Beware False Prophets of HealthCare Value

Healthcare 'Value' is the 2019 Healthcare “Phrase of the Year”.?One hears the word ‘Value’ screamed from the highest peak by Politicians, Government administrators, Futurists, social media influencers, health insurance companies, medical centers and hospitals, pharmacies, drug stores, IBM, Siemens, Pharmaceutical Benefits managers, physician network administrators, Academe and human resources bureaucrats.?Physicians are getting used to clinically meaningless phrases thrown at them by industries and mandated by industry’s patron politicians and ‘Value’ is another in a long line of clinical scams.

Most healthcare Phrases market well, raise venture capital well, support the redistribution of healthcare resources to raise the EBITDA of new and old healthcare corporations very well and often, if not always, explode into meaningless ashes and dust at the patient’s bedside. Popular Phrases promulgated by industry never translate into meaningful clinical value at the bedside where the 4 clinical outcomes; preventive, medical, surgical and palliative are manufactured and produced by patients with their physicians. The quality of these 4 products manufactured by physicians can be easily assessed with dozens of contributing variables contained in all patient charts. Healthcare Value which is defined as clinical outcomes/costs is just another in a long line of healthcare phrases which us skeptical, burned out, wary and bleary-eyed physicians understand all too well, but must work-around day and night in order to keep our patients alive and well and avoid their fiscal and our moral bankruptcy.?

Beware when health insurance companies claim they’re practicing medical ‘value without ever revealing all clinical outcomes according to all contributing variables, costs to patients or reimbursements to physicians. Any idiot working for a health insurance company can lower reimbursement to physicians, capitate or bundle reimbursement or fire dozens of doctors and remove hospitals from health insurance provider panels or ration diagnostics and treatments to improve the denominator on the value fraction; outcomes/costs. Physicians in Boston get paid by private insurance companies twice what physicians in SE Florida receive.?Are Boston patients receiving worse value (outcomes/costs) because their physicians are reimbursed more??Are Florida patients paying less insurance premiums or out of pocket costs for healthcare because their physicians are paid less than Boston Doctors by insurance companies? Insurance companies lie about value by not revealing all clinical outcomes, costs and reimbursement. In fact a recent review of Government subsidized value based care programs involving ACO's, Alliances, oversight Networks and other 'Healthcare Designer Innovations' revealed few if any saved any money without even analyzing the effects of corporate oversight on most clinical outcomes. These Govt subsidies did pour hundreds of millions of dollars into value based care executives and network administrators pockets.

?Beware when EHR companies which claim they are improving the value of the practice of healthcare and making better physicians without demonstrating outcomes, doctor workflow or costs or clinical evidence. They’re lying. Beware when pharmaceutical companies and pharmaceutical benefits managers tell you they are manufacturing medical products of value without all supporting outcomes according to charted variables or cost benefits revealed about their drugs or devices. They’re lying. Beware when digital health and wearable companies claim their devices have healthcare value if they don't reveal all 4 clinical outcomes, costs and morbidity and mortality for all their users. Beware when hospitals and medical centers state that they are practicing value-based healthcare when they refuse to reveal all supporting preventive, medical, surgical or palliative outcomes according to all contributing variables or costs from the charts of all their treated patients and the institution.?They’re lying. Beware of false prophets, which come to you in value’s clothing, but inwardly they are ravening wolves.

We physicians have heard a cacophony of other phrases shouted which while well meaning, have demonstrated no significant benefits for doctors or patients and have not enabled access to quality affordable healthcare for most Americans.?For example:?

“Electronic Medical Records”: This phrase designates the forced software leasing from a decades old industry and associated purchased hardware which was supposed to transform healthcare into an evidence-based clinically efficient data and communication aggregate benefiting both patients and physicians.?EHR’s failed patients and physicians as soon as the EHR industry recognized that the sale of ‘proprietary’ patient data to ancillary industries (which physicians actually paid the EHR companies to input), was worth a lot more to the shareholders, bondholders, executives and their patron politicians than to their sharecropping physicians (workers) and patients (crops). In addition, due to forced leasing, the EHR companies have no fiscal incentive to deliver a product which improves physician practice workflow which would interfere with their data harvest and sale.

