Friday, April 25, 2014

If Not ObamaCare, What Next?**

When we look at revolution, we find outward acts against the old order are invariably proceeded by the disintegration of inward allegiances and loyalities.  The image of kings topple before their thrones do.

Peter L. Berger (born 1929),  American Sociologist,Invitation to Sociology
Next: The New New Thing

Michael Lewis ((born 1960),  American financial journalist, Title  of his 2001 book,  W.W. Norton. Inc.
It may be that government and health plans are about to be partially replaced by independent direct contracting between patients and doctors and between self-funded corporations  and doctors.

“Next” is a powerful word, a forerunner and a forewarning  of  an incoming wave of what  comes next.  What comes next may be direct contracting in health care while cutting out government and health plan middlemen for outpatient  primary care and specialty care contracting.

This is happening because American people and their doctors are unhappy with ObamaCare.   In 458 ObamaCare polls since 2009,  95.5% of people oppose he health law, 65.3% by double digit margins.   About 60% of physicians oppose the law, and 90% are advising their children and other young people not to enter the profession.

But if ObamaCare falls or falters badly, what’s next?  What’s the next health care frontier?  What’s next?

·         An ObamaCare fix – keeping the good, throwing out the bad?

·         A GOP marketplace- based  alternative plan?

·         A blend of government regulations and market regulations?

What is the next  incoming wave?  

It may be patients and and businesses contracting directly with direct independent  primary and specialty practices, acting in tandem, to reduce costs, increase convenience, reduce complexity  and bureaucratic impediments,  and make health care more personal,  by cutting out 3rd party middlemen for routine primary care and specialty care outside of hospitals.   In hospitals,  catastrophic insurance-mediated care will likely remain intact.

Primary care, routine 0ffice-based care outside of hospital and specialty care, comprises only 6% of total health costs, but is important because it is where most health problems can be first most efficiently addressed and  because it serves at the gateway to hospital and specialty care.

Specialty care, in offices, ambulatory surgery centers, hospitals, and after-care facilities and nursing  make up roughly 50% to 60% of total costs, when one factors in associated hospital and followup care.

Management, regulation, and compliance costs , through government and public insurers, contributes  30% to 40% of  total costs.  No one knows precisely how much.

But physicians know this -  50% to 60% of their overhead can be traced to regulation and compliance issues and to their  costs  contributing  to doing business.   And major self-funded corporations know that costs of  direct contracting  for procedures like hip and knee replacements offer  dramatically  lower costs than those costs done through insurers. 

And doctors and specialists are keenly aware that the cost of going through insurers or Medicare or Medicaid programs consumes 25% or more of their time – time that would be better spent spending time with patients, diagnosing, listening, and treating them rather being parked behind a computer, hiring scribes to enter data for them, or on the phone pleading for authorization.

Direct pay independent practice, is, well, more direct and less costly, not only in terms of  money but in more personal relationships.

**(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.)

Tweet:  The next wave of the health care revolution may be direct patient contracting between patients,  self-funded businesses, and primary care and specialty doctors.

No comments: