Sunday, May 18, 2014
Direct Pay Independent Practice: Physician Success or Government Failure?
Success has many fathers, failure is an orphan.
As always, victory finds a hundred fathers but defeat is an orphan.
Count Galeasso Ciano (1903-1944), The Ciano Diaries (1939-1943)
Something big is going on out there. Some call it Direct Pay Independent Practice. I call it Physician Recognition of Their Success and Re-Assertion of Their Rights.
Whatever you call it, there is no doubt modern medicine is a success. Infectious disease is on the wane, chronic disease is slowly being conquered, people are living longer, and many are living healthier lives well into their 80s and 90s.
Among the orphans of this success are centralized state-run health systems. With aging populations and rising health costs, these systems have become unaffordable and unsustainable. Everywhere social welfare systems face financial and political crises. Governments cannot control what transpires on the ground.
People everywhere are growing restless with expenses and waiting times, impersonal nature of government-run bureaucratic systems, and they are turning to more private, more direct solutions - be they personal insurance or direct pay relationships between consumers and doctors, or more self-care and self-responsibility on the part of consumers and patients.
Doctors are beginning to recognize that something is fundamentally wrong with systems that reward health care managers and executives more than skilled specialists and primary care physicians (Elisabeth Rosenthal, “Doctor’s Salaries Are Not the Big Cost,” New York Times, May 18, 2014). According to Times sponsored Compdata surveys, the base pay of insurance CEOs ($584,000), hospital CEOs ($386,000), hospital administrators ($237,000) often exceeds those of surgeons ($306,000).
Maybe, just maybe, solutions to high costs reside in cutting out the highly paid middlemen, growing armies of health care managers, executives, and insurers and placing that care directly back in the hands of patients and doctors.
Maybe the answers rest in decentralizing health care rather than centralizing care.
Maybe self-care principles, as taught by experienced primary care practitioners with enough time and rewards to spend with patients, are more effective than compliance guidelines from institutions and government.
Maybe consumers will respond to a system in which they have to spend more of their own money for routine primary care and less on insurance premiums with catastrophic backup for hospital-based procedures, will work more effectively and efficiently than the present system.
Maybe consumers will welcome the idea of the certainty of upfront transparent costs for a cash retainer for a global set of services rather than the uncertainties of individual fees and a surprise indecipherable bill that will come long after the event.
Maybe direct pay independent/concierge/retainer/cash only practices are a test of these “maybes” as an alternative to the current 3rd party insurance system.
Maybe these practices are a test of the efficiency and fairness of free market forces versus government regulation.
Maybe they are the reason many physicians are re-asserting themselves in the marketplace of ideas by forming networks of independent top doctors, by contracting directly with employers rather than 3rd party insurers, by doing as much work on an outpatient rather than an inpatient basis, and by culling out as many middlemen as possible.
Maybe these activities are driven by the fact that ObamaCare has become an orphan by failing to cut costs, by cancelling many current policies, by driving many doctors out of the market, and by creating bureaucratic barriers between consumers and doctors.
Tweet: Doctors are re-asserting themselves by turning to direct pay independent practices as as a lower cost alternative to ObamaCare.