A few weeks ago a patient came into my office referred for evaluation regarding surgery on her carotid artery. Although she had no symptoms, her primary physician had performed carotid ultrasound and found a severe narrowing on one side. She presented the results of this examination, and several additional diagnostic studies that had been performed recently. As it turned out, the doppler was inaccurate and she did not have any narrowing. As I explained this to the patient, I asked her if she understood that this test might not have been necessary. She replied, “He is a nice man, he deserves to make a living.”

Think about what is wrong with this picture and how things can be improved to save Medicare funds.

Unnecessary tests are being performed. This is widely known and understood. It is a way for physicians to generate income that is much easier than seeing additional patients. Patients don’t mind as long as they don’t feel the cost. Physicians do this testing at least partially because they are not paid enough to see patients. Some testing is a result of self-referral, such as the radiology report that says “consider performing the following examination for clarification.”

Physician’s time is not valued. In the case of this patient, I was able to help her avoid a possible surgical procedure and additional testing, saving the system thousands of dollars. In relationship to this visit, I fielded telephone calls from the patient, her children, and the referring physician. Payment for the visit does not compensate for this time. Doctors are unique among professionals in this respect; their time has no value and is regarded as free. Try this with your lawyer, accountant, or plumber.

Medicare beneficiaries don’t want any cuts. A recent study published in the New England Journal of Medicine indicated that most seniors are not willing to discuss any cuts in Medicare.

Everyone knows we are at a critical time. As we accept that resources are no longer infinite, all stakeholders need to accept that they will play a role in the survival of Medicare. Changes in behavior can be promoted by system modification. Some ideas:

Time for Medicine to leave the sidelines and reduce waste. Every medical specialty knows where the waste is in their field. Legislators should challenge medical associations to reduce costs without denying useful services.

Patients need to feel the cost of medical care. Before every test and procedure, patients should be informed of what the system will pay. The idea of annual coverage limits on ambulatory diagnostic services is not unthinkable.

Doctors should be paid for their time. The technology is available to allow physicians to be paid for actually talking to patients, in person or by telephone. Appropriate systems can control abuse; there are only a limited number of hours in the day.

Payment systems need to be implemented that prevent abuse and fraud. The credit card companies know how to do this, and it is long past due in healthcare. We have written about this previously.

It is time for the providers and consumers of healthcare to face the fact that they have allowed insurers and legislators to dictate changes in the healthcare system that do not improve healthcare or control costs. Soon it will be too late. Medical societies should step forward, doctors should present the facts to their patients, and legislators should encourage the achievement of these goals.

Steven Rudolph is a neurologist who blogs at Thoughts on Technology and Medicine.

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