Are you as tired as me of hearing all the doom and gloom about our health care system? To say medicine is in a state of flux is an understatement. Well, believe it or not there are some good changes which will benefit all of us.
The key is improved technology, specifically electronic health records, which has opened up a toolbox, only dreamed of by physicians in the past. Electronic health records allow me to instantly obtain a list of needed age-appropriate vaccines, diagnostic or lab test for each individual patient recommended by the United States Preventive Services Task Force. I give my patients a list of these recommended services at each office visit. The USPSTF (U.S. Preventive Services Taskforce.) is an independent, non-governmental panel of experts in prevention and primary care. They conduct rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services. These recommendations are considered by most physicians to be the standard of care in the United States as well as many other countries. Insurance companies usually adapt their recommendations as well.
With paper charts it might take 20 minutes to review a chart and come up with a list of preventive services needed such as mammograms, DEXA scans, colonoscopies, diabetic blood work and many other labs and procedures that have been proven to improve the quality of care for patients. Using new software this information is printed out showing when the patient had the recommended procedure or blood work and a list of recommended preventive services not yet completed. The patient’s medications as well as their active diagnoses are printed out allowing the patient to make corrections.
Another major factor in improving healthcare is the way primary care physicians will be paid for their services. In the past physicians have been paid for office visits and procedures they perform. Payment has not been linked to the quality of care they provide. There has been a major shift towards “Pay for Performance.” This means physicians will be paid for actually keeping their patients healthy. An example of how it is measured would be how well a diabetic’s blood sugar is controlled along with how well their blood pressure is controlled. Studies have shown if you control the blood pressure of 15 diabetic patients for 10 years you will save one life. For every 6 patients whose blood pressure is controlled, one patient will avoid a serious diabetes related complication such as blindness, heart attack, stroke, amputation or kidney failure.
Since I have about 276 diabetes patients who also have hypertension, if I controlled them all, I could save 18 lives and prevent 46 serious complications of diabetes over 10 years! I have personally had dozens of patients who after weight loss and exercise have been able to stop their medication and eliminate the diagnosis of diabetes altogether!
“Pay for Performance” is an interesting phenomena because it is a “triple win” where all parties involved benefit from instituting this method of payment. The patients win because they have improved their health, the physicians win because they get paid for providing high quality medical care and the insurance companies win because they meet their goals, which affect their ratings and ultimately reduces the cost of medical care.
So how does this all tie into exercise? I have spent most of my years as a physician trying to convince my patients to exercise. It is really a very hard sell but occasionally it does occur. Recently, I had a patient come in saying with much excitement that she had just finished her first 5K race. She told me last year I had suggested she start exercising and lose weight because her blood work showed she was becoming diabetic. She started running, lost 30 lbs., said she had much more energy and had never felt better! Her lab results had returned to normal. The smile on her face was the best gift I could ever get!
Now that doctors get paid for keeping people healthy I actually will get paid for convincing patients to start exercising. Exercise treats almost every disease there is. That is why medical schools are teaching young doctors to give a prescription of exercise as opposed to medication. See http://www.exerciseismedicine.org/.
After all of my years as a physician, I have concluded the single most important thing I can possibly do for my patients is to convince them to exercise. It is the magic pill we are all looking for, it is just hard to swallow.
The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician. This information is based on research by the author and represents his interpretation of the literature.