Interoperability: This phrase lasted about 5 years before vaporizing upon reentry.?Interoperability was supposed to improve communications and workflow among healthcare proletariat by standardizing and interconnecting disparate EHRs with custom API while at the same time aggregating outcomes and cost data to improve outcomes and costs and the practice of medicine for patients and their physicians.?This too failed, not due to the technology of interoperability which has existed for years, but because the healthcare industries (insurance, pharmaceuticals, pharmaceutical benefit managers, publishing, Medical Malpractice and EHR’s) realized that revelation of transparent aggregated interoperable patient population health data via software API and standardization while helpful to patients and their doctors, would be deleterious to industry's EBIDTA.

Health Information Technology:?This phrase which persists to date was supposed to bring improved outcomes and costs to patients and their families and their physicians but has failed. HealthIT remains the only IT of any industry with no value to consumers.

Digital Health:?A phrase describing an industry which produces Devices and wearables which failed to bring improved outcomes and costs and decreased morbidity and mortality their patients and their families.??Physicians and patients continue to hear the phrase digital health uttered daily.

MIPS: This time consuming and expensive government phrase forces physicians and their staff to re-enter redundant insignificant patient data into a computer and pay their EHR companies extra fees to submit this data to the government. This government phrase which hoped to improve outcomes and costs for patients has demonstrated to have no clinical value or significance for the patients or their physicians. The phrase however has enriched the EHR companies and bolstered yet another government bureaucracy.

“Ask Your Doctor if Our Drug is Right for You”:?After the phrase “Provider”, 'Ask your doctors' is perhaps the most despised phrase heard by physicians.?Direct to consumer advertising by pharmaceutical companies ask the viewer not to trust their doctor’s history, physical exam, discussion, assessment and plan, but instead to ask the doctor if their new drug is right for you.?This proven market manipulating phrase increases the sale of expensive non-generic name brand drugs by 15% without proven clinical benefits, while damaging the physician patient bond.

“Blockchain & FHIR”: These phrases represent a thought about ?decentralized Software mechanisms and code in order to aggregate, reveal and share patient data and physician communications from disparate mobile, fixed and cloud-based systems in order to improve practice efficiency of healthcare delivery and outcomes and costs.?These phrases about codes and pathways for population healthcare applications failed because if instituted the aggregation and revelation of patient data would destroy the insurance, pharmaceutical, medical malpractice, publishing, Hospital and EHR industries.

Accountability Care Organizations:?This phrase also Known in the Medicine world as ‘slow motion HMO’s’ was spoken to save healthcare dollars through more efficient and value-based care oversight incentivizing and or punishing physicians.?Of the $500,000,000,000 spent per year on patient by Medicare, ACO’s have purportedly saved taxpayers and patients $300,000,000 less than .01% while obscuring outcomes and redistributing huge fortunes of $10s of millions to?ACO clearing house executives, ACO Administrators and software companies and resulted in no lower costs or improved outcomes for patients.

Prior Authorization Rationing:? This phrase legally allows Insurance companies and Pharmaceutical Benefits managers to obtain prior authorization approval on most physicians’ prescriptions diagnostics and treatments. It was falsely believed by the industries paid patron politicians that by allowing the bureaucrats of insurance and pharmaceutical benefits industries to practice medicine without a license via prior authorization rationing of up to one million physician care recommendations a day that healthcare costs would lower and the quality of care would rise.?Prior authorization rationing of care by insurance and pharmaceutical companies has failed to lower healthcare costs, improve patient outcomes or enable access to quality affordable healthcare for most Americans and devastated physician workflow and morale.

Telemedicine: A 50 yo phrase in search of EBITDA and widespread value beyond the remotes of the world and use in pandemics.

