American medical care has been through a very rough last 2 decades. While the price of care and health insurance has increased at double digit rates, physician reimbursement (and particularly primary care reimbursement) corrected for inflation has been stagnant. Because of the insurance driven reimbursement system and its emphasis on payment for individual services, physicians have found themselves seeing more and more patients every day, spending less and less time with each patient and wondering where this will all end. Our practice decisions are increasingly dictated by the insurers and we are often in the uncomfortable position of being the enforcer for healthcare policies created to serve the insurer, even when this means worse care and service for the patients. Most physicians are unhappy about these developments, but feel powerless to reverse trends that are backed by trillions of third party payor dollars.
Even more disappointing, physicians feel themselves being dragged into a medical practice style wrought with mediocrity and progressively worse relations with their patients. We do not have the time to do the job well and yet every year we are told to see more patients faster. We are more likely to be ruled by corporate decisions that seem irrelevant to our sense of professionalism and commitment to patients. Predictably, as relationships with patients deteriorate, the malpractice attorneys begin to circle and the cost of malpractice insurance climbs steadily.
For those in primary care, the costs of getting reimbursed have increased until some insurers fail to cover our overhead costs. The endless hours on the phone getting authorization and the costs of upgrading and maintaining our billing systems gobble up much of what used to be our profit margin. Unlike our overhead costs, Medicare reimbursement has failed to keep pace with inflation for the last 2 years and once again is threatening a substantial reduction of reimbursement in the coming year. Medicaid has been underfunded for years and its payments to physicians are frequently below overhead costs, particularly factoring in the staff time required to get paid.
There is now a ray of hope on the horizon for physicians and it is getting brighter. There is more and more agreement amongst all parties that something needs to be done, and soon. As things currently stand, the future will be guided by insurance companies, government and employers likely producing more dysfunctional medical care unless physicians act decisively to take back the high ground and find a way to offer patients excellent care at a price that they can afford.
Is this even possible? WE SAY YES! Since 1996, physicians in the United States have been experimenting with new practice structures that take them out of the treacherous waters of third party controlled care and allow them to once again take care of their patients directly, with decisions controlled by doctors and patients, not by spreadsheet mavens and government bureaucrats. The key principle that allows these practices to exist is the notion that when patients buy their care directly from their physician, high quality care becomes possible, often at far lower prices than the existing healthcare market will permit.
How can care be both better and cheaper. Just take a look at how you are now spending your time and money. Most physicians are expending huge resources on simply getting paid. This often amounts to 20-50% of overhead complex computer billing packages, constant phone calls to insurers with long waits and high frustration, multiple bookkeepers and distraction of staff members from patient care, prolonged delays in reimbursement and too much time and money spent negotiating reimbursement rates from oligopolistic payors. Our medical records have been turned into complex, wordy tomes written more to justify reimbursement than to inform us and our partners of medically important details. Although computer technology offers the possibility of genuine improvements in care, we have few resources left after the billing wars are funded to look at ways to measure and improve the quality of care, except for a few very large institutions that can dedicate some manpower to this mission.
Put simply, physicians have picked the wrong employer. We have fallen for a Trojan horse in the form of contracted insurance reimbursement. We have each signed dozens of contracts that specifically take away our right to set our own prices and maintain our professional control over our own medical practices. In our rush to prove that money was not the prime mover in our medical decision making, we have turned over financial control of medical care to those who do not share our ethical stance.
As a physician, who should you work for? We say you should work for your patients. How can you assure that you will be able to do so? By making your patients the major source of funding for your practice. When you ACTUALLY work for them, the conflicts of interest begin to evaporate and the patient and doctor (finally) begin to determine how medicine is practiced. One cannot overstate the power of this simple shift in the financing of medical care. There are now hundreds of medical practices in the United States that have adopted this principle, and thousands of patients who can attest to the improvements in medical care and service that followed. This is a grassroots movement and it has taken several forms. These include:
Cash Fee-for-Service charging a cash fee for each service and receiving payment directly from the patient. The patient may seek reimbursement from his or her insurance, but that is no longer the responsibility of the physician.
Pure Monthly Fee Practice The physician charges his patients a monthly flat fee and in return promises an array of services (often primary care services provided by the physician and his staff). The price can be high or low, and the list of services can be extensive or limited.
Hybrid Monthly Fee and Insurance Practice The physician charges a monthly fee PLUS individual insurance reimbursable charges for services covered by the patient s insurance. This allows physicians to reduce their monthly fees and still provide exceptional care while still putting the patient in the driver s seat.
Does this sound promising to you? It has allowed hundreds of physicians in this country to improve the medical care they provide and restore a sense of professional commitment and medical excellence where mediocrity and despair once reigned. If you want to join this movement, we encourage you to join the one organization that champions the role of physicians and physician entrepreneurs in making this a reality for all Americans. This is not a movement of do-gooders ; it is founded on solid business principles and requires physicians to give up their ivory towers and enter a world in which the needs of patients will determine their success or failure. Nobody will guarantee your success and only those who can determine what patients want and need – and provide it a price they can afford will ultimately succeed. So far there are few failures and many successes, but you don t want to be the last physician in your town to make the transformation.
If you want to meet other physicians who are considering the move, or you want to find out how to do it yourself, come to our next conference and find out how it is done. If you want to know more about our organization, call: 877.448.6009 or email us at: [email protected]