Doctors and patients getting off the medical merry-go-round

Published February 26, 2016

by Tom Campbell, Executive Producer & Moderator, NC SPIN, February 26, 2016.

We’ve talked for decades about healthcare reform but the only significant attempt to change the skyrocketing costs of health insurance, escalating pharmaceutical costs and deepening dissatisfaction has been Obamacare. Even its ardent supporters agree The Affordable Care Act is flawed and has not yielded the hoped-for benefits.

Patients are fed up with the impersonal treatment and mind-numbing paperwork at doctors’ offices. Insurance premiums and deductibles are rising faster than the cost of living. Patients question why our pharmaceutical prices are so outrageous while other countries costs are lower and wonder why millions are spent on television ads promoting drugs. Medicaid and Medicare ranks swell every month, increasing the role of government in healthcare decisions.

Doctors, especially primary care doctors, are equally frustrated, awakening to the reality they no longer work for their patients but instead are working for insurance companies. To be economically viable our fee-for-service system requires primary care docs to schedule four to five patients per hour; they don’t have the time to improve patient wellness and are essentially relegated to treating symptoms all day, filling out endless forms to receive established Medicaid, Medicare or insurance company reimbursements. After a frantic day seeing patients many go home to complete paperwork. No wonder doctor burnout is rampant and few medical students want to go into primary care.

So the medical merry-go-round continues. Nobody can get off, but they can’t hang on much longer. There is good news, a radically different approach to healthcare called Direct Primary Care (DPC).

Patients pay a monthly fee to become “members” of a practice, usually ranging from $15 to $60 per month, depending on the patient’s age. Doctors in DPC typically schedule only one patient per hour, ensuring they have much longer than the 7 minutes or less previously spent with a patient. Not only do DPC physicians treat chronic or symptomatic conditions but spend more time working with patients to improve overall health and wellness. Some have onsite nutrition and exercise consultants and frequently offer an in-house pharmacy or discounted prescription drugs by mail. But DPC practices do not accept, nor will they file insurance claims to the government or insurance companies.

The benefits are dramatic. Patients are significantly happier, report greatly reduced admissions to hospitals, take fewer prescription drugs and are healthier, restructuring their health insurance to cover major medical events. Recognizing the significant overall cost savings, a growing number of employers are signing up workers as members. Doctor burnout is reduced, since they no longer race from one patient to the next and their operating overhead is cut by as much as 40 percent due to the reduced paperwork.

DPC is not without problems. Only those able to afford the monthly fee can join. If DPC is to be the new model for healthcare something must be done to resolve this situation.

Direct primary care is a growing trend across the county and in North Carolina. Over 15 practices with more than 22 physicians now operate in communities as small as Nashville and Williamston and as large as Raleigh and Charlotte. The number of providers and patients is increasing daily as this has promise to be the healthcare revolution that gets doctors and patients off the medical merry-go-round.

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February 26, 2016 at 10:09 am
Richard L Bunce says:

Need to get US HHS and NC DPI to not regulate to prevent healthcare insurance policies from working with DPCs. A HDHCP with HRA that lowers premium to take into account using HRA to pay for DPC would be ideal.

February 27, 2016 at 9:00 am
Richard L Bunce says:

Georgia is taking some action to get the State regulations under control... US DHHS still an issue especially for those of us in the ACA Marketplace.

http://news.heartland.org/newspaper-article/2016/02/27/direct-primary-care-protection-bill-offered-georgia

February 26, 2016 at 10:17 am
Norm Kelly says:

What's the biggest impediment to DPC?

Government!

Using DPC takes Government OUT of the equation. Which pol is going to let this happen?

Even with the failure of socialized medicine, commonly referred to as Obamacare, left-wing zealots continue to say the reason for the failure isn't socialism, but too much free-enterprise still in the system. Left-wing radicals tell us that completely eliminating private insurance companies from the equation is the answer. Single-payer, as Ms. Hagan desired, takes insurance companies out of the picture, puts them out of business, and makes central planners the ONLY source of medical care. Single-payer, as designed by the left, makes it illegal to pay for medical care out-of-pocket, eliminating DPC.

The lie of obamacancer is becoming apparent, even to ardent supporters of socialism. Their answer is more of the same. Premiums went up because insurance companies are greedy, not because socialized medicine fails. Deductibles went up because insurance companies are greedy, not because socialized medicine fails. Coverage actually went down because insurance companies are greedy, not because socialized medicine fails. Just ask your friendly neighborhood socialist/lib voter, and they will tell you that single-payer is the only answer, and no other option should be considered. Ask Crazy Harry, or our own ex-Senator K, and they will tell you, without hesitation, that single payer is the way to solve the cost/benefit challenge. Taxing medical equipment manufacturers on gross income, the first ever business to have this done to them, works in the mind of zealots, and their solution would be to tax every business on gross income. The next step to 'solving' the medical 'crisis' is to take over 'big oil' because the profits from that business alone would allow central planners to provide free medical care to every individual in the nation. At the same time, it would eliminate 'subsidies' for big oil! A left-wing zealot utopia! (and, yes, the zealots have already floated this balloon!)

