For Doctor Shawna Yates, recent advances in medicine have given her everything but what she really needs.
“For me, to do a really good job, I need more time,” she said last week.
Dr. Yates is a physician who cares for the elderly and is the chief medical officer for Butte-Silver Bow’s Community Health Center.
She attended a roundtable recently at Butte’s Belmont Senior Center. The event was sponsored by Sen. John Walsh, and it focused on senior issues, specifically those related to Medicare.
Yates describes her practice as being 99.99 percent seniors, but she notes that most doctors don’t want to see seniors. Seniors take more time, and they take more medications, and they take longer to get into the exam room, she said.
And under Medicare’s fee for service program, that affects the quality of care.
“For everything we’ve done in medicine, we’ve never given me more time,” she said.
Every morning, including Saturday and Sunday, Dr. Yates gets up at 5 a.m. to work on her charts. At the end of the day she works “on the minutiae of paperwork,” she said.
Her nurse spends five to six hours per week on the phone to get preauthorization from Medicare for the medicines that the practice’s patients require, even if some those meds are commonly prescribed and have “been available for 50 or 60 years,” the doctor noted.
Every year when Medicare brings out its new drug formulary Dr. Yates and her staff spend hours and hours getting drugs preauthorized that have been around years and years, she said.
“It eats up all of our hours that should be going to patient care, but don’t,” she told the senator.
The government’s approach to cost cutting doesn’t make much sense to Dr. Yates. As a physician, when Dr. Yates thinks about keeping costs down, she thinks about ordering fewer tests that duplicate tests that have already been run on the same patient.
Under Medicare’s fee for service reimbursement plan, the more patients she sees, the more money she brings into the clinic. If she has a patient who takes more time, she orders the tests on the spot, even though the same tests may have been run on the same patient at St. James Healthcare the previous month. Tracking down those tests just takes too much time, she says.
“I know that this goes on throughout this country a billion fold, so these costs just keep going up and up,” she told the roundtable.
Sen. Walsh asked why the duplication was necessary in the age of electronic medical records.
One of the roundtable participants noted that electronic records were not as accessible as the public might think.
“Records don’t talk to each other the way that we in the world think they do. It doesn’t work that way,” Shannon Holland said. Holland is vice president for patient care at St. James Healthcare.
Part of the problem comes down to Medicare requirements, the vice president said. Some of the extra documentation that Dr. Yates described is required by Medicare, Holland said.
One of the boxes that must be checked when a senior visits a healthcare provider asks about pneumonia vaccination, and that brings on another type of duplication, Dr. Yates said.
Medicare wants all seniors to be vaccinated so that pneumonia can be prevented in seniors. That’s a worthy goal, agrees Dr. Yates, but because of faulty communication, “We’re giving pneumonia shots left and right, making sure,” she said.
Then the patient goes into the hospital, which has the same check boxes, notes Yates, and so the patients are vaccinated there as well.
“How much does pneumonia shot cost, $200?” Yates asks. She notes that the duplication occurs nationwide.
“That’s happening all across the country, not in one hospital, but many hospitals,” the doctor said. She added that the same scenario applied to shingles and flu shots.
Dr. Yates said that even though electronic medical record systems were only in partial communication, Medicare was able to closely monitor physicians. “They can monitor me like big brother,” she said.
She noted that although Medicare’s data collections systems allow Medicare to determine what she costs the program, Medicare isn’t helping her take care of patients.