OK, I know it sounds a little ambitious, but I want to change our healthcare system.  Yeah, probably not just a little ambitious...but I am convinced that the model of care my practice uses (direct primary care) has the real potential to change everything. 

It may seem like the system is far to big with too much inertia to ever be significantly changed, especially by a small idea like direct primary care.  But consider the world outside of healthcare:

  • Eastman Kodak was totally disrupted by the creation of digital photography and social networking (I wrote about this in detail on my blog).
  • The recording industry has been totally disrupted by iTunes and other online sources of music.
  • The newspaper industry is a shell of what it once was with the advent of the Internet.
  • When is the last time you called a travel agent, or an airline for reservations?

Technology can be used to create new methods of solving problems can make complex tasks much simpler and greatly reduce cost.

I think that direct primary care (where my patients pay me a flat fee for their care), combined with smart use of technology to enable efficiency, can change everything.  Add to that the fact that there is almost universal acceptance of the fact that the system is seriously broken (among doctors, nurses, patients, and even politicians), and there is very strong motivation for change.  The model has many features that stand in stark contrast to "business as usual" in healthcare:

  1. It is simple.  Patients pay the doctor for their care.  The doctor does not have to figure out codes to submit to insurance companies, or write a 5-page note for an ear infection visit to justify being paid.  The doctor has only one person to please: the patient.
  2. It aligns motivations of doctors and patients.  The regular health care system motivates doctors to have sicker patients and to do more procedures on them.  It also discourages doctors from spending extra time listening, discussing, and educating patients (since it rewards for seeing a higher volume of patients).  In my practice I am paid the same if my patients are healthy or sick, and for an empty office as a full one.  This means that I am rewarded for getting to the goal my patients want: to be healthy and avoid going to the doctor.
  3. It is more efficient.  Since my payment system is simple, I don't need any staff to focus on submitting codes to and getting money insurance companies.  This greatly reduces my overhead.  The office model also allows me to handle problems without requiring office visits, so I can handle problems over the phone or electronically.
  4. It saves money.  I am motivated to find ways to save patients money (by getting cheaper medications, avoiding unnecessary ER/Hospital visits) because that gives them return on my monthly fee.  I am not motivated to order more tests or unnecessary consults.  

I truly believe that, if this model is adopted by a large enough number of physicians, we can create a force bent toward less spending, healthier patients, and better communication.  This could change everything.  

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