Not only in the Dark Ages. But way more expensive than it need be. Can you imagine what a car would cost if regulated this way?
Much of the problem stems from Medicare. That massive program runs by billing codes. Billing codes control the way various services are packaged and priced; currently, Medicare has a list of about 7,500 physician-related tasks they can get paid for doing. As John C. Goodman of the National Center for Policy Analysis points out, private insurance tends to pay the way Medicare pays. So do most employers.
But think of the two most common—and most critical—tools in our technology-driven world: communicating by telephone or email. One of these is a very old technology and the other one not new. Yet Medicare won’t pay for physicians to consult with patients using either of these devices—at least, not in any meaningful way. State laws and regulations also make it difficult to for physicians to offer medical advice by email—especially if the patient lives across state lines. Doctors are typically licensed to practice in only one state, and so might not be able to offer medical advice in another.
Imagine for a moment that producers of all manufactured products were barred by federal regulation from using telephone or email. How much do you think products would cost if their production were subject to such rules? How much would any product cost if its production and delivery had to stay in the dark ages?
There are many other examples. Let’s say you need to refill your prescription. Medicare will only pay the doctor if you come to his office and make it an “office visit.” It doesn’t matter that you probably don’t need an office visit and this is just wasting everyone’s time.
While these may be mere inconveniences for most of us, for others they represent dangerous gaps in their quality of healthcare. Disabled patients might not be mobile, and are often in need of even more frequent contact with doctors—though they don’t necessarily need an office visit. What if they could have actual conversations by phone, or get quick answers by email, or even have face-to-face consultations via Skype? These tools would benefit patients living in rural areas with limited access to medical care the same way.
It’s not just phone and email and prescriptions. Medicare won’t pay for your doctor’s assistance in getting a low price for a CT scan or for negotiating on your behalf for specialist services or for any other cost-saving he or she devises. It won’t pay a doctor to teach a diabetic how to monitor his own glucose level and in other ways manage his own diabetes. The same goes for all chronic illnesses—even though that’s where most of the money goes and even though studies show that well-trained patients can manage much of their own care, with lower costs and higher quality outcomes.
Once a medical office has a system is in place, it is very difficult to change it—even if it reduces medical costs. At a time when doctors feel that they are being squeezed on their fees by insurance companies, most become very focused on which activities are billable and which are not—and most are going to try to minimize their non-billable time. They are certainly not going to do anything that takes money out of their own pockets.
Speaking of out-of-pocket expenses, you may be interested to know that Medicare (and therefore most insurance) doesn’t cover blood and urine tests unless prompted by an illness, so even if you can get your doctor to order them, you have to pay for them yourselves, and that may subject your doctor to all sorts of risks, even the risk of jail, which we will discuss in a future article. Yet these types of screening tests are vital; they are where the future of medicine lies.