Harm by the healer: the core issue of the US healthcare system

Harm by the healer: the core issue of the US healthcare system

A couple of years back, I was working as a rehab doctor when I met Alice*, a 72 year old woman who needed rehab following a spine fusion surgery. She shared her story with me and how she ended with such unnecessarily aggressive procedures. Her story just broke my heart. Alice was experiencing back pain for a few years. She didn’t seek any therapists or doctors’ advice, and decided to follow her step-sister's recommendation who works at a hospital. Her step-sister recommended a spine surgeon and Alice simply trusted her advice and walked into that surgeon’s office. What happens next is horrifying: she received an extensive spine fusion surgery and ended up with 21 screws on her spine. That overly aggressive surgery is never a good option to treat back pain, it exacerbated her pain and left her unable to care for herself. Alice could barely walk and needed opioids around the clock to cope with the pain. Through physical therapy, we did our best to get her mobile and caring for herself but the damage has already been done and Alice will have to pay the price for the rest of her life.

As a practicing physical medicine and rehabilitation physician (doctor of function), I feel a visceral gut punch every time I see a patient like Alice, who was presented with the most expensive and aggressive treatment as a first-line option, often by a physician having sold false hope to that anxious patient for monetary gain. Too often, that aggressive care leads to a lifetime of catastrophic chronic pain and drug dependence for the patient. Unfortunately, this scenario happens all too frequently, and oftentimes safe, conservative care is too late to significantly reverse these adverse effects. A study of more than a million Medicare patients showed how often they had received one of twenty six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. In just a single year, the researchers reported, twenty five to forty two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Choosing the right doctor at the outset has a ripple effect on the patient's outcomes and life, and impacts their families, employers, community, and society in general. Currently, there is no credible or systematic process in place to help guide patients when making this important decision especially because the multibillion dollar industry rewards doctors for unnecessary opioids, procedures and aggressive surgeries.

Physicians take an oath to first "do no harm", and it is a basic expectation for physicians to act in the patient's best interest. It is essential to use procedures and surgeries only when the benefits outweigh the risks of harm to patients. There is nothing wrong with profit if we give value in return, but we should never promote harm to achieve profit.

“There is nothing wrong with profit if we give value in return” Ali Alhimiri, MD

Fortunately, not all doctors put monetary gains above their patients’ wellbeing. Those outstanding doctors should be recognized and rewarded for better outcomes at the lowest total cost of care. This new approach contrasts with today’s established trend to provide care via discounted networks where clinicians compensate for the discount by providing a higher volume of lower quality care. This very often exposes patients to aggressive and expensive procedures or surgical care that results in poor outcomes. The US healthcare system needs a way to identify those outstanding doctors, reward them for doing the right thing, and empower them with access to industry best practices.

At Modus, we decided to take on the challenge of improving the healthcare system for the better. The key differentiation with Modus is the business model. Our doctors are rewarded for doing the right thing, and empowered with our sophisticated and patented technology that rates and directs quality care in real-time vs in months (the current norm). Thanks to this technology, Modus predicts patients' risk of long term disability with a few simple questions, to steer our doctors in providing tailored approaches to high risk patients. Our patented AI-driven clinical best practices technology continually assesses the cost vs benefit of all available knowledge, wisdom and experience of the best doctors in the field. The beauty of AI is that it only gets smarter as it learns from new data. We digitally scale clinical quality and deliver better care measured by the ultimate quality metric: patient reported function. This ensures our approach remains simple and clear for everyone to focus on. Patients seek medical care because they want to restore or maintain their ability to function. Modus helps them achieve this at lower cost to the employer.

*Name was changed for privacy reasons

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