The Final Solution (TFS)

Doctors are increasingly monitored, quizzed, inspected, tested and re-tested for competency and to be sure he or she is current in all that a doctor must know.  MOC (Maintenance of Certification) has become the new buzz acronym that makes doctors re-certify their competence at regular intervals.  Surgeons require a three-year cycle, while internal medicine starts the process at two years.  Attestation signatures and doctor self-evaluation assessment and self-reporting mechanisms are not good enough!  Recent laws have been introduced to requires mandatory random drug screening for doctors.  We already do it for airline pilots and athletes, why not doctors?  Don’t trust your doctor? Did he just have one glass of wine as he alleges?  Would you like to be sure? Send off for his/her last six-month’s record of random drug and alcohol screening from the Office of BIG BROTHER in Washington, DC for just a small fee to cover administrative costs and the postage.

Attempts to allow public access to the, so far, secret deliberations of state medical boards of pending investigations have been launched.  And why not?  Just the suspicion of wrong doing should alert the public to a potentially dangerous doctor.  Guilt or innocence doesn’t matter when lives are at stake.  Bringing back the jurist prudence used in the Salem Witch Trials or the Inquisition only makes sense in such important issues.

Doctors have to sign numerous documents everyday that attest to their activities under penalty of perjury:  that he/she spent 40 minutes not 39 on this or that patient encounter, that he/she did this operation and all the component parts, that he/she did not fraudulently add some parts that would reimburse better.  That he/she fully supervised the resident, etc. etc. Reimbursement of doctors is outdated anyway and needs to be more value based.  After all value is used in almost all human interactions, and of course value is such an absolute and clearly definable concept.  What is a Monet or a Mozart Opera worth?  Well maybe that is not the right metaphor.  Who doubts the value of Kobe Bryant whose net worth is $366,000,000?  Even Dennis Rodman’s net worth at only $1,000,000 is reasonable for what he has done for humanity.  George Clooney’s average yearly income is a paltry $19,000,000 considering his value to our lives and the greater society?  The old concept that value is established by what people are willing to pay for an item is outdated, obsolete, so capitalistic and even decadent.  Now it can be determined by government decree, as evidenced by how well price controls have worked in the past.  Just look at rent control as an example, it works great at producing shortages and slums.  Clearly “Democracy is the worst form of government” as stated by Winston Churchill, but you need to leave out the last part of his sentence “except for all those other forms of government that have come along from time to time”.

But we need to accept the new definition of value in health care.  If the operation didn’t help or the pill didn’t reduce the blood pressure sufficiently, why – it clearly was worthless!   CMS (Centers for Medicare and Medicaid) has already introduced the general concept of such corrections to the idea of value, so that if a urinary tract infection or a ventilator acquired pneumonia occurred in the hospital it obviously was caused by the hospitalization and the wrongdoing of the doctors.  CMS just doesn’t pay for those flagrant attempts to defraud the government any more.  Thank God!

There is a better method however, that will solve all the problems and even make doctors happy (well maybe not so much, but they have been very compliant with all the hairbrained tasks and rules that have been foisted upon them to date just like lemmings who run to the sea when overpopulation looms). The title, “The Final Solution (TFS)” for this new and improved mechanism should not be confused with a similar title used during the era of National Socialism as that has unfortunate bad connotations.

The technology is already available and our current laws governing privacy, presumptive innocence until proven guilty, equal justice under the law, and civil rights are just outdated rhetoric and theories our Founding Fathers made up in 1776, nearly a quarter of a millennium ago.  A small unobtrusive camera would be implanted in every doctor. This is not without precedence.   Police are being armed with cameras for their own protection.  They can record an intervention in its entirety and thus prove they did everything by the book.  The best spot for such a camera would be the forehead, right where the red dot in upper cast Indians is located.  It could come in several designer styles: the original red dot, a hairy style that would simulate a unibrow, or natural skin color. A small microchip to transmit the video and audio to CMS live would not need much additional surgery.  I would recommend the location of the chip to be in the perineum right next to the anal sphincter because of the good blood supply and rapid healing in that locus, additionally it could monitor sphincter tone which would give CMS a clue to the doctor’s anxiety level.  CMS could immediately time the encounter, make sure that all HIPAA (Health Insurance Portability and Accountability Act) rules are followed, assure competency, check to see if Meaningful Use rules have been followed. Among these known unhealthy behaviors should be appropriately addressed such as anti-smoking counseling and gun ownership, seatbelt use, avoidance of high fat containing foods and of course high carbohydrate drinks.  Immediate tally of the number of system review items that were covered would be easily calculated to assure completeness and compliance with required level of the examination.   Above all CMS could immediately assign a value of that service.  Much of the data could be processed by artificially intelligent non-medical personnel only slightly increasing bureaucratic costs as these employees would get just above minimum wage to match their minimum intelligence.  As CMS gets more experience with the latest value based scheme, MIPS (Merit Based Performance Scores), and finds that that too doesn’t meet its intended purpose of cutting health care costs sufficiently, it could easily revise the rules by just a click or two in the BIG BROTHER main computer and make compliance more difficult to meet, and thus slash costs (and services).

There would be additional benefits.  CMS could judge the attitude of the doctor, by vocal intonation and nonverbal body language.   If re-education were necessary to correct attitudinal or knowledge deficits, a mild shock would initially be sent to the perineal chip to alert the doctor that corrections are necessary.  This has worked very well with dogs.  A simple on-line test could then be filled out by the errant doctor.  If that didn’t correct the problem a Mao Tse Tung style re-education camp would be the next step.  If that too failed then more drastic measures could follow depending on the seriousness of the infractions.   Privilege restriction, licensure termination, and even jail time come to mind.  One benefit to the doctor I have not touched on is that doctors would no longer need a chaperon as CMS would be right there to watch the potentially embarrassing breast or pelvic exam.  The government has already got access to our private parts anyway as we go through the TSA scanners at the airport.  So it isn’t like they haven’t seen it all before. These scans could easily be incorporated with the EHR (Electronic Health Record) which would further add to the volumes of useless information that is already packaged in it.

Further secondary benefits would be the ability to data share with the ABMS (American Board of Medical Specialties) which already acts very much like a branch of government to be clued in when a doctor’s behavior is showing signs of burn-out so they could take corrective action to terminate that doctors board certification.

This would be the Final Solution to prevent doctor drug and alcohol addiction, fraud and abuse, establish value, and resolve the overpayment issues, and if shared with the ABMS will signal the need for retraining thus eliminating incompetence until such time when doctors, thank God, will be replaced by robots.