“A lot of what is done doesn’t necessarily help the patient a lot. We hear a lot about defensive medicine, that [physicians] feel they need a lot of tests to rule out possibilities,” says Richard Rohr, MD, MMM, FACP, FHM, hospitalist program director at Guthrie Healthcare System in Sayre, PA. “The fact is that the best defense is a good offense. A well-trained internist should be able to examine a patient, form a differential diagnosis, and confirm the diagnosis with two or three carefully selected tests.”
Controlling costs with health reform
Just as inpatient costs can hit the patient’s wallet hard; the government might also take the brunt of the financial hit.
Although Medicare’s DRG system does place some limits on what the hospital can charge, there is really no limit on what the physician charges can be for a given case, according to Rohr.
“You can call as many consults as you want—get as many physicians on the case as you want—and Medicare really has no choice but [to] pay the bill,” Rohr says.
“Everyone who touches the patient feels the compulsion to order some additional testing, look at something else. This drives up costs significantly.”
As healthcare reform is implemented, one of the major elements to be considered is controlling costs.
“You need a health system where the skill of the physician—to think about a patient’s problem and analyze it—becomes valued; that’s really the key to health reform and what we’ve been missing for the last 50 years,” says Rohr.