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July 5, 2007

BehindTheMedspeak: Medical students visit 'The Real World' — Insurance company visit forces a look in the mirror... and it ain't very pretty

Doctor1

John Dorschner's June 10, 2007 Miami Herald article was about a look behind the curtain by one-fourth of the third year class at the University of Miami Medical School, who spent a day at AvMed, a nonprofit insurer which covers 200,000 people.

All I've ever heard is my crowd's point of view, which consists of "mostly say, hooray for our side."

These visits to what many physicians consider "enemy territory" should be mandatory for medical students.

When – not if — the U.S. finally revamps its health care system, you can bet that the insurance companies will have a seat at the table hammering out the details.

It may not happen this decade, but I'm betting on this century.

Or your money back.

As always, the FerrousClad™ bookofjoe guarantee applies.

Here's the Herald story.

    Medical Students Get a Dose of Reality

    UM med students took a break from their textbooks and traveled to insurer AvMed for a day to learn about the financial realities of U.S. healthcare.

    For one day at least, Miami med school students took a break from learning about illnesses and healing — and got a hard dose of the financial realities of health insurance.

    The place: The Kendall headquarters of AvMed, a nonprofit insurer that covers 200,000 people. The audience: About 35 third-year students from the University of Miami med school. The result: Key insights not only into the insurance system but also what young doctors-in-training think about it.

    Some students don't like the message any more than some patients do. At the opening morning session, a female student frowned as Marc Rivo, a physician who's AvMed's corporate medical director, described how new consumer-driven policies emphasize higher co-payments to help patients understand how much healthcare costs.

    ''So you're being accused of being greedy,'' the student asked, "if you want an MRI after you hurt your knee?''

    Well, not greedy, said Rivo, but the theory is that if patients don't pay something for their own care, they won't care about how much the treatments cost and whether they are worth it.

    What about an annual physical, another student asked. If a higher co-pay caused someone to avoid a physical, that might lead to more expensive complications later. Interesting point, said Rivo. "This discussion will be going on for the rest of your professional life.''

    For a decade now, third-year UM med students have spent a day at AvMed to learn about health plans, which control the purse strings of funds that doctors want to spend.

    ''They'll be MDs 12 months from now, and they don't understand... all of this systems stuff,'' said Mark O'Connell, senior associate dean at the med school who oversees the seminars.

    The tension between doctors and insurance companies has been going on now for perhaps a quarter of a century. In fact, O'Connell said, students are less suspicious of insurers today than previous generations.

    At the seminar, none of the students knew immediately which President started Medicare (it was Lyndon Johnson), and Rivo gave them a quick history lesson, starting with the ''golden age'' of medicine in which "doctors do what they want and charge what they want.''

    That led to soaring medical costs, in part because advances such as MRIs gave physicians more options to spend money. Insurers have been clamping down with various strategies ever since.

    One way to save money is by moving to electronic records, which eliminates duplication of many tests. Students were surprised the industry hadn't moved faster in this and that Jackson Memorial was still mired in paper records, requiring a lot of shuffling to find a record.

    The nearby VA Medical Center has electronic records. ''Easier to find things,'' said one student, but several observed that, with doctors reading computer screens and entering information, "it definitely minimized patient interaction.''

    AvMed is now developing its own electronic record program and also perfecting disease management programs to improve care and cut costs.

    One example: With congestive heart failure patients, fluid retention is an indication of problems. So AvMed bought scales for those patients who didn't have them and asked the patients to weigh themselves once a day. If they gained more than three pounds, they should check with their doctor. After the program was introduced, hospital admissions of these patients dropped by 85 percent in the first six months, Rivo said.

    He said doctors and their staffs needed to be alert about what different insurers offer. For example, AvMed programs might pay for a smoking cessation program, but the doctor must know about it and write an order for the patient. Other insurers might have other procedures.

    A male student noted: "Only 10 percent of my patients might be AvMed. Why should I pay attention?''

