The future of healthcareLearn More

To stem healthcare costs offer more time in the consulting room

It is evident that healthcare costs are outstripping inflation. The drivers are increasing utilisation of services and exponential cost of treatment.

As healthcare continues to take up a larger part of the overall economy, structural changes-such as the push toward paying for value, greater emphasis on care management and increased cost sharing with consumers-are taking a stronger hold, pulling back against rapid healthcare spending growth. Still, with medical cost trend hovering between 6 and 7 percent for several years, health spending continues to outpace the economy. Even the “new normal” is not sustainable. PWC

New or increased use of medical technology contributes 40–50% to annual cost increases, and controlling this technology is the most important factor in reducing them. The Hastings centre

What has been shown to reduce costs is General Practice.

Despite contentious debate over the new national health care reform law, there is an emerging consensus that strengthening primary care will improve health outcomes and restrain the growth of health care spending. HealthAffairs

There are several ways in which doctors in this sector can save the day:

  1. Reduce test ordering.
  2. Prescribe generic drugs where appropriate and avoiding prescribing drugs that have not been proven to be effective.
  3. Stop polypharmacy especially for older people.
  4. Help patients to determine what has marginal value and what is essential if not life saving.

These goals are easier to achieve when:

  1. Doctors have time with patients
  2. Doctors are able to communicate with patients
  3. Doctors clinics/ office are designed to engage patients.

Primary care is also being perceived as ripe for disruption by technological innovation. However not everyone agrees that technology is likely to help:

1. Telehealth.

Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending. Ashwood et al

Using a panel dataset from a large healthcare system in the United States, we find that e-visits trigger about 6% additional office visits, with mixed results on phone visits and patient health. These additional visits come at the sacrifice of new patients: physicians accept 15% fewer new patients each month following e-visit adoption. Bavafa et al

2. Wearable technologies.

35% will stop wearing their devices after six months. It is not known what proportion of people with smartwatches actually use the fitness tracking capabilities of these watches on an ongoing basis. There is little information about the demographics of people who purchase fitness trackers and smartwatches; however, given the cost, consumers are likely to be the “wealthy well”. People suffering from chronic disease on the other hand are more likely to come from the less educated and lower income population. And then there is the issue of what data these devices collect and what we can actually do with that data.  The Conversation

3. Genetic testing.

Cost is also a factor. Estimates of national spending on genetic and molecular testing vary, partly because there are so many different types of tests for different conditions. A 2012 analysis by UnitedHealth Group of national trends estimated the U.S. could see overall spending on genetic tests reach between $15 billion and $25 billion by 2021, up from $5 billion in 2010. Despite the uncertainties, Independence CEO Daniel J. Hilferty said the insurer felt it was important to try to help some members learn more about their disease. He declined to say how much the program would cost but said the expected number of patients would be small, perhaps in the hundreds. Medpage today

4. Electronic medical records.

Electronic health record (EHR) advocates argue that EHRs lead to reduced errors and reduced costs. Many reports suggest otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums. As interest in patient-centeredness, shared decision making, teaming, group visits, open access, and accountability grows, the EHR is better viewed as an insufficient yet necessary ingredient. Absent other fundamental interventions that alter medical practice, it is unlikely that the U.S. health care bill will decline as a result of the EHR alone. Health Affairs

On the other hand there are simple things that doctors can already do when consulting patients to reduce the cost of healthcare. Here are three which have been featured in leanmedicine as well as in the Wall Street Journal before:

a. Slow down

b. Active communication

c.  Minimise competing agendas

In short: ” If you want doctors to improve communication skills with patients, then pay them for their time to do it”

Image by Roswell Park

Comments

  1. Qurat ul ain shafqat says:

    Hello,
    I believe that g.p are paid very low
    As being a non-vr g.p i get 21$ for standard consultation.out of 21$ i got just 10$ and i am getting 10$ after studying hard for 30yrs and i am still studying and i am responsible for my every patient.if i do mistake pt have a right to su ne.

    Instead of that in every street asians and indians are opening parlours after 3month course.they just make 1 room parlour in there house and earn 20$ in 5min just with hair cut…
    Is it fair..
    Are drs paid as per there efforts?
    Govt should pay each dr atleast 100$ per consult…

  2. Post graduate education should be compulsory and not funded by pharmaceutical companies. Money should go to education rather than compulsory credentialing. The fields I know most about are musculoskeletal physical medicine (as distinct from rheumatology) and nutrition. Both are woefully inadequately taught at all levels of medicine. Dean Ornish has proven the cost savings and effectiveness of his diet/lifestyle/community approach for cardiovascular disease. I understand more trials of similar approaches are under way currently. The insurers in USA are likely to demand this type of approach. Money speaks. Our Australian system just encourages awful medicine!

  3. Have you read the paper by Schlesinger and Grob in Milbank Quarterly (2017)? It suggests similar things.

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