What part of government getting out of any aspect of medical care is considered by radicals? Anything other than single-payer is prevented from even being discussed. At least by the zealot lefties amongst us.

The more we can get people in direct contact with doctors, the better off our entire nation will be. Which automatically means getting government totally, completely, 100% out of the picture. When central planners get involved, everything else is eliminated, cuz central planners eliminate competition. Central planners NEVER increase competition. This is another fact that has come out of phase 1 of socialized medicine. Allow me to pick my doctor, pay what we agree upon, and buy the insurance policy that fits MY needs regardless of where the company resides that I buy from! Increase competition among insurance providers, allow me to pick & choose what's covered, and get central planners out of the picture, and watch the market boom!

February 27, 2016 at 9:45 pm
John Clark says:

Tom, Direct Primary Care does not rise to the level of a band-aid in solving healthcare in this country. The Affordable Care Act gets a plus for attempting to expand coverage of millions who were not covered before and it has introduced certain benefits on the preventive side such as coverage for colonoscopies. It however leaves in place the for-profit third party insurance companies which exist first of all to make a profit and secondly to help people pay for their medical bills. Their deductibles, copays and limitations to doctors and hospitals limit healthcare access.

It leaves in place the high administrative costs that doctors, clinics, and hospitals have to pay staff to talk to the insurance companies to negotiate what gets paid. The most recent data placed that cost, including insurance company salaries, at close to $400 billion a year.

On top of all of this, the health results of the U.S. compared to other developed countries is near the bottom while the per capita costs of healthcare, given our private insurance model, is almost twice as much. In short, we are paying twice as much as those countries to get poor health results.

When you add the clout of the big pharmaceutical companies into the mix, the recipe is a dire one for any chance of controlling the rising healthcare costs. Over the next number of years, this will be the galvanizing reason to move to a Medicare for all system. Please go to the Physicians for a National Healthcare Plan website for some solid data about a single-payer system: http://www.pnhp.org/

Thanks.

February 28, 2016 at 1:40 pm
Richard L Bunce says:

Healthcare insurance is a personal financial tool to reduce financial risk... as is all insurance. It is not healthcare as much as some would like to make it. Under the ACA like minded folks could get together in at least regional and probably get a waiver from HHS for a national healthcare insurance cooperative. Single payer is not about getting people who want to be in a national plan into one, it's about getting the people who do not want to be in a national plan into it to provide a significant portion of the revenue.

90% plus of the people in Medicare have private Medicare Supplements and the majority have private Medicare Part D prescription plans because Medicare Parts A and Parts B are substandard government run healthcare payment plans... not insurance. A third and growing number of Medicare beneficiaries are moving to Medicare Part C, a private healthcare insurance plan.

People that do not like private healthcare insurance plans, do not buy one. Leave the rest of use alone.

February 29, 2016 at 8:59 am
John Clark says:

To Richard... The current Medicare program, requiring as you note private supplemental plans, would not require such plans under a national single-payer plan that covers every one.

To Norm... those who keep saying government is the problem is like saying white people are the problem. The ACA comes up short because of the power of the health insurance companies and the corporate pharmaceutical companies prevented meaningful reform when the law was formed. Costs will keep rising until there will be a powerful demand for real change.

February 29, 2016 at 3:28 pm
Richard L Bunce says:

Medicare is essentially that single payer plan for everyone 65 and over... it does require those things and more and more beneficiaries are looking to get out of the traditional program. Government will do better the next time is a claim without merit. THe vast majority of private healthcare insurance plans have had a drug benefit since at least the 80s... Traditional Medicare still does not.

March 1, 2016 at 8:13 am
John Clark says:

Richard, I never said 'government will do better the next time'.... A single-payer plan will not be Medicare as it exists now applied to all. It will have components that make supplemental plans irrelevant (they were simply compromises to allow for-profit plans to have a stake). The ACA is flawed as it piggy-backs on the third-party insurance companies. Check the facts--the U.S. has the highest health costs per capita of any developed western country, yet is way down on the list of positive health outcomes. It's fine if you look at the total picture and then decide you still want for-profit third parties setting rates, copays, deductibles. As for government v. private market, I remember well the crash in 2008--hardly a government failure. Thanks for the give and take.

March 1, 2016 at 10:56 am
Richard L Bunce says:

Government had it's hands all over the 2008 recession...

Healthcare insurance is a personal finance tool, not healthcare. You want to be in a national plan run by the government fine... you and your fellow travelers have at it. Your people in your plan will fully fund it. Those of use who prefer freedom and choice and dealing directly with private business not government bureaucrats for healthcare insurance will be happy to see ya'll move on... and get significant government regulation reduction in our personal finance tools once ya'll are gone.

March 1, 2016 at 11:00 am
Richard L Bunce says:

Government had it's hands all over the 2008 recession...

Traditional Medicare established in 1965 is still essentially the same program while private healthcare insurance evolved to cover the actual financial risks in the market that people were experiencing. The supplements, Parts C and D were a response by the private sector to beneficiaries demands for real healthcare insurance not a flawed government payment plan.

