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twirlgrrlI know I post a lot about health insurance reform lately. Everyone has a vested interest in the topic, but for me it's extra fun that there's a public debate about it, because of my background.
I've worked in health care for 25 years--well, actually, since I was 11, but there were breaks between age 11 and age 17. During that time I've been involved in many aspects of the health care system.
I've taken minutes in peer review meetings, in which doctors discuss potential mistakes made in individual cases. In the mid-80's I was involved with the creation of an early IPA, which is a group of physicians (like Brown & Toland in the Bay Area) banding together to improve their negotiating power against HMOs. I've been the director of Health Information Management at a large multi-facility enterprise; among other things, HIMS is the department that does all the coding of medical diagnoses for reimbursement by insurance companies, Medicare etc., so I had intimate knowledge of how hospitals make their money and how Medicare, HMOs and other insurance companies work. In fact, when I was earning my degree in health information management, the DRG system of Medicare reimbursement had just gone into effect, so I was right in the center of the hospital system's adjustment to the way Medicare reimbursement works now. Also, HMOs were catching fire in the west as a new, rapidly expanding "cost-containment" tool then, so I watched hospitals and physicians adjust (more like contort) their patient care practices around this new way of doing Business with a capital B. I worked in a hospital department that was once called Utilization Review, which was like an internal insurance company compensation board--nurses and social workers who evaluated patients' coverage and the hospital's risk of losing money, and worked to get patients out of the hospital before their coverage ran out. In my personal conversations with the physicians I work with, I've heard a lot about how health insurance companies impact physician practices and individual doctors' finances. And in the meetings I now moderate, I hear plenty about how cancer patient care is affected by what kind of coverage patients have or don't have. And in addition to the several hospitals I currently contract with, I work in a facility that's completely owned, run and financed by the government, which is part of a giant government-run health care system. Socialized medicine for a certain group of patients, you might say.
On the personal side, my dad, uncle, and three cousins are/were physicians. My husband and I have health issues and we are active consumers of health care and health insurance resources. I've been insured by jobs, student health plans, and until very recently was paying nearly $1700 a month for a health insurance plan as a self-employed person. I've never been uninsured, and thank God, because I definitely do not qualify for any health insurance plan on the planet unless an employer is mandated to insure me.
So when I put all that together, I guess it makes sense that I would have a particular interest, not just in the topic of health care in general, but specifically in the topic of how health care is paid for in this country. And when I look at the breadth of my experience in the industry, I guess I feel like my opinions might have some weight. That is probably why I've been harping on this subject more than other "political" topics that I also care very much about.
I've worked in health care for 25 years--well, actually, since I was 11, but there were breaks between age 11 and age 17. During that time I've been involved in many aspects of the health care system.
I've taken minutes in peer review meetings, in which doctors discuss potential mistakes made in individual cases. In the mid-80's I was involved with the creation of an early IPA, which is a group of physicians (like Brown & Toland in the Bay Area) banding together to improve their negotiating power against HMOs. I've been the director of Health Information Management at a large multi-facility enterprise; among other things, HIMS is the department that does all the coding of medical diagnoses for reimbursement by insurance companies, Medicare etc., so I had intimate knowledge of how hospitals make their money and how Medicare, HMOs and other insurance companies work. In fact, when I was earning my degree in health information management, the DRG system of Medicare reimbursement had just gone into effect, so I was right in the center of the hospital system's adjustment to the way Medicare reimbursement works now. Also, HMOs were catching fire in the west as a new, rapidly expanding "cost-containment" tool then, so I watched hospitals and physicians adjust (more like contort) their patient care practices around this new way of doing Business with a capital B. I worked in a hospital department that was once called Utilization Review, which was like an internal insurance company compensation board--nurses and social workers who evaluated patients' coverage and the hospital's risk of losing money, and worked to get patients out of the hospital before their coverage ran out. In my personal conversations with the physicians I work with, I've heard a lot about how health insurance companies impact physician practices and individual doctors' finances. And in the meetings I now moderate, I hear plenty about how cancer patient care is affected by what kind of coverage patients have or don't have. And in addition to the several hospitals I currently contract with, I work in a facility that's completely owned, run and financed by the government, which is part of a giant government-run health care system. Socialized medicine for a certain group of patients, you might say.
