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F.A.C.P., F.A.C.C.
Health Care Plan
Medical Provider Value Score
By Richard R. Schneider, MD
Value = Outcome score X severity of illness score
Average cost per patient
$ 2.2 Trillion per year total
300 million Americans equals > $7000
per person
Recent estimate by Price Waterhouse
more than One Trillion Dollars wasted
every year
31% Overhead
Massive over utilization of resources
What We Get for Our Money
54% correct diagnosis and treatment (Rand
corporation, New England Journal of Medicine)
Huge numbers of medical errors
47 million uninsured at any given time
75 million uninsured during any given year
Solving the Problem
Republicans want a “market based
Democrats want Universal affordable
Everyone wants more for their money
Creating a “Medical Marketplace”
The market for medical care today simply does not exist. One must be
Markets require knowing what you’re getting and how much it costs.
To know what you’re getting: Must Measure severity of illness adjusted
To know what your paying: Must measure resource expenditure to achieve
those outcomes.
Grade “A” providers: Excellent outcomes/low cost per patient.
Grade “B” providers: Good outcomes/average cost per patient
Grade “C” providers: Poor outcomes/high cost per patient
Must maintain “fee for service” payment schedule for doctors. Pay “A”
providers 10% higher reimbursements. Pay “C” providers 10% lower
“Report cards” must be made public so patients can chose the best doctors.
(Similar to recent recommendations by The Institute of Medicine.)
Doctors must have easy and rapid appeals process to correct mistakes in
their “report cards”
Accurate Quality Measurement
Accurate outcome measures can be obtained by simply using the
same statistical tools that have been used for decades to perform
clinical trials of medications and procedures. These analytic
techniques are scalable to large numbers of physicians using
powerful modern computer technologies.
Only outcome measures are meaningful; “process” measures are
meaningless because they do not correlate with better patient
Outcome measures are only scientifically and mathematically
accurate if they take into account initial severity of illness.
Quality and cost measurements must use uniform criteria and
adequate sample sizes and be performed by an unbiased
organization. Hospitals and insurance companies or HMO’s are not
unbiased. Only the Federal Government can be trusted.
Physician Associations and Congress need to work together to
devise methodology and quality criteria.
Which is more important, to measure the performance statistics for
thousands of professional athletes or hundreds of thousands of
professional physicians?
Medicare for All
“We hold these truths to be self evident…the
right to life, …”
When these words were written doctors could do little to prolong life.
In the 21st Century, if one doesn’t have access to healthcare, one
doesn’t have the right to life.
Denying healthcare to anyone is simply Un-American. This is a self
evident truth and is not debatable. Period.
Recent opinion polls indicate a majority of the public and of
physicians are in favor of more government involvement in
Universal Coverage
Expand “fee for service” Medicare to cover all
Medicare to measure severity of illness adjusted
outcomes and resource utilization for all
Resource utilization includes: cost of
medications, testing costs, cost of
hospitalizations, surgeries and other procedures,
Outcomes measurement includes severity of
illness adjusted mortality, morbidity, and
measurements of clinical improvement.
Benefits to Whistleblowers
Government will track quality of care for all doctors.
Whistleblowers will not be needed to report poor quality
care. Good doctors should not have to be courageous to
protect their patients.
The excellent quality of care provided by many
whistleblower physicians will be documented and
available to be used in their defense.
High quality low cost doctors will generate more revenue
for their practices or institutions and will therefore gain in
power and influence over low quality high cost doctors.
Economic Savings
Reduce overhead from 31% to 16% saving >
$300 billion/ year.
Reduce resource utilization by 15% saving >
$300 billion/year.
Massive reduction in episodes of malpractice
with associated dramatic reduction in
malpractice premiums.
Redirect part of economic savings into Medicare
funding to pay for universal coverage and
increased reimbursements for doctors.
Benefits for Doctors and Hospitals
All physician services are fee for service.
47 Million new “paying customers”. No need to provide
“free care”. No bad debt to write off.
Patients free to chose any doctor including specialists
without “gate keepers”.
Doctors will regain professional autonomy. The interests
of doctors and patients will be realigned.
Treatments and tests not subject to excessive scrutiny
and denials.
Greater financial and job security for doctors in addition
to higher incomes.
Benefits to Business
Decreased labor costs due to absence of
expenditures for health insurance.
Employment decisions will be based on ability to
do the job not on age or health status.
Healthier more mobile work force will improve
overall productivity.
Overall increase in profits.
Overall increase in economic prosperity will
increase demand for all goods and services.
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