Congress, President, HHS bureaucrats will come up with the same flawed approach for all as they have for Seniors and the poor and the vets. My providers provide me world class care and many folks around the world travel to the US for that care everyday. You are confusing care with financing... and falling for social engineering nonsense from WHO reports.

March 3, 2016 at 9:23 am
John Clark says:

March 4, 2016 at 10:57 am
Richard L Bunce says:

You have the single payer spin down... despite decades of failed government programs... especially large government programs... this one will be different. Why don't you make it voluntary single payer and revenue can only be collected from those who voluntarily participate and must follow the same foolish regulations applied to private healthcare insurance plans... best change would be to get rid of the government regulations on healthcare plans, private and government in this case. All these great ideas have to be mandatory... clearly not so great.

March 4, 2016 at 12:57 pm
John Clark says:

The private insurance plans have been in control for a half-century, Richard. They are the ones which established co-pays, deductibles, drug coverage limits pre-existing conditions, premiums levels, in-network requirements, etc, etc. If you are wealthy, even $250,000 annual income, you can purchase the best healthcare. The problem is 98% or more of Americans can't always get that and millions are still not covered even with the ACA. Keeping fellow American citizens healthy without pinning them down financially or for many families, bankrupting them should be the major goals. The private market of paying for healthcare is has a long track record and it is terrible when considering those two objectives for all citizens in this country. What role the federal government has played during this time is to moderate the negatives.

March 5, 2016 at 10:10 am
Richard L Bunce says:

You are whistling through the government graveyard... Medicare and Medicaid is over 50% of the healthcare payments in the US. The excessive regulations and low/nonsensical reimbursement rates from these programs is easily the biggest problem with US healthcare. You still have not addressed why if it is such a wonderful system that is must be mandatory for all? I get all of my insurance products (all are personal finance tools, not health, home, auto, life tools) You want to buy in to the VA system fine, leave the rest of us alone.

March 6, 2016 at 10:09 am
John Clark says:

Richard, your fact is wrong. Medicare and Medicaid payments during the past several years have averaged around 30% of all health payments in the U.S. Out of pocket payments have shrunk from about 23% in 1980 to about 11% in 2010, because the private health insurance industry has sought and gained more customers. Check this source-Kaiser Family Foundation (not connected to Kaiser health insurance):

http://kff.org/report-section/health-care-costs-a-primer-2012-report/ You're also not reading what I've written. The single-payer national plan covers everyone, not like it is now with its patch work of payment sources and high operating expenses. The rates for payments would be fair and reasonable and no doctor, clinic or hospital would go broke. Most importantly, medical care providers would not be under the government, like the VA, but would remain private or a nonprofit. After looking at the facts and one disagrees, that's fine, but for those who simply repeat the 'anti-government ideological mantra'I simply shake my head.

March 7, 2016 at 11:16 am
Richard L Bunce says:

Medicare, Medicaid, and the rest of government... 52%

http://blogs-images.forbes.com/realspin/files/2015/07/Health-21.jpg

http://www.forbes.com/sites/realspin/2015/07/29/for-the-first-time-government-programs-make-up-the-majority-of-u-s-health-spending/#2f62fdb78e1c

As for the rest of your claims about the wonders of a single payer system, that is not born out in any government run single payer system in the US... Medicare and Medicaid have the lowest reimbursement rates and providers opting out in increasing numbers. Don't like the government bureaucrat service in your plan... too bad... no other plan allowed. Decoupling payments (risk based premiums) from care always leads to moral hazard issues. When the government only allows payments from government plan to providers the providers will effectively be working for the government. Like all failed government programs, War On Alcohol, War On Drugs, no War on Healthcare Insurance... criminal organizations will step in and meet the demand.

Again, you are free to start/join and national not for profit healthcare cooperative... you and your fellow travelers can reap the alleged benefits of your single payer plan... the rest of use can continue on with private healthcare insurance to cover our personal financial risk and private healthcare providers to cover our healthcare risks... without government over regulation.

March 8, 2016 at 8:12 am
John Clark says:

Your previous comment stated that Medicare and Medicaid represented 50% of health care costs. CHIP is another program covering children of parents whose income is too high for Medicaid eligibility but too low to afford private health insurance. It's another example in our country that shows the marketplace approach leaves million of people out of luck. Our government, through out elected representatives, then decides that we can't let young children be without some coverage in this. The market can be very effective with other kinds of commodities but to make sure our fellow citizens are healthy without going bankrupt or worse it has been a major failure.

March 8, 2016 at 11:34 am
Richard L Bunce says:

Government healthcare... all a disaster in wasted, fraud, and abuse. Private healthcare is doing fine. Healthcare insurance is not healthcare... it is a personal finance tool to reduce financial risk. We do not need more failed mandatory government healthcare payment programs. At least CHIPS is voluntary participation if not funding.

March 10, 2016 at 5:05 pm
John Clark says:

Richard, you're so woefully misinformed, primarily blinded by your anti-government ideology, that I'm happy to give up any kind of exchange.

March 11, 2016 at 11:48 am
Richard L Bunce says:

I am very well informed on this issue... it is you that is locked into a government solution to a "problem" that is largely government created. More government power, more government revenue, less actual healthcare.