Right now American medicine is good, but not as good as it should be given that we pay more per citizen for our care than any other country in the world. Most of us are mystified when we can t reach our physician, wait for hours in the waiting room or find that routine care appointments are being scheduled months in the future. When we call with a genuine emergency, we are shunted to an overflowing emergency room surrounded by dozens of other people who can t get care today either. Many are there because their doctor is simply responsible for more patients than he or she can reasonably care for. Their problem could be solved much more cheaply and efficiently by their own physician, if he weren t already seeing 30 people today in his office. And once you have finally managed to get through a hurried appointment and received a prescription, you find yourself with a bill that seems exorbitant by any measure.
If service were this bad in any other part of the economy, someone would have solved the problem a long time ago. People would be spending their money on the products and services that satisfied their needs. Competitors would have to adjust to consumer requirements or go out of business. Innovators would come up with ways to provide better service at lower prices, and within a few years the clumsy approaches of the past would be gone. Even better, as competition increased, the market price would decline as the quality increased. The industry would focus its research on ways to satisfy the consumer while maintaining healthy profits.
Why doesn t this happen in medical care? It s not as mysterious as you may think. Simply put, the medical marketplace was designed in a way that was guaranteed to produce the current mess. Let s take a look at the design.
When you look at the financial design, the first thing that becomes apparent is that the major money flows are coming from the employers and insurers. The costs are generated by the patients. That means in practical terms that the system will be designed primarily to satisfy the needs of employers and insurers. It also means that patients and physicians are in a position to spend Other People s Money (OPM) for care. This has (predictably) led to very rapid inflation in medical care pricing and marked inefficiency in the care of patients. Since your care is financed by insurance, you are in no position to demand better or more responsive care. Your insurer could pressure the system to get you better care, but the insurance company has no way of knowing how good your care is, and less interest in intervening since this will just increase their costs further.
Your doctor has contractually agreed to let the insurer set prices on services. Those payments are for each individual services, so the way physicians make money is by seeing MANY people daily and performing lots of tests and procedures. In order to have this level of patient flow, physicians take on many more patients than they can comfortably care for. This means that their offices are swarming with patients and there is no place for you when you call to be seen. (Beginning to sound familiar?)
When you finally see the doctor, he has his eye on his watch because he has to get to his next patient in 10-15 minutes. If you have more than one problem, you are now a burden on the system and it means that he will be late for the rest of his appointments today. If you aren t scheduled very early in the day, it is likely that you will wait, since somebody today is likely to have had more than one problem and the schedule is falling apart. Any emergencies further clog the already fully booked day and before long, the office is full of frustrated patients and overworked physicians. In the end this translates to low levels of service, long waits, high prices and less than ideal medical care.
Is there a solution? We think so, and over 200 physicians in the United States have shown that it can be done. What if we simplified the financing of medical care so that you the patient controlled the money? Instead of having your employer pay $700 per month (on average) for insurance, your employer could purchase a high deductible insurance plan to cover catastrophic problems and put the rest of the money in a Health Savings Account (HSA). This money would now be yours to spend as you see fit on care. If you didn t spend it this year, you could roll it over to future years and save it to pay copays, deductibles and medical expenses that your insurer refuses to cover. The doctors would no longer work for your insurance company. They would now work for you. Doctors who figure out how to provide better service, lower pricing and better care would begin to flourish and the ones who continued to herd patients through their offices like cattle would be struggling to find work. In business parlance, patients would become income sources instead of cost centers in medical offices, you don t have to be a business genius to know that income sources get treated better than cost centers.
This isn t just a theory. It is working all over this country now. There are a variety of medical practice designs that accept direct payment from patients. Some of them are entirely patient financed and others take insurance money for medical services and charge a monthly fee to allow smaller patient panels, increased emphasis on preventive care and more physician availability. Some of the earliest versions of these practices have been called concierge or boutique practices, implying high priced fancy care. However, in recent years these designs have become less expensive and easier to find. Monthly pricing ranges from $1000 per month to $35 per month. Extra services vary from practice to practice. They have included:
Same day appointments, even for non-emergencies
24/7 physician availability for calls, emails
Free annual physical exams
Unlimited office calls
Access to educational materials or monthly newsletters
Emphasis on preventive care
Assistance navigating the world outside the primary care office orchestration of health care by communicating with outside specialists to optimize your care and your experience outside the office
House calls or nursing home visits
Coordination of hospital care
Fitness assessment and wellness programs
On-line access to your own electronic medical records and lab results
A portable electronic medical record for travel
Even better, future practices will have to match up to and improve upon current designs in order to compete successfully. Wouldn t it be something if physicians were competing for the privilege of caring for you?
Aren t these practices just inflating the cost of care? No. They are designed to increase the quality, availability and efficiency of care. Less time wasted by you and by your physician. More time spent on what counts: taking care of your health care needs. Many patients are choosing to join high deductible insurance plans, thus greatly decreasing their medical care costs. If they remain healthy, their money has been spent on good care, not on expensive insurance. If they become ill, they will have to pay a deductible, but they still have good catastrophic insurance. Even better, many employers are moving to Health Savings Accounts (HSA) for their employees. These HSA policies effectively turn the money over to you for safe keeping. You decide what services to purchase and you determine the best use of your healthcare dollar. What do you think will happen to the cost of medical care when patients decide what medical care is worth?
Why are physicians interested? You might think that physicians have the most to lose if the financial structure of medicine changes, since we currently are receiving very large checks from your insurance company. However, physicians started this movement because they could no longer tolerate the current medical care financing machine. Physicians spend many years in school to learn their trade and it has been painful for many of us to watch our profession descend into mediocrity. We don t see a reason why patients should wait for hours and then have a 10 minute audience with their physician. We want the time to do excellent work. We are sick of spending our time and staff resources fighting with insurance companies. We want to get back to what counts taking care of you. If this means putting the money in your hands and letting you decide what our work is worth, then we couldn t be happier. It may mean lower prices, higher patient expectations and more competition amongst physicians, but we much prefer to have our work judged and rewarded by you than by the spreadsheet maven at your insurance company. We also want to use our limited time and energy improving your health, not generating paperwork for government and insurance bureaucrats. Most offices currently spend 20-50% of their income on billing and reimbursement. That s too much. We d rather give the money back to you. We don t need the overhead and you don t need the expense.
We also think it is time for medicine to focus on measurable health results and the current system leaves little time or office resources for scientifically verifiable health outcome measurement and computer systems designed to improve care.
What can you do to take advantage of these new practice designs? If you want to join us in our effort, please consider inviting your current physician to join our organization.
Talk with your employer and see whether an HSA account will work for you.
Contact one of our physicians and see if the care might serve your needs better than your current medical care arrangements.
Consider becoming a financial supporter of this organization. Come to our annual conference and see where medicine is going,
Let us know how we can serve your needs better. If you have any questions, contact us at: [email protected]