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12/14/2006
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Attack The Root Of The Health Care Mess: Readers Reply

Readers weigh in on Rob Preston's observations on reining in health care costs.

While I cannot argue that health care costs are a significant issue and we need to take a new direction, I am always dismayed at how people that have not worked in the industry are quick to prescribe solutions or make comments like "...can finally drag the health care industry's legion IT laggards into the 21st century by refusing to do business with hospitals, clinics, and practices that don't digitize their records and adopt open architectures for sharing information."

My company, like many other providers, is investing heavily in information technology that indeed will provide better information and better outcomes, and yes, it should be significantly more cost effective. But before all the pundits rally around companies that think they can build a better mousetrap, you need to look at the core issues.

First is funding. Yes, there is a lot of cost shifting going on. Washington is where it starts. We, like most provider organizations, lose money on just about every Medicare case we treat. This is the only business that I am aware of where we are told what we will be paid for our services regardless of cost.

Second and related to funding is margin. Hard to believe for most of your readers, but a non-academic provider hospital or system is happy to squeeze out a 1% to 3% margin in a good year. High salaries, high cost of facilities, high cost of medical devices, high costs for physicians, high costs for supplies, high costs for IT investments, millions of uncompensated charity care, and the list goes on. We are challenged to balance the need for IT investments against other needs.

Third, our citizens expect the very best in health care, and they should. When it is your turn in the system, you want a 64 slice CT scanner or PET scanner or a specialist that is one of the best in the country, but they come with a seven-figure price tag. People have a tendency to forget the cost issues when they need care but never put their expectations aside.

Health care professionals strive every day to do our best to improve productivity and quality and to provide the best care possible. It is taking us time and scarce dollars, but we are getting it done.

-- Ron Strachan


The Dossia companies, I'm sure, are very focused on providing employees with their medical records, and for normal circumstance this may work. Numerous RHIO's are being formed around the country to provide the same information by community.

Unfortunately, when you are taken to the ER, do you think the physician is going to look to see if a CBC was done in the last month? Probably not. They are most likely going to attempt to save your life. Also consider this: Every attorney in the world is waiting to start a lawsuit the first time that a historical test was used to diagnose a patient instead of a current test being run.

It all sounds great in theory, but not in practice. The real health care costs are associated with malpractice insurance increases. Look into why most OB/GYNs have left Illinois. If you want to solve problems, start with the lawsuits.

-- Bill Moncrief

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