The Problems with the U.S. Healthcare System

July 7, 2017

An interview with the CEO of Kaiser Permanente's medical group in California puts the problem with our health system into perspective.

I came across an interesting article in the Los Angeles Times. Dr. Robert Pearl, executive director and CEO of Kaiser Permanente's medical group in California, and president and CEO of its mid-Atlantic group, did an interview with an LA Times reporter regarding his book, "Mistreated, Why We Think We're Getting Good Health Care - And Why We're Usually Wrong." His quote caught my eye:

"Let me take a classic American playground taunt and turn it around: The line is, if you're so smart, why aren't you rich? So if the United States is so rich, and so smart, why aren't we healthier?"

He really reflects a lot of my core values that have been cemented over years as a PA in a variety of settings and specialties. It has been extremely frustrating to me over my career to see some of the best, brightest, and most hardworking physicians, PAs, NPs and others, thwarted in the attempts to save lives and stamp out disease and disability.

It is equally frustrating to me as a healthcare provider, as it is to Dr. Pearl, that we spend 50 percent more than any other nation on earth on medical care, but our results and outcomes are in the lower half. How can this be? According to Dr. Pearl, it is because the U.S. healthcare system is simply broken, and our problems cannot be addressed without a drastic and dramatic shift in the way we deliver medicine in the U.S. Radical surgery is indicated, not Band-Aids.

I am an expert in our hospital facility's EHR. The EHR highlights one of the many problems with our healthcare system. It is clear to me that the EHR is one of the "Band-Aids" that we throw onto the system in hopes that it improves delivery of healthcare, and ultimately outcomes. It is failing miserably, in my estimation. It was clear to me early that the EHR was developed and adopted to gather data, and support our increasingly complex healthcare billing system; not to support providers in their delivery of care to their patients.

It is telling that no other nation relies so heavily on "fee-for-service," payment as does the U.S.  We have to spend our time painstakingly documenting care, correctly coding patient diagnoses, and procedures, if we want to get paid. It also provides a perverse incentive that focuses on maximizing practice revenue, instead of focusing on outcomes. I know that my view on this is not popular among organized medicine, but the proof is in the pudding. There is no way in which to truly reform the healthcare system in the U.S. until we reform the way in which healthcare is paid for.

The EHR has improved dramatically in the end user experience in my estimation over the last five years, focusing on improving the data (and its presentation) available to providers, and making documentation of patient care much easier. Where we have failed is the integration of data and data sharing, to facilitate continuity of care and avoiding duplication of effort. Pearl points out what we all know working with the EHR. The systems are not speaking to each other and not sharing patient data in a way that improves outcomes and patient safety. How in the world are we going to improve patient care, safety and outcomes, if we are not working towards fixing this monumental data deficit in our healthcare system?

It has been my personal experience that the EHR does improve documentation and safety, within the confines of my healthcare ecosystem, but I'm daily confronted with the barriers to access. I can't even look at patient records from other facilities that are a part of my hospital's organization. This is crazy. Practitioners spend an inordinate amount of time trying to gather data that should be seamlessly and readily available.

One of Pearl's other observations, related to the deadly structural flaws in the U.S. healthcare system, is that we have the leadership problem upside down. Leadership is dominated by politics, and business delivery, and physicians have been relegated to employees and cogs in the "machine."

I could not agree with him more, and I would include PAs and NPs in this equation. The healthcare providers at the point of the sword should be driving change and reform. Right now, we are all just pawns in the system, and we are having change foisted upon us by people who have good intentions, but not a clue as to what is wrong with the system.

We need to have an accurate diagnosis, before treatment is prescribed.