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Should employers be allowed to opt out of offering treatments they object to?
Posted: 04 June 2013 04:37 AM   [ Ignore ]   [ # 46 ]
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FinallyDecided - 03 June 2013 08:52 PM

I think it is wrong and there should be NO exemptions. Lets say there is a “god,” wouldn’t he judge the person who actually decided on “sinful” medical therapies and not the unknowing company? However, there is another side to this: we decide where we work; if I was a female and wanted to make my own reproductive and birth control decisions, I wouldn’t go seek work for a Catholic company, knowing they hold a strong stance against my rights and reproduction.

Also, if med insurance is part of your benefits package, isn’t it “yours” kind of like your pay check? If employers can tell you how to spend your insurance money, what would stop them from telling a someone how to spend their paycheck? When you think about it, your paycheck is yours to do as you wish, whether that be donate large portions to a charity of choice, gamble it all away or whatever. Basically, if you’re offering med insurance, it’s part and parcel to the employees pay/package and thus no business of the employer how it is spent, just because they are contributing to it, the employee earned that benefits package and it is in the hands of the employee (just like a paycheck).

Finally, you point out both sides of the issue. I think the argument that an employee can choose where to work and the implication that they can simply go somewhere else if they don’t like specifics of the benefits available is flawed. Especially now, but even in a good economy, employees can not easily switch from one job to another. They are often financially shackled to the limited number of jobs that are available given their specific skill set. If they live in a big city they may have some options but in smaller cities or little towns there may be few options or none at all. If we applied this reasoning across all potential employment issues we could make an argument that racial discrimination, sexual harassment, and violation of minimum wage requirements would all be OK because the employee has the option to work somewhere else if they don’t like the conditions.

An additional consideration is the complexity of health insurance. Every policy is different in its provisions and these policies are very complex. I deal with this every day and still I am often stymied when i try to help a patient determine if a treatment is covered or not. These are patient who already have coverage and a specific need for treatment. An employee who is evaluating a job offer would have few if any resources available to them if they wanted to investigate the coverage they are being offered. Even if you could somehow get comprehensive information on the coverages for the plans each potential employer was offering imagine how much more complex this would become if employers were allowed to customize coverages. Do you take the job where they won’t cover blood transfusions but do cover fertility treatments, or do you go with the plan that covers both but won’t cover surgery if it is done on a Sunday? It could quickly become difficult for an intelligent well informed person to gather and assess the information even if they had several options. For the average person this analysis would be impossible so that the employee would simply be stuck with whatever plan and restrictions the employer decided to impose.

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Posted: 04 June 2013 05:23 AM   [ Ignore ]   [ # 47 ]
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macgyver - 04 June 2013 04:37 AM
FinallyDecided - 03 June 2013 08:52 PM

I think it is wrong and there should be NO exemptions. Lets say there is a “god,” wouldn’t he judge the person who actually decided on “sinful” medical therapies and not the unknowing company? However, there is another side to this: we decide where we work; if I was a female and wanted to make my own reproductive and birth control decisions, I wouldn’t go seek work for a Catholic company, knowing they hold a strong stance against my rights and reproduction.

Also, if med insurance is part of your benefits package, isn’t it “yours” kind of like your pay check? If employers can tell you how to spend your insurance money, what would stop them from telling a someone how to spend their paycheck? When you think about it, your paycheck is yours to do as you wish, whether that be donate large portions to a charity of choice, gamble it all away or whatever. Basically, if you’re offering med insurance, it’s part and parcel to the employees pay/package and thus no business of the employer how it is spent, just because they are contributing to it, the employee earned that benefits package and it is in the hands of the employee (just like a paycheck).

Finally, you point out both sides of the issue. I think the argument that an employee can choose where to work and the implication that they can simply go somewhere else if they don’t like specifics of the benefits available is flawed. Especially now, but even in a good economy, employees can not easily switch from one job to another. They are often financially shackled to the limited number of jobs that are available given their specific skill set. If they live in a big city they may have some options but in smaller cities or little towns there may be few options or none at all. If we applied this reasoning across all potential employment issues we could make an argument that racial discrimination, sexual harassment, and violation of minimum wage requirements would all be OK because the employee has the option to work somewhere else if they don’t like the conditions.

