Reasons why US health care sucks, part 118

[MannyGoldstein]

A close relative of mine has been in the care of one of central Massachusetts' teaching hospitals since Christmas day. She'll be out in a few days, much better now.

It has been a mess. The biggest part of the mess has been information. The info they got in the Emergency Department apparently can't be read by other parts of the hospital once a person's admitted. Some pretty important things weren't communicated and havoc ensued. We were told the the docs thought they'd need to operate, but for three days we couldn't find out *why* - we couldn't get a coherent diagnosis because the docs knew the diagnosis, but they weren't talking to us directly, and it wasn't in the records that nurse and other staff could access.

Insane.

I happen to be in the medical biz. A few months ago, I was at a conference where I met a couple of fellows who were key in instigating and building up the VA's electronic health records system, named VistA. I know some docs who work at both the VA and the local "civilian" hospitals as they're all part of Harvard, and they much prefer VistA to the EHRs at their other gigs. With VistA, everyone has all the information they need and it's easy to get to. You know, a typical big-gummint fuck up, right?

So I asked the VA guys, "What gives? I hear that VistA is free and open source, and way better than the commercial stuff out there. So why don't hospitals adopt it?"

Turns out that the VistA system is so good because the VA is (dreaded!) socialized medicine. People are paid on salary, not by how many procedures they do and how much insurers pay. VistA doesn't care about billing for procedures - it just does what makes sense medically.

In the civilian world, everything is based on charges for procedures, which makes for funny records. Different insurers may need different diagnoses to pay for the same procedures, sometimes docs can make more money by billing the same procedure in different ways to different insurers, etc. The records are organized around this billing-centric mess. A complete clusterfuck. Complete. A giant game of insurers and docs trying to get richer by outsmarting each other. And VistA doesn't play that game, it just does good healthcare. Suckers!

And that, I realized tonight, is why information flow at the hospital is teh suxxor: it's designed for billing, not for health care.

Thank God we don't have commie medicine like the VA!

[Harmony Blue]

1. Yes billing takes priority over healthcare in the U.S.

when my father was still alive the first thing they would do is scan his arm band, and all the pills he was taking, clothes, blankets (they had bar codes) before he even met with a doctor or a registered nurse when he was staying a night over at the hospital. Then they would ask if he had insurance, and then they would ask what was wrong with him before sending in a doctor that would poke his/her head in for a bit and have the nurse charge that too.

[Systematic Chaos]

2. I'm planning on submitting the mother of all posts here about my 2013 re: health "care"

That which somehow did not kill me has made me much stronger and more outspoken. You will not fucking believe a couple of decisions which were made regarding my care. A so-called doctor ignored the extremely urgent advice of an expert on my condition and sent me to a rehab center to pretty much die. Oh, and you can bet your ass that lovely "tort reform" in the state of Nevada rears its ugly head as well.

I just need to get my semi-numb hands to agree to type the whole thing out....

[mahina]

11. In case you have a smart phone, the l ittle mic on your keyboard works..

You just have to fix the typos rather than type all.
.very sorry to he
sr of your experiences. Good luck.

[Ron Green]

3. Coordinated Care Organizations (CCO's) are Oregon's

tentative move toward the "medical home" model that will fix the problems you describe. It's still not as good as a socialized system like the VA, but my advocacy group http://mvhca.org is watching this transformation in our state, even as we push for single-payer.

[MannyGoldstein]

6. I love the concept

Badly needed!

I hope the IT tools can support the vision.

[Control-Z]

4. First time I've

rec'd one of your posts. I agree with every word.

[babylonsister]

5. Tricare worked for me for many years.

Your point, though I think you are one of those guys who beat around the bush?

[nadinbrzezinski]

7. Among many other reasons

Profit over care

[moondust]

8. As a (commie) VA patient,

I haven't followed the ACA stuff too closely because it doesn't affect me. It would seem, though, that the billing mess remains more or less unchanged since it is still a dance with private insurance companies doing things their own way.

As someone who at one time worked in the huge medical records department of a university teaching hospital, I don't understand why the admitting unit would not have access to ER records. That makes no sense at all.

[MannyGoldstein]

9. As someone with an IQ of more than 70 (most days)

It makes no sense to me either.

Was it too darned difficult to put it in the computer? Do they have systems that don't interoperate?

Nuts! Nuts!

[DeSwiss]

10. K&R

- The ubiquity of ''American Exceptionalism'' was bound to happen......