Thursday, July 10, 2014

What Is The Tipping Point for Direct Pay Medicine and Surgery?

The critical point in a situation, process, or system beyond which a significant and sustainable effect and change takes place.

Definition, Tipping Point

At what point does independent direct pay for care without third party involvement change take place? At what point will it replace traditional or government sponsored health plans?

If you agree with Malcolm Gladwell’s The Tipping Point: How Little Things Can Make a Difference (Little Brown and Company, 2000), you would predict: this replacement will depend on a number of factors, many of which may seem small and inconsequential at first blush.

Gladwell maintains sweeping societal changes are like social epidemics.

They have three characteristics – one contagiousness, often triggered by word of mouth; two, the fact that little causes have big effects; and three, that change happens not gradually but at one dramatic moment.

The Tipping Point comes at moment of critical mass, a threshold, a boiling point, like a viral epidemic. Viral social epidemics usually follow three rules : one, the Law of the Few, meaning a few influential few connectors, mavens, and salesmen spreading the word that change is imminent; the Stickiness Factor, a message that makes an impact that you can’t get out of your head and sticks in your memory; three, the Power of Context, the conditions and circumstances of the time and the places which they occur.

Who are the connectors, mavens, and salesmen for direct pay medicine? There are mainly four -

• one, doctors who have made the switch to concierge medicine and who endorse it;

• two, patients who are dissatisfied with the status quo, who are wholly satisfied with their direct-pay experience and who spread the word,

• three, self-funded corporations and other corporate or organizational entities who suddenly realize they can save a ton of money through direct contracting with direct pay doctors and surgery centers;

• four, the local and national media who are mesmerized by social shifts.

What are the stickiness factors that stick in patients’ minds?

There may be many – immediate same day access, unlimited time with a personal doctor, transparency and predictability of price, being able to call your doctor at any time of the day or night, lack of bureaucracy, bundling of fees with worry about the price of each test, procedure or service.

And what about the Power of Context?

Context factors include- the troubles of, most recently that many find they are not covered even though they have signed on and paid their first premium; the court challenges over whether the government, rather than the states, can provide subsidies; the fact that more older and sicker patients than anticipated have signed onto health exchanges, which is likely to drive premiums to unaffordable levels for the young and the older healthy; the reality that taxpayers are going to have to spend billions to bail out insurance companies because of government miscalculations.

If, because of these and other factors, the finances of ObamaCare begin to unravel and particularly if Democrats lose the Senate in November, the Tipping Point for direct pay care may have arrived.

The Tipping Point for direct pay will come secondary to a series of social outrages:

• failure to anticipate the number of older and sicker people to entering ObamaCare would cause double-digit premium increases in 2014 and beyond .

• limits of one-size-fits-all policies would create wholesale health plan cancellations .

• temporary jobs without health benefits would replace full- time jobs with benefits.

• businesses needing to increase employee contributions, replace full-time workers with part-timers and raise deductibles.

• Awareness that administrative and management costs comprise 50% or more of all health costs.

All this bad news will hit the fan in 2015, and the stage will be set for the direct pay epidemic.

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