Direct Primary Care Physician | Advocate for free-market healthcare & patient-centered reforms
JUNE 2, 2015 – The traditional way in which we pay for and access healthcare impacts all of us negatively. And I’m not just talking about our wallets – that connection has been well documented.
In previous posts I have made the case for the linkage between the way we buy (pre-paid network plans) and sell (deliver via CPT claims billing) healthcare and the out-of-control costs of healthcare over the last 50 years. See here, here, here, here, here , here and here. Many health economists and many in the healthcare financial industries have made similar arguments based on the economic mal-incentives created by government intrusion, excessive third-party intervention, inequities in our tax code and excessive regulation. See here, here, here, here, here , here and here.
But let’s set aside costs for now and focus on the consequences of how our leviathan-like expensive claims driven system impacts patient care on a practical level; and how it leaves both doctors and patients frustrated and unsatisfied due to the needless barriers our payment system places between the patient and doctor.
There is certainly no paucity of clinical care insults added to economic injury as a result of our dependence on a bizarrely inefficient, expensive and complex insurance payment system. Our dysfunctional third-party dominated payment system often leads to dysfunctional clinical practices & habits for those physicians and patients who are still at the mercy of the complexities and barriers created by the third-party network billing apparatus. This behemoth is driven by complex codes and contracts destined to force the participants into untenable choices, rigid protocols, narrow networks (or lacking the one doctor you need) or receiving care unknown providers based on network restructuring or migration.
The whole insurance network system has led to a lot of customer-unfriendly and non-patient-centered habits, protocols and practices cropping up within medical care establishments. It is almost as if we don’t work for the patient anymore… but instead play the role of contracted providers for the insurance network. Reality check: Unfortunately, that is exactly the way it is!
The managed care approach (HMO and PPO variety) of the last 40 years has forced physicians to be “the heavy” and do most of the dirty work for the insurer as a contractual obligation of “benefitting” from the network; often ending up looking like the bad guy to the patient.
What used to be serving our patients as their personal physicians has been replaced with the label of “provider” of contractually determined care for a network subscriber; a subscriber that will move on to another doctor if their employer changes networks. It doesn’t get much more impersonal than that!
Within the current Fee-for-Coding system, doctors are too busy to get to know patients the way they want to, with only enough time to decipher the simplest problems while referring the remainder to specialists so they can try to keep on schedule. They rarely have time to return phone calls personally due to rushing from room to room trying to see enough patients to generate revenue to cover over-head; over-head forced on them due to unnecessary administrative costs of our payment system combined with increasing costs and falling reimbursements. Not to mention being slowed-down by tedious unnecessary data entry via an expensive piece of coding and billing software, AKA the EMR.
Clinical shortcomings abound. These can take the form of fragmented care, over-utilization of specialists, poor communication between doctor & patient and dissatisfied patients that can usually be traced back to our healthcare payment methods with the moral hazard, disincentives and bad habits it fosters in our patient relationships. To be fair, primary care doctor share in some of the blame for ceding territory once “owned” by the family doctor, which has helped the rise to the Retail Clinic and Urgent Care industry – further fragmenting care.
Within this role of “gatekeepers” and enforcers of policies and procedures, the front-desk staffers have become very skilled at saying “no” to a litany of patient requests:
We don’t do that here. We can’t work you in, you will have to go to the Urgent Care. I realize you were just here 4 days ago for the same thing, but you still have to pay a co-pay. We can’t call that in for you, you will have to be seen even if you are feeling fine. We can’t see you anymore for that problem since you consulted a specialist. You have to have a physical on the first visit before any medications prescribed. We can’t refill your asthma inhaler because you haven’t been in for more than a year (automatic trip to the local urgent care). No we can’t email it to you, that’s a HIPAA violation. We need all your old records before we can see you. A severe headache? Might be an aneurysm, go to ER. Nose bleed 3 days ago? Go to ER. Your insurance is not in force so we need a $250 deposit and credit card on file.
Alternative payment models like Direct Primary Care (DPC), sometimes called membership medical care, and insurance-free cash practices don’t have to depend on billing out encounters in the office to drive revenue. This liberates the physician and staff to provide the right care at the right time via the right modality; whether that be in-person, over secure texting app, phone, video or even a house call.
With DPC and similar practice models, the artificial constraints and moral hazards of Fee-for-Coding disappear, replaced by the satisfying joy of just helping to solve our patient’s problems as life happens and helping them on their journey to better health within a non-rushed, lifestyle friendly atmosphere.
I call this “everywhere care”. It happens because the doctor is paid to be available and accessible and give their undivided attention to the problem or issue, as opposed to having to “document elements” the chart in order to get paid. “Everywhere care” allows the doctor be ultimately flexible, creative and innovative in deciding how to best deliver care for each individual patient. It allows liberal use of online tools, mobile communication apps, and flexible scheduling. “Everywhere Care” can offer seamless two-way communication modalities on secure trusted platforms that patients are accustomed to using via smartphones, laptops and tablets devices. I can attest to the fact that patients love the easy connectivity and appreciate the accessibility.
So not only is DPC a more cost-effective and affordable way to render highly effective primary care, but revenues result from ongoing satisfaction and superior outcomes which drives loyalty and patient retention. It’s hard to argue against better and cheaper!