Congress is currently considering proposals that could penalize doctors who practice personalized care or use the most advanced medical technology. To me, this is misguided, harmful, and very, very personal.
Four years ago, I was a healthy, 41-year-old, avid athlete who intensely enjoyed the challenges of swimming, running, and biking. Who would have thought that I would lose nearly two years of my life to misdiagnosis and treatment for heart disease that failed and caused life-threatening complications?
It was only after a battery of tests, multiple procedures and various failed treatments, that I finally saw a specialist -- with access to the latest research and technology specific to heart disease in women -- who found a treatment regimen that gave me my life back. So I was alarmed when I recently learned of some legislative proposals that could limit a patient's access to diagnostic tests, specialists, and medical advancements, as well as many other patient services.
In their effort to reduce waste and unnecessary costs, some in Congress have proposed mechanisms called "gainsharing" and rewarding physicians for "efficiency." Gainsharing is an agreement between a hospital and physician where the hospital passes on a percentage of cost-savings to the physician, based on that physician's reduction or change of services offered to patients. Simply put, these are financial incentives that create a conflict of interest for physicians where they would be rewarded for using one technology over another even if it might not be in the best interest of the patient. This might entail reducing the use of diagnostic tests, using only particular products on which the hospital has negotiated discounts, using less advanced and less costly products, reducing the use of supplies, or shortening hospital stays. Physician profiling compares each physician's cost-savings measures with those of their peers, to determine and reward the physicians who save the most money.
What might my care have been like if my doctor was rewarded for cutting costs based on averages or a negotiated discount by a hospital? I question whether I would still be alive. I had access to optimal medical care and insurance coverage, as well as my own inner circle of personal physicians -- both my husband and father are well-connected physicians -- and I still had an extremely difficult time receiving the quality health care I needed.
It took three visits to cardiologists to convince well-meaning doctors to run an EKG stress test and echocardiogram, which finally diagnosed my disease. It's easy to imagine that under aggressive cost-savings mechanisms, that an EKG stress test and echocardiogram would never have been run for a one-year-old, pre-menopausal, otherwise healthy woman. After my eventual diagnosis, I received catheterizations, stent implants, brachytherapy, and emergency bypass surgery, but it wasn't until going to a specialist at the Women's Heart Clinic at the Mayo Clinic that I was able to walk from room to room again without having intense, incapacitating chest pain. My recovery and survival depended on that visit to the Mayo Clinic. If I had not been able to see the specialist at the Women's Heart Clinic, I would not be the active, self-reliant, mother of three boys that I am today. Furthermore, I would not be able to advocate for the rights of all women heart patients to receive adequate and timely quality medical care.
In such an unparalleled time of medical advancement, no patient should suffer needlessly or risk their life simply due to lack of access -- which is exactly what could happen with gainsharing and physician profiling. Who "gains" under gainsharing? The hospitals and doctors,not the patients.
Patients could be denied important diagnostic tests, prolonging their suffering and delaying the beginning of their recovery. Patients could be restricted from receiving treatments specific to their needs that would allow them to more quickly return to their daily routines as employees, family members, and community leaders. Medical advancements could be obstructed, keeping some patients who could be rehabilitated, debilitated for life. It's a step backwards to implement a policy that would block health care decisions most likely to lead to recuperation of active, healthy communities, not to mention stifling burgeoning medical research and development.
Yes, sky-rocketing costs and waste in the health care system must be addressed -- but not at the risk of quality health care that allows people to regain their lives. There have to be other ways to reduce health care costs in this country without threatening the lives of women by denying their access to the care they need, deserve, and are entitled to.
Kathy Kastan is the author of From the Heart: A Woman's Guide ot Living Well with Heart Disease (Da Capo Lifelong Books, 2007), President of WomenHeart: The National Coalition for Women with Heart Disease, and Chair of the Northwest Region of the American Heart Association.