“Acquiring physicians’ practices is not that profitable of an endeavor,” said Dr. Wayne Jenkins, who oversees Orlando Health Physician Group, hundreds of multispecialty physicians employed by Orlando Health. “It gets to where we’re going in the long run.” That long run is a move from a fee-for-service payment model to value-based reimbursements, which reward good outcomes, fewer readmissions and nonduplication of tests, Jenkins said. State Newspaper article here.
On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as "Dr. Hodad." I hadn't heard of a surgeon by that name. Finally, I inquired. "Hodad," it turned out, was a nickname. A fellow student whispered: "It stands for Hands of Death and Destruction." WSJ article here.
“White House officials said cuts to Medicare would fall on health care providers, not beneficiaries.” NYTimes article here.
The quotes above, one from the NY Times, one from the Wall
Street Journal, and one from The State (Columbia, SC) combine to offer a
glimmer of hope about the future of health care in the USA. It is a future not inconsistent with the
Affordable Care Act (Obamacare) but one that would render much of the new legislation
of little consequence and would satisfy one primary interest of President
Obama, elimination of the fee-for-service payment model. The way that could happen would be for the
health care providers, hospitals, physicians, nurses, and support staff, to
seize the initiative and form one stop total health care provider organizations
willing to work as teams, publish their performance statistics and prices, and
offer “memberships” directly to health care consumers. A few thousand Mayo
Clinics, all publicizing their prices and results, scattered around the
country. That kind of change could put
the insurance companies completely out of business and rebuild the
customer/supplier or physician/patient relationship that has been lost over the
past few decades.
A hint of that kind of change can be seen in the first quote
above, a positive note buried in a 9/23/2012 The State Newspaper article threateningly titled
“Fees Rise as Hospitals Take Over (Physician) Practices.” The gist of the article is that physicians are
joining hospital staffs because hospitals are more powerful negotiators and can
extract higher fees from insurance companies than small medical practices and
because small medical practices are tiring of the cost pressures, increasing paperwork,
and other management difficulties that accompany their basic work of providing
medical care.
But Dr. Jenkins, quoted
above, strongly hints that he believes that consolidation is an
unfortunate first step required for ultimate improvement of efficiency and
quality in delivery of health care. He
is probably less excited about the competition that is sure to come as
competing consolidated teams begin offering full range health care of greater
quality and with higher customer satisfaction ratings at decreasing and
transparent prices, but we will all be better off for it. And most health care providers will enjoy
greater job satisfaction.
The second article with the quote about “Dr. Hodad,”
addresses a problem that has to be fixed for such one-stop health care provider
organizations to succeed. That is the
problem of poor or non-existent quality measures and standards combined with a
culture of silence or professional courtesy, allowing continued substandard
treatment by individuals. Some
physicians with poor reputations are apparently referred to as Dr. Hodad (Hands
of Death and Destruction). Tolerance of
such performance on a top-notch health provider team should be at about the
same level as of an NFL lineman who keeps missing his blocks and allowing QB
sacks.
And, in the third quote, there is that nonsense about
Medicare cuts falling on health care providers and not on beneficiaries,
patients I assume. Well, whatever it takes to avoid scaring people on Medicare, I suppose. But, I have been on
Medicare 5 years now and, as far as I know, all the benefits paid in my name have
gone to providers. At least I haven’t
received any checks.
I do get a lot of funny Medicare-related snail mail such as a recent notification that
a trip to the dermatologist resulted in “submitted charges” of $229, payment by
Medicare of $17.23, and payment by United of Omaha of $144.31. The missing $67.46 was deemed “NON APPRVD.” I have no idea how all that was determined
and suppose it is none of my business, but I’m guessing that if I had told the
check out person at the physician’s office that I had no insurance and offered
cash on the spot with no paperwork or waiting for payment, they would have
wanted to collect $229 from me. That is
ridiculous, and it is part of a broken system bogged down in medical waste.
But, back to the point.
This paperwork burden and control of payments to physicians, which will
increase as some Medicare funds are moved to fund the Affordable Care Act, will
only result in fewer physicians willing to serve Medicare patients and will, contrary to the administration promise, fall on beneficiaries as physicians give up their small practices to
retire or join hospitals that will put them on salary and handle all that
troublesome paperwork and insurance negotiation. At least until the hospitals get strong enough and
capable enough and successful enough to operate on a membership basis,
eliminating those troublesome insurance companies.
So, in my dreamy future, I look forward to being able to study the fee schedules, “membership”
fees, capabilities, physician ratings, and quality records of three or four
major health care provider organizations in the Columbia area, choose one, and
go there for all my health care needs. A
good target price in today’s dollars for such a service on a membership basis should be about $500 to
$600 a month. If I am a person with ample resources, I will just go there as
needed and pay the fees published on their fee schedule. If I am a middle income person concerned
about financial security and with limited resources, I will sign up for the
membership and send in a check every month. And if I am poor, able to prove unaffordability,
I will have the privilege of making the same study, choosing my provider, and getting federal or state
assistance in paying the membership fees.
That would be pretty simple, wouldn’t it? And, of course the provider I choose would be unable to reject me for pre-existing conditions or fire me if I get sick, two promises of the Affordable Care Act fulfilled.
A number of medical practices are moving toward outcome rather than fee for service. The Eau Claire Cooperative is one such organization in the Columbia Area. Despite that the medical practice may be starting to look like the service still remains within our fee for service environment, the greatest obstacle to driving health care costs down to be more inline with other developed nations. The political magic trick of biblical proportions is to end the insurance business.
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