New Orleans   Recently I had my annual physical. I’ve used the same doctor for a dozen years. She chatted and asked me about other family members that I’ve sent her way. She asked me a series of basic, rote questions, checked my pulse, pulled out the stethoscope to take a listen, and then sent me on back for blood and urine samples. All of these were simple procedures that frankly could have been done anywhere and with basic training by a whole range of people, and certainly by nurses or nurses’ aides. The clinic was part of the giant nonprofit Ochsner in Louisiana. They no longer have an x-ray machine there or the capacity for EKG’s so that’s another trip to a larger location, if I’m willing to take it. A doctor or other health professional could as easily review the tests and pronounce me “good to go” or “come back in.” I’m not whining, but once I step back and think about the process my own experience starts to outline part of the problem of the “volume” provision model for healthcare versus the “value” model touted for the future. It also brings to mind the crisis in rural health care facilities that cannot sustain the volume and are challenged to provide the value. Are there some other fixes for this problem?

One might entail a significant expansion of telemedicine. Extensive US-based pilots have established at the least that using telemedicine can link specialists in larger hospitals and cities with patients in rural areas. With equipment and training there are widely reported cases establishing success in matching health needs in other countries, like Latin America, with doctors and specialists in the USA. The Georgia-based Global Partnership for Telehealth touts on its website not only an extensive telemedicine network in that state but a project begun in Africa in 2014 that they claim is the first on the continent. Telemedicine embraces the full range of technical tools from smartphones to computers, and in some developed country experiments, even robots.

In the current clinic-hospital model in the USA where costs continue to be out of control and access continues to be frustratingly difficult, breaking the bricks-and-sticks model of healthcare and embracing access, tools, and outreach could be revolutionary. A telemedicine primer offer this insight:

Globally, the tipping point will be the care model realignment under healthcare reform, where payment is value-driven, not volume-driven. Care providers (hospitals, physicians, and ancillary caregivers — all part of the overall care team) are paid for results, and whether the venue is the office or a virtual visit at home will no longer matter. Quality is measured and payments made for meeting targets. Finally, there are incentives for preventive care — for keeping citizens healthy so there is a decrease in the number of physician’s office visits and hospital admissions.

“The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring and other such enabling technologies.”
(Federal Register, Vol. 76, No. 67, p. 19531, 4/7/11)

They are talking about the call and promise of the Affordable Care Act as the herald to reform and a different model of healthcare. The more you think about it, the more you wonder “Why not?” and “When?” I also start to wonder if the real opposition to Obamacare in the United States by some is their persistent toadying to all of the vested interests of industrial medicine and healthcare delivery systems that have been the standard for decades and need to have voices to protect their old models rather than embracing the change people deserve for universal quality care? The more we deal with the intransigence of hospitals providing even their required financial assistance plans, the clearer we have become about their unified resistance to change.

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Please enjoy a new arrangement of Natalie Merchant’s Carnival.