On the personal side, my dad, uncle, and three cousins are/were physicians. My husband and I have health issues and we are active consumers of health care and health insurance resources. I've been insured by jobs, student health plans, and until very recently was paying nearly $1700 a month for a health insurance plan as a self-employed person. I've never been uninsured, and thank God, because I definitely do not qualify for any health insurance plan on the planet unless an employer is mandated to insure me.
So when I put all that together, I guess it makes sense that I would have a particular interest, not just in the topic of health care in general, but specifically in the topic of how health care is paid for in this country. And when I look at the breadth of my experience in the industry, I guess I feel like my opinions might have some weight. That is probably why I've been harping on this subject more than other "political" topics that I also care very much about.
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Date: 2009-08-26 05:38 pm (UTC)no subject
Date: 2009-08-26 05:45 pm (UTC)no subject
Date: 2009-08-26 08:35 pm (UTC):P
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Date: 2009-08-26 08:40 pm (UTC)no subject
Date: 2009-08-26 09:11 pm (UTC)the thing that gets me in what i see is that SO SO much of what is done (and paid for by someone somehow) is just craziness - ruling everything out to prevent a law suit, treating things because that's just *what you do* and not looking at the big picture. not to mention stuff that's completely pointless and redundant! which just reminded me of something, remember when banjo had all those GI problems and we were in and out of the ER? at one point they wanted to do a rectal exam and guiac even though they were intending to do another more exact (and expensive) test that would have ruled out/in the same illness (all of the potential diagnoses are blurry right now). and when i asked them if there was actually any reason to do it, since they were still going to do this other test, the doctor admitted that really there was no fucking point other than that *that's just what you do*. of course a rectal exam and guiac isn't a big money pit, but it's just an example of how procedures are done without any weight being given to their consequences/costs.
back to stuff-i-see-at-work rather than as banjo's mom.... when i hear the real deal with all this "death panel" stuff i'm like BRING IT ON AND CRANK IT UP. these are discussions that should be happening! people need to think about and talk about what they would/will want! maybe they should make people think and talk about this stuff on a yearly basis. i don't know. i just know that i spend a lot of time looking at people and wondering how they could live in those conditions rather than have palliative care... and then wondering if anyone really truly ever found out what they wanted. and, while i'm babbling, did you see the daily show interview with... betsey whoever? i saw the TV version, which i guess is unedited but just cut off when they ran out of time. the way stewart was reading it it gives people MORE of a chance to say that they DO want life sustaining treatments. but people just read it as pro-DNR etc even though it is pro-DISCUSSION.
sigh.
ok that was a whole lotta babbling.
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Date: 2009-08-26 09:15 pm (UTC)to clarify, she didn't really SAY that, but basically acknowledged that i was right and (i think) thought i was the bomb diggity for thinking logically about this stuff instead of just having her traumatize a small child for no reason. when i saw her once, out and about, she gave me her digits/email and asked about having a playdate!!!!! she has a kid banjo and blue's age. i never remember where i put that piece of paper though. i sometimes wonder how weird it would be to write to her now and be all "hey remember me, wanna hang at the park?"
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Date: 2009-08-26 09:22 pm (UTC)Hanging out with docterz is kewl!
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Date: 2009-08-26 09:22 pm (UTC)All I'm going to say on that right now, so that I don't spoil my Big Pending Post, is that Medicare regulations have required SINCE 1990 that every patient who is admitted to the hospital is asked whether or not they have an advance directive/living will. The "death panel" idea is a hilarious (but sick) joke to me now that I know it is all about advance directives. If people think that the government encouraging physicians to have end-of-life discussions with their patients is NEW, they are HIGH. End of story.
You have a much better window into the unnecessary-procedures/standard of care/risk management/evidence-based care stuff than I do, although I neglected to put in my summary above that I do deal with treatment protocols and guidelines quite a lot from a clinical perspective, not a reimbursement perspective. And I used to work with Risk Management in the hospital a lot, plus I was on a medical ethics committee concerning fetal surgery, which was fascinating. Hmmm, should I edit my post for the sake of posterity?
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Date: 2009-08-26 09:26 pm (UTC)i look forward to your pending post!