In this article, I my proposal for how we can reduce the costs of healthcare by implementing a system of periodic assessments of CPT codes and costs.
I am not suggesting that all CPT codes are unnecessary or wasteful. My point is that there is a lack of periodic reassessment of healthcare costs associated with caring for people with Type 2 diabetes. Such a reassessment would likely find better explanations for what causes high blood sugar and diabetes in adults and better, less costly ways to treat it.
Two basic requirements for improving America’s healthcare system are giving people access to reliable information and affordable care. The problem is, that these are both vulnerabilities that can (and have been) exploited by dreamers, innovators, and entrepreneurs, based on their level of greed.
Although the work of these players may advance science and technology, some level of greed is necessary, especially among innovators and entrepreneurs who are unlikely to risk capital on producing and distributing new drugs, gadgets, and remedies without the promise of excellent payoffs. However, there has to be a balance between greed and the needs of people.
How can we rebalance the current exorbitant costs of healthcare in the U.S. between greed and need?
When it comes to Type 2 diabetes and several other “lifestyle conditions” such as obesity and heart disease, I propose a few ideas.
First, by definition, lifestyle-associated health conditions are preventable, improvable, and possibly reversible through lifestyle changes. This opens up enormous opportunities to exploit vulnerable people with false promises of useless tests, gadgets, vitamins, food supplements, and treatments. A significant number of people may not have the critical thinking skills needed to evaluate these, and thus end up choosing a path based on gullibility, ignorance, or personal trust in the vendor, spokesperson, or salesperson. This is evident everywhere today, with extensive disinformation and misinformation about medical conditions and treatments in the media. We even see it occurring due to popular and political pressure that leads to the approval of new CPT codes to compensate medical practitioners for heavily promoted but unverified remedies. All this disinformation and misinformation unnecessarily adds to our healthcare costs.
To remedy this, I propose that at least every 20 years, due to the pace of technology and medical advances, we conduct a formal review of the impact of expenditures related to the testing, treatment, and prevention of lifestyle conditions. There should be more frequent reviews for CPT codes associated with substantial payouts, as agreed by both public and private providers of healthcare funds. The costs of these reviews should be paid for by public and private health insurance programs.
These reviews can lead to significant new understandings and evaluations of costs. They should cover:
Testing: Reevaluate tests that have been previously approved for CPT codes and used to detect the causes of the most common lifestyle conditions: Type 2 diabetes, obesity, cancer, and heart disease with two main objectives: to assess the effectiveness of these tests to correctly identify the lifestyle condition, and identify critical opportunities for formulating more effective preventive measures.
Treatment: Assess the overall result of treatments that the healthcare system pays for to ensure they are worthwhile, and identify any subgroups of people whose results differ from the the norm in these treatments. This information could help us assess when treatments are less effective due to the presence of interfering agents such as drugs, coexisting conditions, or genetic variations.
Prevention: Evaluate new evidence related to causative factors of lifestyle conditions so better preventive measures can be formulated. This could also help identify more effective communication methods for the most vulnerable populations regarding testing, treatment, and prevention. The more the public understands lifestyle conditions and their role in causing and treating them, the better.
Educating the Public The value of this periodic review would not only legislators, policymakers, and the medical community, but also the public. Most people have no concept of the true costs of the healthcare they receive. Even those who may be aware of the costs are not likely to know the details of those costs nor the level of health expenditures by the U.S. government.
Senate hearings could be used to educate the public about the complexities involved in research, development, manufacturing, and marketing of procedures, medications, and gadgets, and how this contributes to healthcare costs. Researchers and healthcare professionals would need to explain how they decide the type of test needed to identify a lifestyle condition; how they research to evaluate the usefulness of tests; and what criteria they use to submit the test for official CPT approval. They would have to explain treatments and prevention strategies similarly.
Federal regulators could also explain the criteria they use to approve new processes and what mechanisms they use to ensure that any test, treatment, and prevention method meets stated expectations. They would have to identify what safeguards are in place for early detection of potentially harmful side effects that may appear in the course of treatment or afterward. This could help cut health expenditures by avoiding costly complications that sometimes accompany new treatments.
Such hearings could weed out taxpayer money wasted on tests, treatments, and prevention programs that do not improve the quality of life, prolong the lifespan, or lower the incidence of complications in lifestyle conditions. They could be a first step to raising awareness about the excessive costs of our healthcare system and enlist the entire nation to begin reducing these costs while also taking better care of themselves.
As a best-selling author and Nationally Syndicated Columnist, Dr. John Poothullil, advocates for patients struggling with the effects of adverse lifestyle conditions.
Dr. John’s books, available on Amazon, have educated and inspired readers to take charge of their health. There are many steps you can take to make changes in your health, but Dr. John also empowers us to demand certain changes in our healthcare system as well.
Follow or contact Dr. John at drjohnonhealth.com.
John Poothullill practiced medicine as a pediatrician and allergist for more than 30 years, with 27 of those years in the state of Texas. He received his medical degree from the University of Kerala, India in 1968, after which he did two years of medical residency in Washington, DC and Phoenix, AZ and two years of fellowship, one in Milwaukee, Wisconsin and the other in Ontario, Canada. He began his practice in 1974 and retired in 2008. He holds certifications from the American Board of Pediatrics, The American Board of Allergy & Immunology, and the Canadian Board of Pediatrics.During his medical practice, John became interested in understanding the causes of and interconnections between hunger, satiation, and weight gain. His interest turned into a passion and a multi-decade personal study and research project that led him to read many medical journal articles, medical textbooks, and other scholarly works in biology, biochemistry, physiology, endocrinology, and cellular metabolic functions. This eventually guided Dr. Poothullil to investigate the theory of insulin resistance as it relates to diabetes. Recognizing that this theory was illogical, he spent a few years rethinking the biology behind high blood sugar and finally developed the fatty acid burn switch as the real cause of diabetes.Dr. Poothullil has written articles on hunger and satiation, weight loss, diabetes, and the senses of taste and smell. His articles have been published in medical journals such as Physiology and Behavior, Neuroscience and Biobehavioral Reviews, Journal of Women’s Health, Journal of Applied Research, Nutrition, and Nutritional Neuroscience. His work has been quoted in Woman’s Day, Fitness, Red Book and Woman’s World.Dr. Poothullil resides in Portland, OR and is available for phone and live interviews.
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