Real health care reform

Forget the disaster of ObamaCare. Real health care reform is coming from doctors around the country. They are providing better health care at lower cost. The better care is due to not letting an insurance company come between doctor and patient. The lower cost ditto.

More and more doctors are refusing to accept insurance, including Medicare or Medicaid. That lets them do what they think is right for their patients, not just what an insurance company (or government agency) will allow. These doctors refuse to sign contracts requiring them to spend no more than 7 1/2 minutes per patient. They now spend more time per patient, not just solving a current problem but teaching patients how to be healthier. These doctors don’t have to phone an insurance company to determine if a certain treatment or medicine is covered. They prescribe what they think is best for the patient.

The result for Dr. Brian Forrest: “We are in the top 5% nationally for control of hypertension, lipids, diabetes, and hospitalization rates based on an independent ongoing 3rd-party audit of our charts, which resulted in our being designated as one of 33 Cardiovascular Centers of Excellence in the US.”

A Direct Primary Care (DPC) practice has much less overhead than a traditional (insurance-based) practice. A traditional practice has 4.5 employees “primarily dedicated to billing, coding, and working with payers to get reimbursement rather than actual patient care.” By not having to process insurance paperwork, Dr. Forrest was able to reduce his overhead by 80%, cut his prices, and spend more time with patients.

Dr. Forrest charges less than traditional practices. “Occasionally, his charges wind up being less than just the co-pays for Medicare or private insurance. He’s negotiated deals with a lab company to reduce his patients’ costs for tests. The lab loves being paid on the spot for services rendered and allows Forrest to charge his patients $30, for example, for a prostate-cancer screening test that the company bills to an insurer at $184. He’s found other doctors happy to join in, such as a cardiologist who’s willing to give discounts of 80 to 90 percent to his patients if he’s paid cash up front.”

But how can his patients afford to pay him without insurance? One might turn that around and ask how can insured people afford to pay high premiums, high deductibles, and high doctor’s bills? Half of Dr. Forrest’s patients do not have insurance. Eliminating overhead allows him to charge lower than all doctors who do accept insurance.

Better quality, lower costs, and improved access – isn’t that what everyone wants in health care reform?

via Daniel J. Mitchell, The Way Healthcare Should Function

Eliminating the Middleman

Everything that is really great and inspiring is created by the individual who can labor in freedom. — Albert Einstein

Lower costs, improved outcomes, better consumer experience – isn’t that what we would all like in health care? That’s not just a dream – it is the actual result of a growing number of physicians you might label “Do-it-yourself Health Reformers”. They haven’t been waiting around for politicians to fix the broken health care payment system; they have been implementing new models for the practice of health care.

Improved outcomes? How about 91% of patients achieving their target blood pressure within 6 months? (Compared to a national average of less than 50% of patients.) How about being named one of only four Cardiovascular Centers of Excellence in the state?

These physicians focus on keeping patients healthy and out of the expensive parts of the health care system, such as specialist offices, emergency departments, and hospitals. ER visits are down 62%, specialist referrals are down 55%, advanced radiology down by 48% and surgeries down by 73%.

The net result of better primary care was a savings of 20% to 30% in overall health care costs. Customers of this new model of health care delivery provided their employees a better health benefit and also saved 20% compared to what they had been paying. How often do you hear about health care costs actually going down?

Or consider this case. A diabetic woman had been spending $5,000 per year on medical care. When she switched doctors, her new doctor reported that “When she arrived her HGBA1C was 11.9 – meaning very poorly controlled. One year later her A1C was 6.8 (well controlled) and she had only spent about $450 for an entire year of care with us – including the annual physical, all of her follow-up visits, all of her lab work and ancillaries.”

So how do these doctors deliver better health care at lower cost? The answer is surprisingly simple: They eliminate the middle man between doctor and patient, i.e. the insurance company or government (Medicaid or Medicare). Removing the bureaucracy from the mix cuts 40% of fat out of the process. Not just money, it saves paperwork and frustration, leaving more time for the doctor and patient.

A traditional primary care practice has a large staff just to deal with the paperwork. The national average is 3.9 non-medical staff members per doctor or nurse. A typical Direct Primary Care (DPC) practice has just one staff member for two doctors. Some have zero staff. This reduction in overhead allows a DPC physician to charge much lower fees yet still spend more time with each patient.

Many DPC practices provide lab services in-house, further reducing costs and providing better service to their patients. Most negotiate with lab companies. The lab companies offer huge discounts for avoiding the time and hassle of billing insurance companies or the government. One DPC physician reported that he could get a cholesterol test for $3 versus the $90 the lab would have billed an insurance company. An MRI was $400 compared to a typical rate of $2,000.

In addition to primary care, most DPC offices also provide urgent care such as stitches or casts, handling many of the same problems as an emergency room. They provide treatment for about 80% of health care needs.

Most DPC providers operate on a mixture of monthly membership fee, typically $75 per month, and per visit charges. Members receive an annual exam, a discount on fees, and access by phone or email. About a third of the patients are uninsured, some because they cannot afford insurance premiums, others due to preexisting conditions such as diabetes. Ironically, uninsured patients at a DPC practice receive better service than insured patients at a traditional practice.

Insurance is a terribly inefficient way to pay for most health care. Primary care, even including occasional urgent care, is relatively affordable – much more affordable than the insurance premiums. It is more economical to pay the doctor and nurse, than it is to pay the doctor and nurse, and pay their non-medical staff to process paperwork, also pay the insurance company staff to process paperwork, and also pay the insurance company profits.

The most sensible way to pay for health care is with a high-deductible catastrophic policy that we hope we never need to use, put the huge savings in premium cost into a Health Savings Account (HSA), then pay a DPC physician via a debit card from the HSA. There is much, much less overhead, the DPC practice spends more time keeping patients healthy, resulting in lower costs for specialists, surgery, or hospital care.

What doctors enjoy is interacting with patients, solving problems, helping their patients stay healthy. What they hate is paperwork, overhead, and a bureaucracy pushing them to spend less time with patients. They are so frustrated by middleman-governed health care that 9 out of 10 are unwilling to recommend health care as a profession.

DPC eliminates the paperwork, overhead and bureaucracy, leaving doctors happily working to improve their patients’ health. These doctors say “I am finally back to practicing medicine the way I was trained.” And that is the major reason that surveys show that 16% of primary care physicians plan to move to DPC or other retainer-based practice.