Our Approach To Healthcare

Healthcare Crisis: A Broken System in Need of True Reform

Today’s healthcare industry is in crisis. Access to quality healthcare is diminishing, billions of dollars are being wasted, and millions of people are going without care. These problems are being complicated by the majority of medical students choosing to specialize rather than go into primary care. Healthcare reform legislation is taking steps to address some of these problems, but significant progress remains nonexistent.

What is the cause? Health insurance – a product originally created to cover unplanned serious illnesses and crises – has grown to manage our routine, everyday health needs.

Insurance remains a critical element in the healthcare of Americans – for expensive, unusual, unpredictable events. When health insurance is used as a payment system for everyday healthcare, significant problems arise. When insurance infrastructure is used to administrate the high utilization and low cost of primary care, it actually makes primary care more expensive and less effective.

 

Americans are paying more for health insurance but getting less.
  • The costs of employer-based health insurance premiums have risen 114% since 2000.
  • Americans are paying higher deductibles. The average family deductible increased from $1,034 in 2006 to $1,518 in 2010.
  • American families are not only paying higher deductibles, but also higher co-payments as well. In 2004, only one in five people with health insurance through an employer had a copayment of more than $25. In 2008, that number was one in three. In 2009, it was nearly one in two.
  • A middle-income family with individual coverage spends an average 22% of household income on healthcare while a similar middle-income family with employer based coverage spends about 8% of their income on healthcare costs.

 

Millions of Americans are going uninsured or underinsured because of escalating healthcare costs, decreased access to healthcare, and gaps in quality of care.
  • 86.7 million Americans were uninsured at some point during 2007 and 2008.
  • Working families make up 80% of the uninsured.
  • Insured Americans are going without needed medical care due to expensive co-payments and deductibles.

 

Primary Care Defined

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Take a moment and examine the primary care services you receive. Does the above definition describe what your primary care looks like?
  • Diagnosis and treatment of acute and chronic illness? Check. We all currently get this through our healthcare providers.
  • Health promotion? Does your doctor promote good health to you?
  • Disease prevention? Does your doctor discuss with you and implement methods to prevent disease?
  • Health maintenance? Does your doctor work with you to maintain good health?
  • Counseling? Do you receive counseling from your doctor?
  • Patient Education? Do you receive education during your visit about your body chemistry, physiology, health status, medications, testing, results, or treatment plans?

Do you have the “how” and “why” questions answered, or does the nurse simply pat you on the shoulder and tell you your tests were normal?

 

Do you believe your healthcare is cost-effective?

The average person visits their primary care provider 3 times per year and consumes no other healthcare services.

  • The average primary care visit lasts 15.7 minutes.
  • The average annual insurance premium is $6,797 per person.
  • When calculating the average premium cost in proportion to the average consumption, the ratio is:

$2,265.67 per 15.7 minute visit or $8,658.62 per hour.

Is your healthcare a partnership?

Are you knowledgeable enough to engage as a partner in your healthcare, or do you simply trust whatever your doctor says? Most people blindly trust their doctor. Do you take this approach with your finances, your business, or any other area of your life?

 

What role does your insurance play in your relationship with your physician?

Insurance companies dictate the delivery of care, as well as payment for services rendered.

According to a study by Health Services Research:

  • Median visit length = 15.7 minutes
  • Median of six topics
  • About 5 minutes spent on the longest topic
  • Remaining topics each received 1.1 minutes

 

The study conclusion?

Many topics compete for visit time, resulting in small amounts of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on patients and physicians, the effects of financial incentives, and the time costs of improving patient- physician interactions.

A typical primary care visit:

  • Patient presents with a chief complaint
  • Testing may or may not be performed
  • Diagnosis is made
  • Symptoms are treated
  • Visit ends

Does your physician perform everything referenced above, or does your physician simply manage and control your symptoms? If you are obese and have high blood pressure, does your physician work with you in a way to resolve your condition, or does your physician simply prescribe medication to control your blood pressure until it becomes uncontrolled and your physician decides to increase your dosage?

This is a very reactive approach to medicine, and it is failing.

 

A Clinical Model That Is Backwards

There are two drivers in healthcare, and only two: Volume and Acuity

The more volume, the more money a physician makes. The greater the complexity, the more money a physician makes. These drivers cannot work in tandem, as you cannot have volume and complexity at the same time. Therefore, one must win out. In the realm of primary care, the money is in the volume. If volume is the primary driver, then quality suffers.

That then raises an interesting question…

If you have a condition that requires you to visit your physician once a month for a year and you are cured of that condition and resume your average consumption of three visits per year, then your physician will take a big pay cut.

If physicians need volume to sustain their practice, are physicians incentivized in our current healthcare model to keep us sick?

Example: When you phone your physician’s office for a refill on your prescription, does your physician require you to schedule an appointment to see him? Many do, so that they may bill for a visit.

 

Our Healthcare Industry Is Unsustainable

Healthcare in this country is plagued by the following factual trends.

  • Consumer premiums are increasing.
  • Costs for insurance companies to operate are increasing.
  • Complexity of the process is increasing for all players.
  • Industry sustainability is decreasing.
  • The Patient/Provider relationship is deteriorating.
  • Access is decreasing.

Regardless of your political affiliation, unbiased healthcare experts and industry leaders all agree that “Healthcare Reform” will continue to make all of these symptoms much worse.