Suggestions to Lower Costs in our Healthcare Delivery System

We have all been reading in the news the latest efforts proposed by our lawmakers to curtail out-of-control healthcare costs. As a busy primary-care physician, I can suggest several areas by which we can save tremendously. Those savings can be realized by not only controlling spending but by using our healthcare delivery model more efficiently and effectively. Certainly I respect our elected lawmakers, but no one is better suited to control the costs than the professionals directly involved in providing services to our patients.

Primary-care physicians need to have more incentives available to them to properly counsel and advise our patients. Currently there are billable codes for counseling patients regarding smoking cessation and alcohol abuse. Certainly this can be effective if used properly. However, there are many other areas that primary-care physicians can be very effective. How about providing billable services for lifestyle-modification counseling? We need to be able to spend more time counseling our patients to prevent them from making improper food choices, getting more exercise, and avoiding sedentary activities. How better to prevent heart disease and the costly procedures such as catheterizations than to provide the advice that patients need in order to change their lifestyles and make better food choices to avoid those costly procedures in the future?

Prescription medication costs are certainly spiraling out of control. Of course I realize that research trials are needed as well as the research and development to engineer these drugs, but why should the cost of a proton pump inhibitor exceed three and four dollars per dose? Stop the direct-to-consumer advertising that enables the patient to "ask their doctor if drug A is right for them." Bring the costs of prescribing medications down so that we are not forced to only use generic medications that are not as effective as the brand name competitors.

We need to be able to capture revenue from the harmful substances that propel costs out of control in the first place. We all know that smoking is unhealthy. Why not place a three- or four-dollar tax on every pack of cigarettes and funnel this tax directly to healthcare in order to treat the diseases that cigarettes cause in the first place? Not only will revenues for healthcare increase, but the behavior of smoking will be negatively reinforced and the disease rates will plummet. Place a tax on fast foods that increase rates of hypertension and heart disease and funnel those funds directly to healthcare. Again, the behavior will be negatively reinforced and disease rates will then fall as a direct result. Earlier this week, one of my patients justified their unhealthy fast food choice as being the only available affordable choice compared to leaner meats and vegetables.

Patients need to be encouraged to utilize the lower cost of seeing their PCP in the office rather than go to the more expensive urgent care clinic or the ER for convenience. Increasing the reimbursements for primary-care services will encourage more graduating medical students to enter primary-care residencies. A higher percentage of PCPs will be able to more effectively counsel their patients and prevent disease rather than using costly procedures and drugs to treat what could have been avoided in the first place.

Medical malpractice costs need to be lowered and the threat of frivolous lawsuits need to be discouraged so that physicians are not forced to practice defensive medicine. Many of the very costly imaging procedures are not needed when a detailed history and physical examination can provide the same level of information. Wasn't it Osler who once said, "...if after performing a history and physical examination you have not arrived at the correct diagnosis, perform another history and physical examination."

We have the greatest healthcare system in the world. The United States has long been recognized as the leader in medical care. However, our costs are higher than any other developed society even though our outcomes are no better than those of countries that spend far less than we do. Provide the incentives for physicians to be able to counsel and advise our patients and reimburse those services appropriately and the rates of disease and the level of spending will certainly decline. In terms of treating disease, it is far more cost effective to fix it before it becomes broken.

Find out more about J. Scott Litton, Jr., M.D. and our other Practice Notes bloggers.