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What Patients NEED to Know about Managed Care! Part I

I wish to refer to this phenomenon with a more appropriate term: MANAGED COST. Note, I prefer to call it managed cost because the concept is not care based but cost based. The care term is used to give the concept credibility and as a clever marketing twist to confuse and cajole the public.

The big question is why managed care came to be the, so called, trend in healthcare?

A need to reform the healthcare system is obvious to everyone. Although the US system has developed into the best in the world as far as treatment advances, quantity and quality of life enhancement, costs have been rising at a rate that will, if left unchecked, crash the system. The politicians solution---Managed Cost! In my opinion, there must be a better way!

The next question that comes to mind is why have these costs skyrocketed! A number of reasons can be sighted for these larger than inflation increases. For the purposes of the next few paragraphs I will be talking about dentistry and medicine in general. In reality, the story for dentistry is quite different. In the marketplace, or when politicians are speaking, these two very different economic animals, dental care and medical care, are mistakenly lumped together.

The malpractice boom for the legal profession is only one of the reasons for increased costs. The public is superficially aware of all of the ramifications of the legal assault on their medical system. Obvious increases in costs are caused by the awards for misjudgments or downright mistakes made by medical professionals. No one has an argument with patients being compensated for improper care by health professionals. Some argument could be made against the amounts awarded, but, in general, it is agreed when a patient is injured they should be compensated. Yes, doctors do make mistakes and they must purchase insurance to provide for restitution for those mistakes. The problematic attitude seems to be that the medical profession can solve all problems and should. If results from treatment are less than satisfactory then let's sue. The public views medicine as being an exact science. The point is lost that when dealing with biological systems results can vary widely doing the same procedure with the same skill. The outcomes of these attitudes are a massive proliferation of very marginal and questionable lawsuits. The public doesn't realize the vast expense of these types of suits. The cost increase is massive because the doctor must spend time being away from his practice conferring with lawyers, court appearances, trying to prevent suits with mountains of paperwork, informed consent issues, taking continuing education courses just dealing with lawsuit prevention, and lastly doing procedures and ordering tests just to cover himself in case he is sued. These costs are a significant part of the increase in medical care costs.

Increased government regulations have made a huge increase in costs of care. Many of these regulations, while well intended, are unnecessary and even impossible for the average health care provider to comply with. These regulations seem to feed on a paranoia that exists that no one can be trusted, and everyone must be double checked. Things have progressed to such a point even those doing the checking must be further checked by someone else. In reality, the responsible care givers are constantly trying to do what is correct for their patients and employees and those that would abuse the system will continue to do so with or without many of the regulations. I will mention a typical example occurring in my home state of Ohio.

X-ray regulation is a hot topic in Ohio. Two significant changes have occurred in the last few years. The first regulation deals with monitoring X-ray equipment. This monitoring includes, testing equipment to ensure the equipment is working properly and checking that proper safeguards are in place for its use. The regulations require that a state X-ray inspector come to each office, test radiation levels, equipment accuracy etc. and make sure that employees have a written manual that outlines proper technique. These ideas sound well and good but some of the results are silly and add quite a bit of cost to running a dental office. First of all to fund this massive task of checking all offices, we are now required to pay the state something like $300 per year for permits for our X-ray equipment. I really have little argument with this fee and the equipment checking that goes with it. It's probably a good idea even though you can usually tell if your equipment is not functioning properly by the quality of films you are seeing. The office manual is very time consuming and no one reads it even though I spent many hours preparing the documents and submitting it to the state bureaucrats for approval. (I did spend staff meeting time going over the documents page by page.)

One of the additonal requirements was particularly disturbing. We take a special kind of X-ray for orthodontic patients called a Ceph (for short). This x-ray has a special film holder that aims the radiation at the film and holds the patient's head. The X-ray machine is the exact same one that we use for all other X-rays with the timing and the exposure the same. Because it is considered by the state as a medical x-ray we are required to have any employee taking x-rays this way wear a film badge. That adds $300 per year per employee (I have 4 that would take these pictures so my extra cost is $1200 per year.) These badges always come back with no exposure recorded. As long as we are not changing procedures why do we have to keep paying for these badges! This is a blatant example of regulation that is totally useless and expensive.

The second new law was just enacted. This law requires all assistants that take X-rays to be licensed by the state. They must take a course on X-ray procedures. The costs for the license is $25 per person, renewable for $25 every other year. So in my case $100. For this fee what is accomplished? Zero! The next part of the law requires all assistants to take a course on x-rays techniques. While I do believe that a course when beginning your career as a dental assistant would be a good idea, requiring already practicing dental assistants to take this course and retake this course at regular intervals is basically a waste of time and money. Do the lawmakers really think I am going to allow my assistants to take bad x-rays! The idea is absurd. I can't do my job with bad x-rays. If they aren't performing properly I will of course train them myself out of frustration etc. The doctor is already well motivated to make sure the staff takes good quality x-rays. By the way the cost for this course is $95 per assistant and requires a day of their time. Cost to me about $400/ year. The really sad part of this regulation is that in my office we are switching to digital x-rays which involve totally different exposure principles with no chemical developing involved since the exposure is developed by a computer laser. What they will be taught and tested on really has very little bearing on how we take x-rays in my office. On my own without government mandates I am upgrading my x-ray system to one that will eliminate 90% of the current radiation my patients receive. My ability to make this transition (come up with the money) is actually hampered by the extra cost of the above regulations . The money would be astronomically more efficiently spent on letting dentists purchase these new machines instead of regulating with next to worthless rules.

We will continue this discussion next month!

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