An additional consideration is the complexity of health insurance. Every policy is different in its provisions and these policies are very complex. I deal with this every day and still I am often stymied when i try to help a patient determine if a treatment is covered or not. These are patient who already have coverage and a specific need for treatment. An employee who is evaluating a job offer would have few if any resources available to them if they wanted to investigate the coverage they are being offered. Even if you could somehow get comprehensive information on the coverages for the plans each potential employer was offering imagine how much more complex this would become if employers were allowed to customize coverages. Do you take the job where they won’t cover blood transfusions but do cover fertility treatments, or do you go with the plan that covers both but won’t cover surgery if it is done on a Sunday? It could quickly become difficult for an intelligent well informed person to gather and assess the information even if they had several options. For the average person this analysis would be impossible so that the employee would simply be stuck with whatever plan and restrictions the employer decided to impose.

Unrelated, but I’ll ask anyway: what do you think of ICD-10 mandate and EHRs. Are they worth it in your opinion? Or, would do you prefer the traditional chart?

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Posted: 04 June 2013 05:41 AM   [ Ignore ]   [ # 48 ]
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There should be one Universal Healthcare Program. The basic one.  There can be other private programs for people who wish to pay more.
The Universal Healthcare Program can be private too. But it should be Federally Regulated.
Every single person should be eligible for this program through their employer. A nominal percentage of gross wages could be charged from the employee.
Say 3-5%. The employer should pay into the system as well.
If a person is unemployed, or unable to work, they get the same UHP for free.
This UHP should be the result of a huge overhaul of the current menagerie of systems.
The system should be set in stone. No omissions, substitutions, clauses, special circumstances etc…
All available Licensed healthcare services should be in the plan.
This leaves debate over what can be licensed and what can’t be licensed to the regulators. Of course this would require a huge overhaul in itself.
The only deciding factor in regulating who gets a license should be efficacy. Not religion, morals, sexuality, race, cost, politics, etc.
Doctors should determine if some levels of CAM are allowed based on their ability to substitute treatment at a more cost effective basis.
Obviously this is getting into the chronic hypochondriac issues. And this in itself should be diagnosed and treated-to save costs.
But for example, aside from hypochondria, lets say someone has a legitimate pain issue from their back. As is the case with backs, there often times isn’t any treatment for the pain or cure. If it can be found that the patient doesn’t want drugs, or the patient prefers massage and responds to massage, and the massage is cheaper than drugs then massage should be licensed and available.
I’ve said it before but a large part of this is that doctors have to step up and recognize hypochondria. Or they have to recognize when doing nothing
is more effective than useless treatments. And there should be standards, and these should be followed in these cases.
Let the hypochondriac turn to unlicensed CAM and they can pay for it out of their own pocket.

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Posted: 04 June 2013 09:04 AM   [ Ignore ]   [ # 49 ]
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I was attending a lecture about separation of church and state and the subject came up about whether employers should be forced to offer health insurance that includes coverage for things the employer is against on religious grounds.  It occurred to me at that moment that everyone in the US must pay extra taxes because churches are exempt, which means that I, as atheist, am forced to support religions I object to on religious grounds. My objection is that since I am forced to pay for something I object to on religious grounds, why should it be different for employers who object to paying for insurance on religious grounds? I’d make a deal with them.  Lets have a system where churches give up their religious tax exemptions and, in return, health insurance coverage for employees whose employers don’t want to provide it on religious grounds can come out of the taxes we all pay. Everyone would save a substantial bundle on that deal and nobody would have to compromise his religious sensibilities.

Lois

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Posted: 04 June 2013 10:14 AM   [ Ignore ]   [ # 50 ]
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FinallyDecided - 04 June 2013 05:23 AM

Unrelated, but I’ll ask anyway: what do you think of ICD-10 mandate and EHRs. Are they worth it in your opinion? Or, would do you prefer the traditional chart?

I don’t want to go off track here but i doubt enough people are interested in this answer to justify a separate post.

As far as ICD -10, I understand the rationale but i personally believe it places an undue burden on primary care physicians such as myself. ICD-10 requires physicians to add another level of specificity to their diagnosis codes presumably for research purposes but for generalists like internists and pediatricians who need to use a wide variety of diagnosis codes the change to ICD-10 means we may have to now increase by a factor of ten the number of codes we are familiar with. Thats a lot to ask of the class of physicians that are already over worked and underpaid compared to the rest. My personal take on this is that I am going to do my best to ignore ICD-10 partly in protest and partly because I dont have the resources to do much else.

