My Plan to President Obama

I was watching Larry King today and the show was about the healthcare reform being put together by President Obama. My response to the President is why reinvent the wheel.
I wrote a letter to the President offering a clear cut plan on how to deal with the disastrous US healthcare system today.

Dear Mr. President

I am a 67 year old retired healthcare executive with 35 years experience in managed healthcare.
The following is a short road map on how to reform healthcare in America. I think you will find it workable and agreeable to the American people.

1. The US government already has the HSA program in place.
2. Electronic health record keeping and the transfer of records electronically is already in place, although some standardization is required.
3. Software for paperless run clinics, hospitals and health institutions is already in place but requires standardization.
4. Healthcare manpower in the US is adequate, but requires government incentives to to redistribute the manpower to make accessible to all US citizens. Require the government to give incentives to Healthcare providers to increase efficiency and eliminate waste.
5.Equitable distribution of Healthcare requires the government guidance and incentives to redirect Healthcare providers to rural America and to provide the rural areas with improved access to major health centers.
The above are the essential ingredients for an efficient Healthcare Delivery System (HDS)

Healthcare Delivery System (HDS)for the US

When my father started his general practice in 1938, patients who did not have the cash paid in farm produce or farm animals. Bartering was an acceptable practice. Some doctors in the ‘olden days’ required their communities to pay them a lump sum per month for taking care of the constituents of the community (a capitation fee).

In our day and age if we keep the doctors well paid and the institutions in which they practice profitable, efficiency in Healthcare Delivery can be achieved.

REMEDIES, THE PLAN:

Require from doctors and hospitals:

1. Mandate the usage of only electronic claims, Paper Claims constitute close quarter of a trillion dollars in waste. Require medical schools to train doctors on standardization of paperless record keeping and the use of electronic bill paying systems.

2. Hospitals and Doctors should be required to use a universal standardized record keeping and billing systems.

If medical schools can teach standardized basic science courses, they should be able to teach standardized medical record keeping and bill paying systems

3. Require PCPs to purchase catastrophic health insurance for their clinic members/participants.


Required From Patients

1. A. Each HSA holder, whether individual or part of a couple or family, will be required to pay 50% of their maximum HSA contribution to the PCP’s office. The 50% contribution will entitle the patient to two free annual physical checkups, the AMA recommended vaccinations and all the AMA recommended lab work, X-rays, ultrasounds for a wellness checkup.

B. The PCP will be required to do all the referrals to specialists, admittances to hospitals, ordering procedures and providing all other reasonable healthcare needs when he deems necessary for his patient. The PCP will oversee the quality of care given to referred patients.

C. In case of major health problems requiring hospitalization the PCP’s office will pay up to $2,500 of incurred expenses before the government or private Catastrophic Illness Insurance kicks in.

Required From Insurance Companies and Third Party Payers (TPA’s)

1. Insurance companies will handle all Catastrophic Illness Insurance paid by the the PCP offices.

2. Insurance companies will continue selling indemnity insurance for interested buyers.

3. Insurance companies will be required to use standardized billing software for settlement of claims and will be forbidden to use paper claims. TPA’s likewise will be required to settle claims electronically.

Required from Employers

1. Employers with more than five employees or more will be required to contribute 50% of the maximum HSA of each employee.

Required from US government

1. The US government will pay the 50% of the maximum HSA for all non-insured and/or all non-employed eligible patients. Patients who get government assistance will be required to file for health benefits in the same way as unemployment benefits, which will be paid back as soon as they are employed or acquire assets. Illegal immigrants will be entitled to the same benefits as US citizens or permanent residents as long as they pay taxes and employment benefits.

Conclusion:

It is best to take the elements of healthcare that work and put them together with additional innovations to maximize efficiency rather than reinventing the wheel.

Sincrely

Allen Rafeh MD/PhD