Thursday, April 17, 2014

Disappointed Direct Care Coalition: Forces at Work, For and Against**

Don’t fight forces, use them.

Buckminster Fuller (1895-1983),  Shelter(1932)

Here I shall have a go at describing  forces at work  for and against primary care physicians – an endangered species,  and direct care without 3rd party meddling - who and what  everybody seems to want but nobody seems to know how to organize or back with support and capital.

Hospitals -  Hospitals need primary care doctors for referral to specialists,  their main source of income.   That is the  principle reason why hospitals  have acquired hundreds of thousands of primary care practices and why they now employ over half of the nation’s primary care practitioners.   As government systematically reduces payments to hospitals for Medicare and Medicaid patients,  however, down the road, hospitals will be forced to  lay off many of these physicians and to discontinue their services. What then?

Government -  Government’s answer to the primary care physicians  seems to be to place them as leaders of “teams” in  medical homes or accountable care organizations in order to cut costs and to "save"  Medicare and Medicaid,  by rationalizing care and cutting down on specialty referrals.   Primary care doctors,  partially replaced by nurse practitioners, physician assistants, and others, will, government reasons,   cut costs.  Primary care physicians are skeptical, for they know “teams" cost money and boost overhead.

Patients -  A sizable proportion of patients,  no one knows how many,  want  to be seen directly, quickly, and confidentially by personal doctors, who have time to spend with them without constantly looking at their watches in order to “process” them to get to the next patient,  so the doctor can ends meet with reduced government and private health plan payments. At the moment, many patients, both insured and uninsured, are realizing they cannot afford premiums and deductibles in ObamaCare exchange and private plans.

Doctors -   Primary care doctors want to practice medicine,  a skill that took  them 12 to 15 years and a $500,000 or so to qualify for, without spending 25% of their time punching data into computers, coding,  hassling with 3rd parties,  or dealing with bureaucratic regulations, all while devoting 50% of their practice overhead to these activities.  They want to spend their time talking to, listening to patients,  and examining them rather than being glued to a computer screen.  Primary care doctors  seek to make a reasonable income while practicing what they have been trained to do.  These doctors know they are not the source of soaring health costs, for primary care consumes only 6% of total health costs.

Employers – Employers want to cut health coverage costs for workers,  costs which have doubled or tripled over the last 10 years, without cutting benefits, raising workers’ premiums,  or paying stiff penalties to the government for not offering comprehensive “essential benefits,” which many workers do not need or wish to pay for.  They want their workers to have a choice of reasonable plans, and to have personal incentives to shop for care using part of their own money with rest left over for a rainy day in the future.

Satisfying Constituencies

How to satisfy all these constituencies while providing affordable, accessible, convenient care is a vexing question.

The answer will require private capital and private leadership, a tried and true business model, and overcoming stereotypes of doctor entrepreneurs who decide to go it alone by offering 3rd party-free, personal care, affordable care.   

 The capital may come from self-funded business who want to cut their expenses while offering their patients direct care to local physicians.  

 It is more likely to come from a coalition of forces.  One of these forces is likely to be businesses offering  health savings accounts,  with contracts and contacts with local direct independent  practitioners, including specialitsts, and new relationships with local and regional banks, who would profit from administering  funds for HSAs.   It is more likely come from  a coalition of forces demanding realistic change.

A Coalition for Direct Care

As things now stand,  a number of organizations are coming together behind the concept of “direct patient care,” without parasitic organizations and consultants profiting from direct patient-doctor relationships.   This effort will require a coalition of organizations bringing to light the need and demand for direct care and spreading the word.   

We live in an age of coalitions.  Obama has mobilized a “coalition of the ascendant” – minorities, young people, single women, and college-educated cultural elites.  Opposing them  is a gathering and building of a  “coalition of the disappointed”   - the shrinking middle class, the unemployed,  the uninsured, the working insured,  and primary care physicians – none of whom can afford ObamaCare.

Tweet: A disappointed coalition of organizations, doctors, and patients is growing promoting the need and demand for direct affordable  patient care. 

**(If you wish to comment or need more information,  email me at, or call me at 1-860-395-1501.  I am available for writing columns or articles  and for speaking engagements.   I would be happy to publish your comments on my blog, which is currently getting 4000 to 6000 page views each day. If you are interested in being a sponsor for this blog, feel free to contact me.)

1 comment:

Doctors Choice Placement said...

We've seen that government funded projects like USPS are failing as well. Private companies such as UPS on the other hand have shown steady growth from over $40 to $99 today in the last 5 years.

I could not agree with your opinion more, in that the privatization of convenient care. We've seen this model do fine in other sectors, and I assume it "if managed properly" would be a successful route here.

Informational post, thank you.