Stuart--by Kelly Jadon
*A Sub Series—Part 1
Change is coming to the United States medical system. It is an effort not just to bandaid the situation, but to renew it. Economic drivers like rising costs of innovative pharmaceuticals, post modern technology and the Affordable Care Act (ACA) are fueling the overhaul.
What does this mean for citizens of South Florida in Martin and St. Lucie Counties?
As the medical system changes from a “sick care” system to one with more emphasis on “well care,” our culture will shift slightly. Shifts in a part of the culture are not unusual, but medical care, hospitalization and wellness in the United States will affect everyone—seniors, youth, babies, children. For readers in Martin and St. Lucie Counties, these welcome advances are already in process—medical care is expected to significantly improve.
Right now hospitals are in crisis. The medical system is broken. Health care costs have grown more rapidly than the rest of the U.S. economy during 32 of the last 40 years. In 2010, health care cost the U.S. almost $2.6 trillion; in 2011 it reached $2.7 trillion; 2012 health care costs were expected to be $2.8 trillion and the largest contribution to U.S. debt.
Kaiser Education reports that the major factors in the rising costs of health care are: newer technology (US Congress) and prescription drugs, the growth of chronic disease due to longer life spans, the need for prevention, and administrative costs.
Each day, 10,000 U.S. citizens turn 65 and become eligible for Medicare. This will continue for approximately 20 more years. During 2012, 50 million people were on the rolls of Medicare. Medicare cost the U.S. $551 billion and Medicaid $251 billion in 2012 (Congressional Budget Office).
Medicare costs are expected to continue to rise as more baby boomers join its ranks. The same may be said for Medicaid, which will gain enrollees because of extended eligibility under the Affordable Care Act (ACA).
Medicare costs rely on a fee-for-service plan. The Heritage Foundation’s Robert E. Moffit, Ph.D. and Alyene Senger report that this payment plan for physicians is unsustainable as it pushes costs high. A physician is paid a fixed price per service given. This method increases the number of services per patient. Sometimes services are unnecessarily repeated. Furthermore Moffit and Senger state, “Medicare's rising costs are unsustainable and have put the program's future in jeopardy. The Hospital Insurance Trust Fund is projected to be insolvent by 2024, and Medicare has a total long-term unfunded benefit obligation of $37 trillion.” Of the Federal Budget, Medicare is the most rapidly growing program due to baby boomer enrollment and rising health care costs.
Costs for hospitalization are increasing. Have you ever visited the hospital, as a patient? If you have, you’ve probably received a bill. In 2010, the average length of stay in a hospital was 4.8 days (CDC). The cost of a typical hospital stay in 2010 was $9700.00 (Agency for Healthcare Research and Quality).
Most interestingly, Medicare had the highest average cost per stay at $11,600.
The American Association for Justice reports that a rising tide of error within the medical system has made it the sixth biggest leading cause of death in the United States. Do you know anyone who received the incorrect medicine in the hospital or who had the wrong part of his body operated on? The Institute of Medicine found that approximately 98,000 people die every year as a result of medical errors. The ensuing cost is estimated at $29 billion.
The Association of American Medical Colleges reports that there is a looming doctor shortage. More medical school spots are needed for students. However, there are residency placement shortages for training. We need 10,000 new physicians in the United States. The Affordable Care Act has only allowed for 300 more each year to be trained in residency programs which is funded by Medicare (GME).
Waste. There are many kinds of waste in the medical system—time, the needless redundancy of duplicate tests, and the like. This loss is estimated to be 30 percent.
Did you know that approximately 20 percent of discharged older patients return to the hospital in less than 30 days? And did you know that Medicare will not cover this readmittance? This costs the hospital money. Dr. Peter Dayton of Martin Health System, gives the following example: If a patient who has had a knee replacement returns to the hospital with a knee infection, the cost is $100,000. The key: Avoid the knee infection.
There is a lack of patient responsibility regarding compliance after hospitalization. Many patients who leave the hospital require medication, special diets, and rehabilitation. Non-compliance usually lands them right back in a hospital bed. This costs thousands of dollars which really are unnecessary expenditures.
Even worse, hospitals are closing or under financial strain. Indian River Medical Center, a neighboring hospital, cut 50 positions due to “financial pressure on IRMC’s operating budget,” stated its President and CEO Jeff Susi.
There are many other issues in the medical world which are not visible to the general public. But because the medical system is in need of a major overhaul, positive changes are coming.
Dr. Stephen C. Schimpff, author of The Future of Health-Care Delivery (Potomac Books, 2012) writes that the changes will be disruptive, but they are necessary. This will include the balancing of patients’ rights with their responsibilities and the necessary clarification of misconceptions.
Martin Health System, under the guidance of CEO Mark Robitaille and the Board, recognizes that the American health system could be functioning better. It has begun to implement new programs using models from other hospitals which will provide better patient care with greater financial savings.
The Director of the implementation is long time Stuart resident Peter Dayton, M.D., F.A.C.O.G. He is a Board Certified doctor who has delivered babies for 27 years and provided medical care to women for more than 28 years through his practice at Physicians To Women. Dr. Dayton is on staff at Martin Memorial Hospital and he has most recently served as a Member of the Department of OB/GYN Quality Review Committee and is currently a member of the Martin Memorial Ethics Committee.
Dr. Dayton expects the implementation process will probably take three to four years to get up and running.
A concern many have is about the Affordable Care Act. Dr. Stephen C. Schimpff states that there are currently 47 million without insurance or access to medical care. “Health care reform is not about health care, but mostly about paying for it: providing medical care to the uninsured, eliminating some health insurance restrictions of consumers, and expanding coverage.” It will add expenditures and not reduce costs and unlikely will reduce the cost of insurance and health care.
For example, 70% of all medical care expenditures in the United States is due to chronic disease. With today’s technology, patients are living longer. Now, patients must become more responsible for their health. This occurs in two ways; first, patients will be expected to assume higher deductibles and co-pays. Second, their care will change, becoming better and more efficient. No longer will a patient expect a referral from one doctor to another. Instead, he or she will be given access to a team of physicians and other providers. This team will work together for the good of the patient. For example, there will be no need of duplicate tests, x-rays, etc…This results in higher quality, coordinated, integrated and less expensive care with better outcomes for the patient.
Dr. Dayton recommends that the public read Dr. Schimpff’s book The Future of Health-Care Delivery (Potomac Books, 2012). The book is written in layman’s language and helps the reader understand the current medical crisis and illuminates the coming changes.
© 2013 "Good News" Kelly Jadon