EHR’s are a mixed blessing. The story the public is getting in the media is as usual completely inaccurate. I am speaking as someone who is highly computer literate and has already implemented an EMR in my own office for the past 2 1/2 years. The proposed advantages of EMR’s were supposed to be, better access to records for physicians and patients, improved safety for patients, reduced costs of health care ( through decreased duplication of services), improved care, and greater efficiency for physicians. I can say with good authority after the first few years of this experiment in my office that none of these goals have been met and while EMR’s have definitely improved some aspects of medical practice in some areas EMR’s have had the opposite effect. specifically:

1) Better access to records - The idea was that all EMR’s could communicate so that doctors could easily access records you had compiled through visits with other doctors. In reality none of our systems communicate with those of other offices. This is partly due to privacy concerns but it also has to due with the structure of medical practices. For example, in the community where i practice hundreds of doctors are employed by the local major hospital. Within that system every doctor has access to every other doctors records. Those of us in private practice do not have that type of connectivity though. The system i purchased is the exact same one the hospital uses with its doctors and despite the fact that I am an attending physician at the hospital my system cant share info with theirs. On the plus side I do now have access to a patients records if they are in the ER and the ER doc needs some information from me after hours.

When it comes to patient access to records the situation is not much better. The original idea was to have patient portals where patients could look at all their results and records. I did not agree with this approach in its original form so I am not all together disappointed that it hasn’t materialized but while some systems do have patient portals many do not or they require the doctor to pay an additional fee to implement this feature. EMR’s are so expensive that few physicians are likely to chose that option if there is an added cost.

2) Improved safety - Our EMR has some features which actually do improve safety. Prescriptions are now cross referenced to the patients allergy history at the time that they are ordered in the system and a warning will come up. Unfortunately as an example of poor implementation, the system flags so many irrelevant or unimportant issues that physicians automatically ignore the warnings after a while because 99% of them are inconsequential and it wastes time having to read through them.

Another safety issue that come up with a lot of physicians has to dot with the accuracy of the record. As an experienced physician I now how to draft my note so that the important items are in there and the unimportant stuff is left out. Its the difference between reading a 10 page long history and physcical written by a first year med student who examined a patient with a cold and reading a 5 line note by a doc with 20 years experience during a similar visit. The med student note may be more detailed but it may miss important points and the pertinent items are buried in pages of useless fluff.  Current EMR’s are like a first year med student. Notes produced in an EMR are generic, long, and not as informative as they could be because the most important facts are buried among pages of useless info. In addition EMR’s tend to slow physicians down so most of us start looking for shortcuts to try and recoup some of the lost time. These shortcuts come in the form of templates for the exam and history. Instead of checking off a hundred boxes for a normal physical you can check a box that says “all normal” and all the boxes get checked for you. The problem is that you may be checking boxes for things you didn’t actually do not because you are trying to cheat anyone but simply because you may forget what’s in the standard physical for that particular template. The first 2 months that I had an EMR every patient I saw had a rectal exam.. or at least thats what the EMR said because I didnt realize the person who made up the templates thought a rectal was part of a brief exam until i noticed the error.

3) Reduces costs of healthcare - Briefly, untl the correct the interoperability issue and allow all systems to communicate this will never happen.

4) Improved care- this was supposed to happen by allowing systems to incorporate standards of care so that when a doctor is treating a diabetic for example the system would remind us that the patient was overdue for a foot or eye exam if it hadn’t been done in the prescribed period of time or if a woman over 50 had not had her mammogram in the past year etc. While some systems have this feature many do not so there is a lot of inconsistencies in implementation of the stated goals

5) Greater efficiency - This should have happened but has not primarily because the people designing these systems are computer engineers and not doctors. They dont understand our work flow or our needs and since they don’t they have no idea how to design a system that would allow us to work more efficiently. I am very active with our computer vendor in suggesting things that need to be improved but the responses have been luke warm because they are more interested in satisfying the governments demands and those of the insurance industry than they are in making the system work for the actual health care providers.

The biggest flaw in the entire plan is that despite their heavy involvement, the government never demanded that all EMR vendors use a common database. It take weeks or months to evaluate a system and while the cost of purchasing the system is high the cost of implementation and data entry is a huge investment. By the time we determine a particular system is not the best fit we have invested so much in data entry that we cant afford to switch. If there was a common data base someone could throw a switch and we could change to a new system with minimal costs. This would have forced vendors to create better systems because there would have been real competition. The way it is set up now, once they have us we are prisoners to the system we have chosen and they have no incentive to innovate very quickly.

Essentially, EMR’s were a great idea that have been very poorly implemented.

[ Edited: 04 June 2013 10:55 AM by macgyver ]
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