President Letters - Dr. Riveland 2009

With all of the focus on health care and what is happening in Washington, most of us are preoccupied with dealing with the system as it exists today. I was reminded of this in recent contract discussions with a payor. I pointed out to the payor that reimbursement has not changed at all over the last 5 years. The payor’s response was the “market” does not allow them to Increase our reimbursement. They seemed to admit that they do not understand how primary care practices can manage. I would argue the trend is not sustainable.

The results are in. Thank you to the 96 of you who took the time to fill out the survey on health care reform. While not statistically valid it is helpful to get some idea of the thoughts and perspective of the membership. One of the challenges that any broad based organization has, is to adequately represent its membership. However, as the survey results indicate not all physicians are of the same opinion about most things, even something as central to our profession as health care reform.

The cost of health care in the US is a daily news item. It is the major focus of the Obama administration. Recently “providers” got together and promised to cut health care costs; however, missing in this extensive coverage is a step-by-step outline of just how are we going to do this?

Let me get this straight right from the beginning. I have no idea how to fix the problem. However, I do have opinions as to where, as a practicing internist, I see that health care dollars are wasted. This certainly is not an all inclusive list and each item could be an article in itself.

The patient’s medical record has changed dramatically over the last many years. There was a time that the medical record had a fairly simple function. It served as the guide to what the patient was experiencing, the diagnosis, and to document the treatment and plan for further care. In its ideal form, it clearly represented what was done and served as a communication tool to others involved in the patients care. This no longer seems to be its primary function.

I typically do not dwell in the past but allow me to recall one of my first consults as a young internist. A local family practice physician asked me to manage a patient in the ICU. The patient was admitted directly from the ER and he called me to see the patient that night. When I arrived I was surprised to see the family physician was there to assure his patient that he was involved. I later came to know this physician quite well in addition to the other family physicians in his group.