Skip to main content

Technology and Health Care

One of my tennis friends asked me about new innovative smart phone technology and why it hasn't been embraced in health care.  She had just watched a video about Dr. Eric Topol, Chief Academic Officer at Scripps Health in San Diego, and his demonstrations of how a smart phone could monitor blood sugar, take EKGs and cardiac ultrasounds and really deliver health care to the patient at home. 

My friend's question; "If this technology is here, why isn't it being used?"

According to Dr. Topol, new apps for the smart phones could eliminate 80% of echocardiograms that are done in facilities at costs between $300-$1500 each.  Having patients come into the office when they experience symptoms or for diabetics to get their blood sugar regulated could be eliminated.  New technology could be data driven and personalized and save millions of wasted dollars in health care.  So why is medicine so far behind the innovation curve?

The answer:  No-one pays for it. 

Why aren't all physicians using email to communicate with patients and save them an office visit?  The  politically correct answer is "remote medicine is not as good as seeing the patient in person and making sure the diagnosis is correct".  The real answer is:   No-one pays for it.

United States health care has complicated payment systems for work done.  The payor for health care services is either Medicare/Medicaid (CMS)  or hundreds of different (for-profit) insurance companies.  CMS sets the payment rules that everyone follows.  Medicare and all insurers will only pay for face to face visits.  Reimbursement is for doing more and the more you do the more you get.

The doctor that tries to save a patient time and travel by covering a number of problems in one office visit will not be rewarded and, in fact, will be reimbursed less.  If you do a skin biopsy on the same day you do a visit for arthritis flare, CMS and insurance companies will not pay for both things.   Do them on separate face to face visit days and...voila...a better reimbursement for your time and skill.

Email, remote monitoring, remote echocardiograms, discussing tests via a smart phone are freebies.  No patient visit means no reimbursement.  The cost of putting in high technology is borne by the physician too.

Most physicians and hospitals and surgery centers and labs and pharmacies are happy with this status quo.  There is great fear of change and so we continue to spend more on health care than any Nation in the world.  We do wasteful mass screenings and 1/3 of all prescriptions are a waste.  People who need care are not getting it and others are getting too much that they don't need.

ObamaCare is trying to make some gradual changes by supporting pilot programs to change the way healthcare is delivered.  But it is slow going and innovative answers are out there.  If we could just figure out how to pay for services, while using new cost-saving technology we would all be following Dr. Topol's future dream.


Ellen S. said…
Excellent post - everyone should read this. Explains a lot about the things in our healthcare system that are broken, and the reason costs are so high. Thank you Toni!
Mo said…
I think you are the Wikileaks of medicine.... great article.

Popular posts from this blog

scintillating scotoma

Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate is flashing, sparkles.  Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century  by a Dr. Hubert Airy who had migraine headaches.  The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain.   The scotoma affects both eyes and closing one or the other does not make it go away.  Sometimes the term "ocular migraine" or "retinal migraine"  are used to describe this phenomenon but these involve only one eye, not both.  The terms are often …

Do Doctors Make Too Much Money?

An article in theNew York Times says the reason health care costs are so high in the United States is because doctors are paid too much. I saw that and my eyes bugged out. I just came home from a meeting with physicians and hospital administrators and the entire meeting was spent discussing the financial challenges physicians face in keeping their doors open to see patients. The goal of this meeting was to keep health services in that community so patients will have someone to care for them. Not a person in the room would agree that the doctors earn too much.

Physicians paid too much? Lets break that down. A doctor spends a minimum of 11 years in education and training after the age of 18. Many are in training for 15 or more years. They are living on student loans and contributing zero to their family's income until the residency years. At that time they earn less than minimum wage if you factor in the 80-100 hour workweek. When a doctor emerges from training (and believe me…

Why Are Doctor Bills So High?

Who hasn't wondered why doctors need to charge so darn much for an office visit? If you have insurance and bother to look at what the insurance company pays, it is always much lower than the charge. Why does medical care cost so much? Is the doctor gouging? One of the best explanations I have seen is stolen from another blog. I would like to give credit but all I know is the name Dr. Adam. He shows this letter to his patients:

Why are doctors' bills so high?

Over the past few years several patients have asked this question. It is a very good question that needs to be answered in the context of our current health care system.
When I was growing up and went to my family doctor, my parents or I paid around $10 for a typical minor problem visit (in 1966). With inflation, that would be around $62 today (in 2006 dollars) ( Today Medicare reimburses me approximately $33 to $45 for a similar patient visit. When I was a teenager the overhead costs of…