    ''Good question,'' said Rivo. But that's the way the system is. He suggested a doctor's office manager ''needs to flip through the Web pages of each insurer each morning'' for changes.

    O'Connell, the UM professor, said ''it's really a monstrous issue — this fragmentation. It's expensive'' for providers to deal with many different plans.

    The 35 students who attended the recent seminar — one-fourth of the third-year class comes every three months — said they understood the basic mantra of American healthcare: The country spends about twice per capita as do other industrial countries, but U.S. patients live no longer, at least partly because 45 million or more Americans don't have health insurance.

    But still, that abstraction is different than the reality of an insurer trying to find ways to curtail costs and not paying for some treatments. Student Kathleen Brookfield said she viewed insurers as "a necessary evil.''

    Most students, however, were glad to get an opportunity to hear how insurers worked.

    ''I still feel lost,'' said Charles Stewart, the son of a Boca Raton orthopedic surgeon who hopes to follow in his father's footsteps.

    Stewart had sat at the dinner table many nights listening to his father complain about healthcare economics. But in classes, he heard about diseases and treatments, not business. "Very little of what we've learned is about the real world.''

    To keep costs down, Rivo explained how insurers are emphasizing ''evidence-based medicine,'' finding the best practices for doctors. He pointed to the Dartmouth studies, which found that doctors' predilections caused one town to have three times the rate of hysterectomies of a nearby town.

    He said one doctor might get 41 percent of patients needing mammograms to have them done while another doctor gets 90 percent compliance. Under the concept of pay-forperformance, perhaps one doctors should be rewarded more than another.

    One student immediately objected: ''It's not your fault,'' he said, defending the doctors. Patients should be held responsible for doing what's right, not doctors.

    ''So you should drop bad patients?'' Rivo asked. The student didn't answer.

....................

Well, at least I knew Lyndon Johnson started Medicare.

[via Shawn Lea, head of my crack research team, who's recently been wondering out loud if she can have the painting over my living room couch. Jeez, Shawn, the body's not even cold yet! I've heard of alpha females in the abstract but let me tell you, if she's an example of what's going down out there, I'm staying inside on my treadmill.]

July 5, 2007 at 12:01 PM | Permalink


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Comments

I don't know, this stuff is bullshit.

The industry has been making record profits and keeping it to themselves, and bitch and moan anytime anyone needs anything. In the last 10 years, I had two emergencies that required interventions that were drastically delayed because of these leaches...and supposedly I have some of the best care in the industry. In the first, I ended up with a lung infection round the time of 9/11. Ended up getting help with a friend with the CDC because my insurance wasn't allowing the docs to do the work they needed. Luckily, there was an anthrax thing going on too and he was able to use this to get me some stuff that ended up curing everything (no more spitting up blood, though it took long enough that I have one lung that is permanently damaged because of it...I was able to get diagnosis AFTER someone else took care of things).

Less than 6 months later, my joints started going south. Autoimmune disease -- genetics -- but I'm told that the weakening of my immune system earlier might be the reason that was able to take hold instead of laying dormant like in most people who have the same genes. Couldn't walk, wheelchair, damn near killed me to pour the Absolute to my mouth...ended up needing one of those crazy straws. And my GP was not allowed to send me over to a specialist or get me an MRI. Insurance kept saying the symptoms looked like a car accident...even though if they had read everything instead of just putting in a checklist, it would have been easy to discern that it wasn't. For the most part, I had to rely on my network of friends to get me the diagnostics, and when they did, my insurance TRIED to use this as an excuse to deny my because I was not following the designated plan (even if it cost them NOTHING). Clear proof that I had something that was going to kill me, and they refused to pay because they wanted to see if I healed on my own...again, permanent damage occurred because they waited.

To hell with the insurance industry. No one is crying for you or stock holders. The CEOs need hung from lightpoles in the street (a judgment I normally only hold for Dick Cheney).

Posted by: clifyt | Jul 5, 2007 12:23:59 PM

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