?Maintenance of Certification:?30 years ago the phrase MOC was created when medical specialty boards decided to limit the Board Certification of physicians to 10 years in addition to continued earned license and medical education credits.?This added burden of limited board certification has served to enrich the salaries and pensions of the medical specialty board and surrogate testing industries while demonstrating no clinical value for patients and increased fiscal and time distress for physicians.?

?Patient Centered Care:?After spending 4 years in medical school, 8 years in post medical school residency and fellowship training and 25 years in clinical practice working way more than 40 hour weeks by focusing my energies on delivering the best possible outcomes at the lowest possible prices for my patients and their families, I must admit, I have no idea what people want me to do when they toss this phrase at me.

“Provider”: This phrase was first used in Nazi Germany to degrade Jewish physicians who could no longer be called 'Doctor' prior to removing their license to practice prior to killing them. Today, Physicians practice the art and science of medicine and package and deliver that in empathy. My degree’s all say Medical Doctor which certify that I have 19,000+ hours more training in Medicine than non-physicians, which may mean something to patients if not HC corporations. I have no certification or training as a provider. Grouping all people who deliver healthcare into the 'provider' barrel would be the same as labeling everyone who works for Exxon as a petroleum provider with failure to recognize professionally learned and time earned and applied skills.??Does the CFO of Exxon earn and provide the same responsibilities, education and risk as a geologist, a tanker driver or Ginzel???Shouting the phrase provider and grouping all healthcare workers into a single “title” has not provided any clinical value for patients or their physicians and has only served to degrade the physician-patient bond.

Medical Malpractice Reform:?Another phrase which has ended up in the Bartlett’s trash heap.?Med Mal reform was supposed to allow physicians to perform open transparent quality control as per all other professions without fear of lawsuits to improve quality and diminish errors.?The phrase is meaningless.??Physicians remain the only profession in the world prohibited from performing open transparent quality control instead, we simply sue Doctors scrubs off sealing medical records and creating a never ending cycle of errors and malpractice.

Empowered Patient:?A scalding hot phrase in the early 2000’s which resulted in no clinical value or improvement in outcomes/costs.?Much like the Queen of England Knighting Sir Paul or Sir Branson, empowering is a powerful visual with no broad recognized clinical benefits. Empowerment is simply Pablum for the masses which serves to diminish the physician patient bond without demonstrating any value.

Social Determinants of Health: Every first year medical student who has ever taken a history from a patient understands that social determinants of health are always well documented in a patients medical records or chart. Now health insurance companies and politicians are telling physicians that social determinants of health are important to patients. We know that poor people who can't afford insurance have worse access to quality affordable healthcare. We know that people with previously existing illnesses who can't afford medications or lifestyle and diet changes do worse than people who can afford or who have the ability to change their lifestyle. What the insurance companies and the politicians are not offering is relief for those with social causes of bad health. There's no access to quality affordable healthcare for all Americans regardless of social determinants like age, location, previously existing illnesses, sex or vocation. Social Determinants of health without affordable solutions, will remain a phrase used by politicians and industry without any healthcare value.

Claiming to practice Clinical Value=outcomes/costs without revealing patients’ clinical outcomes/costs or reimbursement to physicians and hospitals is just another in a long line of meaningless paraphrased scams promulgated by the healthcare industry and catalyzed by their patron politicians.?We physicians have been fooled in the past many times by false prophets and phrases of healthcare promising that if we responsively uttered them and practiced them as a congregation it would enable safe quality improved healthcare for all citizens.?We physicians have come to realize that false healthcare phrases for the masses have delivering nothing but increased costs, worsening outcomes, higher morbidity and mortality and misery for physicians and their patients.??We physicians have been fooled in the past by false prophets of healthcare who have never taken the Oath and demand prayer and adherence to their passing phrases. We doctors have seen it, lived it and have been burdened by false phrases and will not be fooled this time by ancillary industries screaming VALUE while at the same time rationing access to quality affordable healthcare for all Americans and interfering with the delivery of clinical value by their physicians.?