quote:
If we're going to say Z91.1 is a reason to justify pharmaceutical treatment at the expense of the healthcare system wouldn't it make more sense to allow those dollars to be spent on the compliant patients?

You do realize the majority of healthcare would fall under this non compliance coding, right? I work in nephrology, 95 % of our patient load would not qualify for medical care under your terms. It’s just not feasible. Hell, 9/10 people would get turned away from the ER under those terms.

The system is frickED, there’s no denying that. But why is it okay for person 1, the non compliant diabetic with a BP of 190/110, to get the care he needs at no additional cost but person 2 shouldn’t get his ozempic filled because that is going to break the system… nahh those GLPs are a drop in the bucket compared to the millions wasted in healthcare on a daily basis.

Maybe some people will get the GLPs and still eat and drink like shite. But I’d be willing to bet over half will change their habits completely and hopefully avoid the predicament person 1 is in above. I believe some plans are already requiring a minimum % of weight loss during certain time frames while on the med, which is fine IMO.

quote:
wasting too much money and resources on the non compliant who have zero desire to be compliant or accept the financial burdens of their non compliance.

Again, this is happening every single minute of the day already. It’s happening in front of my eyes as I type this. It’s not something we can stop but maybe GLPs can slow it down. It’s definitely worth a shot because the current path isn’t sustainable.

This post was edited on 3/8/24 at 1:30 pm

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Posted by LSUfan4444

Member since Mar 2004

54291 posts

Posted on 3/8/24 at 1:31 pm to Uncle JackD

quote:
But why is it okay for person 1, the non compliant diabetic with a BP of 190/110, to get the care he needs at no additional cost but person 2 shouldn’t get his ozempic filled because that is going to break the system

It isn't, that's the point. But Ozempic isn't going to break the system, non compliant patients and a fee for service payment based on services provided not outcomes system will and has. it's ripe for abuse and overuse without enough emphasis opn patient accountability and healthier patients.

There's tons of waste for sure and I don't think it's an either or fix. It's going to take alot of different approaches and a shift in how people think about healthcare and how much burden of responsibility they're willing to accept themselves.

Not too much longer we will have more seniors than kids for the first time in our nations history and we just don't have enough providers to handle the patient load. The model will shift more into the patients home and more into the patients responsibility. If the default is "well, they're non compliant and unhealthy so there's nothing I can do except put them on high cost meds" is the answer without implementing a plan based on patient outcomes and improved health conditions we might as well keep a democrat in the white house for the next 20 years.

This post was edited on 3/8/24 at 1:33 pm

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Posted by LSUfan4444

Member since Mar 2004

54291 posts

Posted on 3/8/24 at 1:33 pm to Uncle JackD