Sunday, January 27, 2008

The Law of Unintended Consequences


Health care is filled with the unintended consequences of laws, regulations and poor planning that plague our ability to care for patients. Here are a few, in no particular order. You may have more to add.
  • Lab laws. I used to be able to contract with labs to do tests on my patients. I negotiated a low fee, kept a few dollars for lab draw and my services and everyone won. Enter California Legislature. Now patients have to go to another lab for blood tests. Pap smears cost $55 rather than $7 and a blood panel that was $22 now costs $180. Unintended consequence: Primary care lost a revenue stream, patients get gouged on test costs. (By the way, this law was sponsored by the big laboratories.)
  • Employee break legislation. A wonderful new law says all employees (think nurses) must take a lunch break within 5 hours of starting a shift, even if she is taking care of a patient, in the OR, dieting, or just not hungry. To stagger breaks some nurses will be eating lunch at 9:30 AM. Yes, more nurses will be hired to cover breaks. Unintended consequence: Watch health care costs continue to soar.
  • Stark Laws. Primary care physicians are not allowed to invest in ambulatory care centers or surgi-centers. It's fine for surgeons, anesthesiologists, gastroenterologists and all others to be part of the out-patient trends for patient care and they are partnering with hospitals and other organizations across the U.S. Unintended consequence: More reasons for demise of Primary Care.
  • Discounts Illegal. Medicare and Health insurers have made it illegal for physicians to offer discounts for their share of the co-pay for covered services. I guess they think patients will utilize more service (?) if they don't pay their share. Unintended consequence: Patients pay more even if they need a break.
  • New Triplicate Laws. The State and Feds have made it so difficult to prescribe pain medication with special prescription pads and regulations regarding refills that physicians are hamstrung in prescribing the best medication. Unintended consequence: patients that need pain meds aren't getting them or are getting the wrong (no triplicate needed) med instead.

10 comments:

Anonymous said...

Don't get me started on the after effects of laws. The nation is spared when congress takes a recess. Most laws are passed for the benefit of special interest groups, not the public good. We live in interesting times, that is for sure.

Healthnut said...

Great blog! I just have to add that the health care crisis will only get worse, but the insurance companies will always make money. In the long run, many will be "mortgaging" their health. It's a real "eye opener", and one to take interest seriously.

There are some with preconditions who are already paying 5 digits for coverage. Yet each year, the insurance companies continue to gauge consumers by increasing on rates and cutting back on coverage.

At the same time, young people are being discouraged from entering the profession. By the time a young doctor finishes medical school from an Ivy, he or she will have accumulated half a million dollars or more in debt, not to mention that he or she must face the Medicare drama that is slowly "unfolding".

Toni Brayer MD said...

Healthnut: You covered a lot in 3 paragraphs. Medical bloggers are pointing out all of these issues. The Medicare insolvency will change everything so stay tuned...Thanks for reading and commenting.

ERP said...

Wow - what a nightmare about the lab tests! In NY they just got rid of triplicates because they were such a nightmare to use. Bout time Cali did the same thing.

Casual Observer said...

All I can say is get used to it.

The trend in the USA is towards *more* legislation, not less. The first fellow that posted a comment is 100% on-target. About the only protected profession left (some refer to it as the world's second oldest profession) is that of a politician. A politician doesn't run any risks whatsoever for authoring/passing unconstitutional/illegal legislation nor apparently for behavior that could qualify as treasonous these days. Even if you could remove the bum from office and jail him, there are a dozen like him ready to take his place.

The system is breaking down, folks. It happened for the ancient Egyptians, it happened for the Romans. Get ready.. we're next!

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