What do we need in Health reform?

Just read this article in the NY times by Pauline Chen M.D. Also I just recently completed my in-patient rotation in the hospital where I was very disheartened by the fact that almost every patient I saw had been in the hospital recently and was very likely to get readmitted in the next 6 months.

Our burden of chronic disease is huge and growing. In a lot of cases the patients' lifestyles contributed to the chronic disease. We are spending huge chunks of health care dollars to treat these patients and keep looking at ways to cut this spending to decrease health care costs - the totally useless "length of stay" parameter comes to mind.

What we need to do is invest in the future so we can change lifestyles before they lead to chronic diseases. Also, we need to provide early treatments of chronic conditions like hypertension before we get into renal failure, heart failure and strokes. This will let us have a healthier productive tax-paying population that will help balance the budget.

The article points out how frequent contact between physician and patients may help in changing lifestyles and improve compliance with medications. With the advent of social networking tools we don't need to physically bring the patient into the office for this purpose. We can repurpose/create secure social networking tools for this.

The barriers:

1. Physicians are inundated with work... a lot of it due to bureaucracy - filling out forms, documenting for purpose of billing, multiple pharmacy call backs due to multiple/illogical formularies
2. There is no model for reimbursement for physician-patient contact outside of the office. And the payment is for the complexity of the office visit. Thus if you call and talk to the patient 15 times in a year and get him to take his meds, exercise and lose weight, you would be paid zilch! But if you see him twice a year, give him more medications as his diabetes and blood pressure go up and he gains weight, and then see him in the hospital when he get a heart attack you gets tons of money.
3. Due to point # 2 the health care system is too top heavy with more specialists than generalists. Hospitals have invested huge amounts of money into high tech and not much into prevention.
   

If we want physicians to work with patients to prevent onset of chronic disease or complications of chronic disease, we need to change our financial model for reimbursement. We need to pay health center to prevent outcomes. We need a secure networking tool that can allow patient - physician communication, motivational "interviewing", and a way to pay for this.