Healthcare Reform


As a business owner and a patient, this is my mission.

By Gina McWilliams

 

With a puzzled expression on her face, the lab tech raised her eyebrows at me and asked, “Why are you here, again? We did this lab work yesterday.”

It was my third visit to the lab in as many days. I was still reeling from my recent breast cancer diagnosis, and though the blood draws were now familiar, I was unsure of what to tell her. All I knew was that I had just taken off more time from work and from life, to make yet another co-pay to another doctor for the same set of lab work that I knew would be known in the industry as medically unnecessary.

Over the past several weeks I had been in and out of “well-intentioned silos” with several providers in the city. If the experience taught me anything, it’s that “patient centric and production centric” are two distinctly different concepts.

From the patient point of view, it did nothing to bolster confidence in the system I’ve made a career out of trying to understand and impact. Already at one of the most vulnerable times of my life, I received the opposite of the patient-centric, value-based experience I deserved. Instead my experience was a case study of the inertia that characterizes our fee-for-service healthcare system.

Since RealTime Medicare Data opened its doors in 2002, I’ve been working to change that. And on July 12th, when I received my diagnosis, this mission became personal.

So? Now what?

That frustrating patient experience has only further fueled my commitment to create a healthcare system that prizes, above all else, value.

In its simplest definition, value in healthcare equals patient outcome achieved divided by resources expended. As consumers of healthcare, it’s what we all should expect. When you think about it, that’s all Medicare is doing. They too, are asking for better value.

Medicare is shifting the conversation about value in healthcare. Watch closely, and you will see other payers begin to follow. This is not some ominous harbinger of things to come, and it’s not impeding on our freedom. It’s really a lot simpler than that, and it boils down to what any of us want when we require care for ourselves or loved ones—the most positive patient outcome possible.

As a patient, you have choices and you want accurate information. If you feel uncomfortable with your choice, change. Request reports. Request explanations. Do not be intimidated by the “technical or clinical information.” You know more than you think and you deserve a provider that will help you understand it.

Understanding takes time, of course, and time conflicts with the production that defines the culture of many provider practices. However, the concept fits hand in glove with value. Your health and time are valuable, and so are your dollars. Those providers who truly are working toward a patient-centered culture will encourage your questions and work with you to seek the best solution.

While it’s heartening that RTMD has been a part of this paradigm shift, our work serving providers is far from complete. Just as providers are working towards best practices across a wide range of diagnoses, patients are becoming savvier; they want dependable, accurate, and timely information to help them choose where, and from whom, to seek care.

Imagine a repository where we, as healthcare consumers, can quickly look up provider data by procedure. Let’s say I am in need of a joint replacement. Within a few clicks, I could arm myself with powerful decision-making data such as how long I should expect to stay in the hospital, who in my area performs joint replacement surgery, and how the provider compares to other providers.

Having access to this kind of data would level the healthcare playing field. When physicians are incentivized to deliver the best outcome, and patients bring a spirit of compliance and commitment to their care, that’s a win-win for all.

Gina McWilliams is the president and CEO of Real Time Medicare Data, located in Birmingham.

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