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Efficiency in Health Care

By on August 28, 2012

One of the other watchwords of Health Care for the future is efficiency. The government, and other third-party payers like insurance companies, want to get the most for their money. They have the right to demand it. Since they have a lot of it to spend, their initiatives will get attention. But efficiency is not the same as effectiveness.

In the good old days, doctors could spend as much time with their patients as they wanted and bill accordingly. They had time to examine a child’s doll a la Norman Rockwell. They could visit and catch up on family events, community gossip, and whatever the patient wanted to say. “How awful about poor Lance Armstrong,” or “My little Pomeranian Fifi had the trots last week.” No one worried about cost or whether time was being wasted. Everyone was happy. Most people could afford their care.

No longer. Ask a primary care doctor what they regret most and they will tell you they are not able to spend enough times with their patients, particularly those that demand added attention. Central to this group may be the elderly, on a number of drugs (a condition called ‘poly pharmacy’) and with a number of conditions that affect one another. Short term memory may be a problem. Writing out instructions for these patients helps. Interval home visits by nurses or other ‘extenders’ is also useful. But nothing will ever substitute for giving the patient the time required to point them in the right direction, motivate them and listen to extraneous matters when there is no one else.

Trouble is, this may be effective but it is not efficient. Unless a patient can afford their own care out-of-pocket, there will be a third-party present in the picture demanding efficiency. Patients will be herded through waiting rooms like cattle. E-visits will replace face-to-face ones. Doctors will spend more time looking at computer screens than faces. Enough of  Fifi, what was the cholesterol level?

There is a small enterprising group of doctors delivering what has been termed ‘concierge’ medicine. They will give you the patient all the time he demands, all day in fact, as long as he pays the bill. No credit cards. Few of us can afford to engage the attention of a cardiologist or a orthopedist for a full day. Few of us can rip off four- and five-figure checks at a clip to pay for this kind of specialized attention. So we will be at the mercy of those wanting efficiency.

Making the most of one’s time, doing more with less, is one of the watchwords of commerce in our time. Everyone is doing it. Doctors are not exempt. Patients must adjust. Medicare and third-party payers in the future will reward those who are most efficient in the use of their time. Forget about Fifi and poor Lance Armstrong. They will want few complications, glorious outcomes and stopwatch efficiency.

Some good doctors are efficient. They please their patients in rapid measure and third-party payers as well. They are the wonders of the profession. There is great art to this. Most doctors however are not. Many don’t even try. Hospitals too are not always ready to give a patient the bum’s rush just because they have hit the day discharge would be optimal. The patient  can’t find a ride home today. The skilled nursing facility doesn’t have a bed yet. The white blood count spiked unexpectedly.

The fact remains that unless you are one of the Astors or the Rothschilds, or a private boutique hospital on Lake Geneva, or part of a small group of concierge doctors calling on patients at the Dakota or some gated community in Bel-Air or South Beach, you are going to be hearing the word efficiency more and more, and liking it less and less.

Are you ready for this?

Tom Godfrey

About Tom Godfrey

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