I went to see a doctor about my hurting hip, but I came away with a hard lesson in the dehumanizing conveyor belt that is medicine today.
My doctor spent more time staring at a screen than talking to me. It was a struggle to get him to listen, converse, or even look me in the eye. He was in and out within six minutes. I timed it.
If this can happen to a healthcare CEO who is a registered nurse, imagine what it’s like for senior citizens who aren’t so familiar with the medical business. As one study found, patients are allowed to speak for a median of just 11 seconds before they’re interrupted. Instead we place them on an assembly line of hyper-segmented specialists, with each concentrating on only their part.
Though their intentions are good, specialists rarely have time to uncover the root cause. Providers say they want to know their clients on a deeper level, but the system isn’t built for those kinds of relationships. It becomes too much about transactions and not enough about human beings.
For seniors, this can be dangerous and destructive, a recipe for repeat visits. Consider it the unintended consequence of a system built around billing, rather than improving their lives. And it needs to change. Now.
Take the 80-year-old woman who arrives at an emergency room with a broken hip. An ER doctor assesses her injuries. She’s then transferred to a surgical group to repair the damage. Finally, she’s moved to the care of a hospitalist who oversees her recovery.
Within a week in just one facility, she’ll be cared for by three different medical practices with three different treatment plans. And her journey is far from over.
Next comes her release to a transitional care unit. She may arrive with some paperwork and discharge plans. But no one really knows who she is. So the entire process begins all over again with a new assessment, new payment methods, and the building of a new electronic medical record because everyone has their own data.
She’ll stay for 17-19 days. Not because that’s what her rehab requires. But because that’s how the reimbursement model works.
She may then qualify for home health care, or assisted living, or a nursing home. Each step launches a whole new assessment, treatment plan, and payment model. Seldom does anyone examine what started all this in the first place – or how it can be prevented from happening again. We need to look at the complete health picture.
Does the woman with the broken hip need safety bars in her bathroom, or non-slippery rugs, or a handrail by a stair? Does she have transportation for follow-up appointments? Is she cognitive enough post-surgery to ask the right questions as she is recovering?
Too often the medical experts don’t even know. Their lens remains in siloed viewpoints, satisfied with the narrowly focused piece of the experience.
Think of it as the inherent byproduct of fee-for-service. When you’re rewarded for simply doing stuff, you naturally do more stuff.
After two or three rides on the roller coaster, she goes from proudly independent to institutionalized. Her life narrows. Her hope dissipates. Despite medicine’s best intentions, the roller coaster is built for sadness. And it doesn’t have to be this way.
Change in medical care is as simple as changing the reward. If we’re reimbursed for keeping people healthy, medicine will go where the money is. A host of Medicare test programs already show that it works.
My company, Lifespark, is involved in one such program. Over the past four years, our emergency room visits are down 42 percent. Hospital admissions: down 43 percent. Admissions to skilled nursing facilities: down almost 50 percent. Despite their limitations, these test programs have already racked up billions in savings.
Value-based care or better yet, global risk, has a way of disintegrating the silos. If providers want to get paid, they must collaborate. That means instead of treating a singular issue, we must reach out to the rest of the ecosystem, coordinating treatment and driving together toward a meaningful outcome.
New federal rules mandate the sharing of data. No longer can each silo guard its own, preventing one practice from informing another.
Best of all, it forces us to listen to people. We already know that seniors are more than just a broken hip or a fractured arm. Their health is built from myriad social determinants. Are they isolated? Living in a food desert or a neighborhood with poor air quality? Has poverty led to a life of skimping on health care? If we’re paid to keep them healthy, we must know everything that’s keeping them from it.
The system isn’t perfect. More immersive care means more complex coding. Some providers exploit this to simply generate larger bills, while doing nothing to change their care. Old ways die hard.
But it’s impelling us to tear down those silos, to listen to a person’s wishes and goals, to build a system accordingly. After all, that 80-year-old woman’s wellness is no longer after thought. It’s the entire point of the game.
Photo: Kiwis, Getty Images