Interesting idea Roger I heard of results based healthcare happening in Europe- I think it was Sweden but honestly I forget. It isn't that the doctor or provider isn't paid if a patient dies e.g., in those cases you just prove you did all that was possible. But, there were arguments made that much waste was eliminated. My father in law is in the hospital right now for a heart issue. We joke that everytime he sees a doctor, they ask to take the same tests on him, and bill it to insurance since he is covered. In results based, there is a much higher incentive to simply get the results from the same tests taken only days earlier that are not likely to have changed. Just one anecdote I know- and I won't claim results based is perfect as Maduro notes, but perhaps aspects of it could be adopted into our current system. Plus- I hear that a law mandating e-records would save many billions of dollars in improved efficiencies. You just have to convince the paranoid types we see here on the board that the govt. isn't abusing private information about your health.
People re-order CT scans and MRIs all the time. Electronic records are present in a lot of places, and the government mandate that every commercial EMR suite save to a common file format was an extremely important regulatory step- a stellar example of something that the government did right. The issue with using an outside scan is that the radiologist's fee for re-reading a scan that was previously read at the outside hospital where it was performed is pretty low, and most surgeons/internists want one of their own guys to look at the image. Thus the scan is repeated. As for labs, I have noticed a tendency to order fewer of them, though there is a strong component of CYA in that. Getting a $50 troponin that you probably don't need is a lot better than having an attorney gnaw on your *** regarding your gross incompetence for failing to order it. The "could a professional arguer make this action/inaction seem like evidence that I hate my patients to people who know nothing about medicine?" test leads one to err on the side of ordering more stuff.
Results-based medicine would be amazing but we need to think about how that would actually be done. When someone gets sick, they usually recover on their own. How fast is a factor of medicine, genes, their health, and the environment. How would we adequately compensate doctors and the hospital for that? What if the patient goes to several doctors, how is compensation distributed? Terminal illnesses would be just as hard to work out proper compensation. Everyone is going to die, and they're probably going to go from a terminal disease. The doctor can try everything they have and delay death, or try everything they have and know to do and fail. Fee for service is very problematic but it's the only practical solution we have now. Maybe with a universal health system where every doctor and hospital are working for the same organization. Then if the patient does well, we can probably attribute it to the correct organization--the only game in town.
I had a high deductible health plan in 2010 and I was made acutely aware of cost issues, since I bore a lot of them myself. I had some issue in my lower GI tract. My doctor referred me to a specialist for a colonoscopy, which I'd "enjoyed" only three years before. The colonoscopy turned up nothing, I was put on a very mild, very cheap anti-depressant and the irritable bowel symptoms disappeared. I felt I had wasted a workday, five hundered dollars out of pocket and insurance resources as well. Then I had an elbow inflamation that persisted and made my bike riding painful even after my GP presecribed anti-inflammatory and I allowed two months for natural healing. I went in for an MRI, big bucks out of pocket,, then to a orthopedist, who prescribed a stronger anti-inflammatory that cleared it up in a couple of weeks. I think I'm a smarter health care consumer now after wasting a lot of my own money. Still, when my son fell on the monkey bars and seemed to have some weakness on the left side of his body that his pediatrician suggested it best we check out -- I wasted antoher $1K out of pocket for an emergency room visit that told me "nothing is wrong." The lesson I learned -- for things outside the expertise of your family practitioner, see the specialist and don't take the tets until after the specialist has explained to you all the options. If you think an MRI, colonoscopy or 20 x-rays is excessive, say so.
AWK, sorry to hear that, and believe me I feel your pain. My wife in our short marriage has been in the hospital an average of 3.3 times per year (excluding the child births), and I can tell you I don't question the doctors at all on how many times they run a test. I'm usually the one calming my wife down when they are trying to run a test for the second and third time in a day. All that being said if there was better communication some of the redundancy of tests and procedures would be eliminated. Unfortunately to have that communication you have to have a doctor step up and take charge of your other doctors and most won't do that. My wife's current main doctor (an internist) has basically taken over ownership of my wife's health and directs all of her other doctors right down to the OB/GYN. Unfortunately it took her years to find a doctor who did this and was willing to do it.
