Is curing patients bad for healthcare business?
Our Beloved FoundFamily:
As COVID-19 continues to present us with new challenges every day, like everyone else, Sherry and I have had to adapt to these dramatic circumstances as best we can. At present, our collective income has dropped by 75%. Sherry’s dental practice remains closed, while I am able to see only the most critical patients at Be Hive of Healing. Even so, that doesn’t mean we’ve been sitting idly by waiting for the world to reopen. In fact, we’ve been busier than ever providing education and information to help people stay emotionally grounded during this difficult time and to avoid being swept away by media-driven hysteria.
In addition to an Instagram campaign, we’ve been acting as health experts for KPFK public radio, answering health questions from concerned callers and helping them keep their fear in check. We’ve also been doing Instagram Live sessions, appearing as guests on podcasts, participating in virtual conferences via Zoom, and acting as medical sources for various radio and TV programs sharing the same message. So while most medical clinics have been closed, we’ve found other important ways to help people.
Our goal has been to be part of a larger conversation that focuses on peace of mind and positivity as we work toward a solution to our current situation. For that purpose, we have been in contact with our state and federal representatives to foster collaborations with public health personnel to share integrative interventions for COVID-19. In fact, several of these interventions were incorporated into the official COVID-19 care protocol published by the Eastern Virginia Medical School after I shared the information with the Orthomolecular Institute.
It was in the midst of this whirlwind of activities that I received a call from a frantic patient last week. It was a 55-year-old woman who had been admitted to a Ventura County hospital. Barely able to get her words out, she told me her blood oxygen saturation level was 88%, and that she was having difficulty breathing. This was a serious situation because oxygen saturation levels below 95% risk cell damage and cell death throughout the body. By the time she called me, she was on six liters of oxygen that kept increasing incrementally.
She was clearly in some kind of panic attack and certain she had COVID-19 because of her breathing difficulty. When tested she came up negative, but that didn’t seem to calm her down. She’d excited herself so much over her fear of COVID-19 that her anxiety had taken on a life of its own and was now in control of her body. I reassured her that she didn’t have COVID-19 and asked if we could just talk our way through her situation. I told her I knew she was going to do very well.
After talking with me for a few minutes, the doctor and a nurse entered her room, preparing to intubate her. I heard her ask them for 15 more minutes before the procedure was performed. By the time the doctor returned, she was in a completely different state of mind, and her oxygen saturation had risen to 96%. The doctor was shocked. When she relaxed her mind, her entire physiology shifted, and she could breathe fully again. There was no intubation, and she wasn’t taken to the intensive care unit. Sometimes we have to treat the mind in order for the body to heal.
Aside from the happy ending, that experience got me wondering how the patient’s condition would later be coded by the hospital for billing purposes. I’d recently read that because the billions in federal relief funding for hospitals was dependent upon their ability to treat COVID-19, that many hospitals were coding all kinds of unrelated conditions as COVID-19 to get a larger portion of the money. Yes, the patient had tested negative, but many of her symptoms were similar to COVID-19, and it would have been easy to make the connection on paper. I’m not accusing the hospital of impropriety, but the possibility brought to mind the unhealthy relationship between healthcare and business.
That reminded me of a news article I’d read a while back that asked whether or not curing patients was a “sustainable business model”. The concern expressed was that curing patients doesn’t generate a recurring revenue stream. Healthy people have no reason to come back to the doctor. For any business to be a success (and healthcare is a business), it needs repeat customers. Therefore, there is no financial incentive in helping people get well. On the contrary, there is enormous profit potential in managing disease through lifelong medication, therapy, treatment, and office calls without actually eradicating it.
Part of the problem with this conflict of interest in medicine is that hospitals and physician groups use pay structures for doctors that heavily emphasize productivity, which translates to seeing as many patients as possible, while providing the highest number of relative value units (RVU). The RVU is part of a formula that Medicare uses to reimburse doctors for services based on the skill level and time required to perform them. Basically, it’s all about throughput; quantity over quality.
Imagine what healthcare would be like today if we paid doctors for what they did do instead of what they didn’t do, if we placed the emphasis and incentive on healing and nothing else.
Fortunately, some healthcare facilities are slowly starting to move away from this type of conveyor belt mentality and tying a percentage of physicians’ salaries to patient satisfaction. There are now several online agencies that grade physicians based on patient satisfaction where the information is available to the public. Physicians are also being rewarded when more patients choose to come to them after seeing their high scores. Some facilities are rewarding doctors when their patients aren’t hospitalized, assuming (at least) it’s because their patients are remaining healthier.
All this is fine, but what does a patient satisfaction score really have to say about a physician’s ability to heal the patient? While I’m a firm believer in the necessity for a good bedside manner, these satisfaction scores often contain criteria such as how “nice” the doctor was, whether he explained everything clearly, if the patient’s phone calls were answered in a timely manner, and little else. What does that have to do with healing? It sounds more like a congeniality contest. To me, patient satisfaction can be summed up in one question: Are you now well, or do you feel significantly better after your prescribed treatment? That’s all anyone really needs to know. With regard to rewarding doctors for keeping their patients out of the hospital, that could easily be viewed as a cost-cutting strategy disguised as a patient satisfaction incentive.
I wonder how different healthcare would be, how many cures we could find, if we reversed the whole payment paradigm where doctors only got paid for the patients that were made significantly better or well. If you think about it, only doctors and lawyers have the privilege of getting their full fees even when they utterly fail. They must be paid in full regardless of whether the patient still feels lousy or dies, or if the client loses the case. If a product is defective, you can return it to the manufacturer and get your money back. If a plumber does shoddy work, he can be made to return and correct the situation or refund his fee. Not so with doctors and lawyers.
Believe it or not, there was a time when the healthcare payment paradigm was reversed. In ancient China, a doctor of Chinese medicine was paid a retainer to keep his patients healthy. If a patient got sick, he would not be paid until that person got well. If a doctor chose to perform surgery, he was looked upon as an inferior doctor because if he could keep his patient healthy, he wouldn’t have had to resort to surgery at all.
Imagine what healthcare would be like today if we paid doctors for what they did do instead of what they didn’t do, if we placed the emphasis and incentive on healing and nothing else. I think we’d see a profound shift in the way research is conducted and healthcare is provided on every level because for the first time, patients would legitimately be placed above profit in a system that’s truly sustainable because it’s grounded in creating health, not maintaining disease.
Love and Light in the Month Ahead,
Dr. Habib Sadeghi
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