Sunday, October 5, 2014

The Physician’ s Role in A Consumer-Driven Health System

The American public supports the idea of consumer-driven health care. When people ask me the title of my latest book, the almost invariable reaction to its name, Consumer-Driven Health Care is, "Well, it's about time!" whether the person is the barista at the local Starbucks, a business executive, a cabdriver, or a doctor.

Regina Herzlinger, Professor, Harvard Business School, Consumer Driven Health Care: Implications for Providers, Payers, and Policymakers, 2004

The winds and saves are always on the sides of the ablest navigators.

Edward Gibbon (1737-1794), The Decline and Fall of the Roman Empire

A school of thought exists that says we are witnessing the decline and fall of the Medical Empire.

Physicians are under attack as the main cause of soaring costs, primary care doctors are in sharp decline, specialists are in league with pharmaceutical companies, ObamaCare is slashing medical fees and burdening everyone with mandates and regulations, and consumer driven alternatives to medical care cropping up on every street corner and every website.

I take exception to this school. Physicians, by dint of their medical training and their experiences on the front lines of care. are the ablest navigators through convoluted maze care.

It is true that information technologies and consumer-driven alternatives are blurring and obscuring responsibilities and medical boundaries. The Internet abounds with medical advice. You can get care at retail clinics in CVS, Walgreens, and Walmart, and talk radio and TV contains countless ads for herbs, vitamins, antioxidants, dietary supplements, gluten-free diets, natural foods, exercise regimens, and miracle weight-losing diets. Chiropractors are into holistic medicine, and acupuncture therapies are proliferating.

Physicians are ideal navigators. They know that most, but not all, components of alternative medicine, have not been proven to work through double-blind controlled studies. Outside of celiac-disease, gluten sensitivity is rare. Vitamin deficiencies are rare, but most vitamins and well as antioxidants do no harm. Physicians know when back pain may be a sign of a serious underlying disease and may requires surgical or medical treatment rather than massage or manipulation.

Physicians are useful backups for nurse practitioner clinics in retail outlets, who serve a useful purpose in some routine care, for bumps and bruises, allergies, and for immunizations. Physicians through their office websites, blogs, and presence of Facebook, Twitter, YouTube, and Google, they serve as reliable sources of useful information and referrals (Kevin Pho, MD, and Susan Gay, Establishing, Managing, and Protecting Your Online Information, Greenbranch Publishing, 2013).

More and more, physicians can help patients and payers save money and administrative expenses through direct care outside of traditional care covered by third party payers. This care, unburdened by government and insurer regulations and administrative expenses, is being provided by concierge physicians and ambulatory surgical facilities offering bundled care for set prices. In concierge practices, which charge monthly or annual fees, physicians are available 24/7 for advice and for first-day appointments, are able to spend extensive time with patients, and provide a variety of services for a set fee. In direct cash ambulatory surgical centers, fees for procedures include anesthesiologist and facilities fees, often at 1/6 to 1/10 the charges of most hospitals .

Increasingly, consumer driven care is being delivered by physician navigators in non-traditional, decentralized, outpatient settings, including direct care practices, urgent care clinics, freestanding emergency rooms and clinics, and even in the home.

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