By Joseph S. Testa, M.D.
Found on a fresco by 16th century painter Giorgio Vasari are the words: cerca trova (look and you will find). Use these words to investigate the state of health care in the United States today. No matter your political belief, you will be surprised and concerned.
Every physician practicing today must have advanced knowledge in accounting, federal and state health care law, actuarial statistics, probability, contract negotiations and guesswork.
Physicians need to have 50 hours of continuing medical education per year to ensure we stay up to date with current evidence-based diagnosis and treatment protocols. Besides learning about biologics, advances in cancer, migraine headache or congestive heart failure, physicians must also be able to understand and use an ever-increasing barrage of medical acronyms essential to the daily practice of medicine. Following is a sampling, and in no way a complete list: PMPM, MACRA, MIPS, ACO, IPA, MCO, FFS, HMO, PPO, MOON, CPC, CPC+, HITECH, AAPM, CMF, PBIP, PCMH and CPCP. Physicians need to know the meaning of terms such as robust, transparency, shared decision-making, withhold, upside, risk pool, value-based, heavy lift and performance-based, just for openers.
Predictions abound by experts in medicine about its future. While all are put forth by well-intentioned, knowledgeable and highly educated people, the simple truth is, they are all wrong. First, if it were that easy, health care would not be in the calamitous shape it is right now. Someone certainly would have been able to avoid this mess. So-called deep thinkers would have been able to foresee and avoid the current onerous climate. Insurers have collected multiple terabytes of patient and financial data over the past 20 years. What have they done with it to avoid today’s situation? Their working model to date is simple: throw everything against the wall and see what sticks. Politicians and insurers at most have a candle in a dark room.
Second, predicting is risky business. Dan Gardner in his book “Future Babble” presents a broad body of research-based studies on predicting, and why most are wrong. Sound bites on TV are great. But when you look into all of the predictions made by experts, the overwhelming majority of them are wrong. Why do we listen to the same people who were so wrong in the past?
Every day brings a barrage of communications from insurers that requires physician attention and action. They are typically titled: mandatory, immediate attention required, time sensitive and action item. Some are even printed in red and all typically are in bold print.
An ever-increasing number of medical societies across all specialties has requested a slowing of this mind-numbing pace.
Politicians, government agencies and insurers have not done a good job so far. They have alienated many physicians while significantly adding to the already stressful job of practicing medicine. The current system is going over a cliff and the people in charge got us here.
The truth is out there.
Joseph S. Testa, M.D., lives in the Town of Tonawanda.