.
  8. by   RRTNurse
    Amen. I couldn't agree more. When Press-Ganey is officially dead and buried I will be ecstatic. Worst thing, how everyone has networked on everyone else so that we have extremes driving healthcare of comfortable bed versus life.
  9. by   RobbiRN
    Thank you to all who responded. I was away for a few days. What a treat to come back and find a ton of useful ideas here. There is a method to my madness, and a direction for change is becoming increasingly clear.
  10. by   Mini2544
    Quote from skylark
    The problem with universal healthcare systems is they are abused big time.
    ERs are full of non emergencies, who just love the free ambulance rides and the free sandwiches.

    The Aus/NZ system is better, where patients pay an affordable fee, something like $25 for an ambulance, and then its refunded IF the ER doc says it was genuine need.

    And those whose health is compromised by their lifestyle need to continue to pay. Why should taxpayers pay up for yet another failed detox, or their third asthma exacerbation of the week because they won't stop smoking?

    Genuine healthcare should be available for genuine need.
    The reason I cringe at the any mention of Universal health care systems is because of what you just mentioned. That sounds like a great alternative
  11. by   Mini2544
    Quote from LovingLife123
    I see many people think there should be universal healthcare on here. Do people on here realize exactly how that works? And that the single payer system in the U.K. Is a mess and so many people are unhappy with it? It's not this perfect system. In countries like France, they still have private insurance. People with the private insurance have access to private hospitals. Everybody else with the single payer insurance go to other hospitals and their access to care is not equal. Here, everybody goes to the same hospitals, they all just have different insurance or no insurance. And they all have equal access. People here would scream if thays how it operated here.
    ๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป I think Americans think If something is provided for them it's free. Which is just silly but we are talking about an imaginary world here where healthcare for all wouldn't cost 34 trillion over a 10 year span and people's tax would not be raised. ๐Ÿ˜Š
  12. by   LadysSolo
    I think Assisted living and home health aides should be covered by Medicare - cheaper than SNF, and many people don't need SNF but can't afford self-pay for AL or home health aides daily. I also agree with universal health care at a basic level for all (preventive care in particular - "we won't pay for PT but you can have all the drugs you want,") and if you want to pay for additional you can, and I agree no "satisfaction surveys" for reimbursement (I couldn't have morphine for my hangnail, so you get poor survey results.") And outcomes to base reimbursement on - PLEASE! GET REAL! Until a way can be found to allow me to force my patients to do what I recommend, despite educating until I am blue in the face, PEOPLE DO NOT LISTEN UNLESS THEY WANT TO!!! I have entirely too many "fix me in spite of myself" patients.

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