From the Married to a Doctor Series of Op-Eds
By Jashar Rentz, M.Ed.
AIM CFO and Operations Director
I made a big change this year. I left a career in education and educational leadership, and took on the challenge of supporting Dr. Brooke’s dream and vision of health and wellness care. Turns out, I have a lot to learn. So I did what any bookish academic would do…I started gobbling up every book I could find. Every article. Every interview. I started digging deep into the world of Healthcare in America, and it didn’t take me long to realize that the core of it may be more rotten than the flesh suggests.
It’s weird to me that in this country we pay more for Healthcare than practically any first world nation, yet are so unhealthy as a population. Pick your citation for this sad truth, as there is plenty of evidence out there pointing to both these facts. But why? Why are our outcomes so poor, when our cost is so high?
This article outlines what I have observed as the three largest issues facing healthcare in our country today. These are based on my experience running a family medical clinic, on research, on dealings with the various players in the industry, and on interviews with a variety of doctors that appeared in print.
I bring them up for two purposes: first, I want people to understand that these issues exist, and are pervasive in America’s Healthcare system; second, I want to share what we at AIM are doing to counter these challenges.
- No Substitute for Time:
I shared an article a few months ago in which MDs lamented the fact that they are unable to spend more time with patients. They shared that such short visits did not allow them to see all the variables that may impact a person’s diagnosis. They bemoaned the fact that patients were seen as numbers, and that they missed important connections because of the limited time they had to spend with the patient.
These aren’t Naturopaths, or representatives of NDs; these are hospital-employed MDs all over the country. I’m paraphrasing, but the principal challenge that they raised is that the system is rigged to encourage doctors to spend the minimum amount of time with a patient in a given visit. This lack of time, they lament, causes otherwise good doctors to miss things. Often, what they miss is the connections between medical issues a patient experiences, or fail to discover the deeper cause of a symptom.
Conventional doctor visits last about 8-10 minutes. In a hospital setting, this can be even less. Even the best doctor can’t be expected to get a diagnosis right in such a short time. Doctors recognize this fact. They write about it, complain about it, and discuss it professionally. So, the question becomes: why does this pattern persist?
- Insurance Companies Make the Rules, because they pay the bills and because they fund a lobby:
The second of these important hidden truths about healthcare becomes evident when you follow the money. Insurance companies pay a doctor based on the code they use for a visit. However, barring some special cases, that code is the same if the visit is 8 minutes or 45 minutes. From there, its just math. If I get $80 reimbursed to me from a typical office visit code, then I have a choice to make. I can see patients for lengthy, comprehensive, visits, or I can see patients for shorter, more acutely focused visits. If I choose the former, I am also choosing to get paid significantly less for a day’s work, even though the patient experience is much better. If I choose the latter, I can still give adequate care in shorter visits, and I can make a lot more money. Consider that in an 8 hour day, the doctor choosing the shorter visit model can see 30-40 patients per day. The doctor choosing the more comprehensive, patient-centered, visits can see around 10 people in that day.
What does that mean? Well, it means that this is not actually a choice at all. Imagine a tech startup making that choice: the choice between better patient service versus a 4-fold increase in revenue. In fact, put another way, could your business survive with 1/4 of its current revenue? Of course not. Therefore, this is not a choice at all. If you want to be fiscally solvent, you have to provide care in the way that insurance companies desire. Now technically this is a choice. Your doctor can also choose to go broke, but technically it’s a choice.
It’s kind of like the “choice” that you have when it comes to insurance companies. You can “choose” not to carry insurance…but it’s illegal now, and you’ll pay out the nose in tax penalties. It’s not a coincidence that the very insurance companies profiting from this law were at the table to write it. Because of that influence, we have a situation in health care where we as a nation spend over 5 times as much as other first world nations, and the result is that we have worse care. In personal terms, we see our premiums going up, and our coverage dropping, even as we are legally all required to carry insurance, and were told that would make cost reasonable. Confused yet? You should be.
- The Insurance Customer Service System Implicitly Encourages Blame-shifting:
Insurance companies employ armies of so-called customer service representatives for the “benefit” of their customers. However, the people you as the patient call are very different from the people that we as an office call. In fact, our experience has been that insurance companies often misinform clients, or clinics, or both. Their confusing policies make certain visits seem like they would be covered, but in a surprise twist, they won’t be. For example, a patient comes in for their yearly well exam. But during that exam, they note that their throat has been scratchy and wants to know what to do if it gets worse. Sounds reasonable right? Nope. Technically, once the patient brings up the throat, it is no longer a well exam because technically the person is not well. Thus, the visit is subjected to deductible and co-pay, creating additional cost for a patient where there should be none.
Let’s take that example one step further. Who does the patient complain to in this example? Well they can go through the random phone tree of their insurance company, only to have a detached voice tell them that unfortunately their policy states that their visit was not technically a well visit. Or they can call the place where they have the actual relationship—the clinic itself.
My friends, this is not an accident. Almost every irate patient I have ever spoken to is ultimately upset over something related to insurance company decisions, but who think that we, the clinic, have some control over the process. They tend to blame us, rather than the real culprit. And, honestly, I can’t fault them for it. If they call us, they get a human who cares about them and advocates on their behalf to the insurance company. If they call their insurance company, they get the run-around.
When you think about it, this makes sense when you are the insurance company. The client has to use you…it’s the law! You have no incentive to make things better for the actual patient.
But what about the free market, you say? If an insurance company is really that bad, people will buy insurance from another company. I would argue that the reality is a lot more like airlines…they are all cramped with poor service, and they all charge too much. So it’s harder to use the free market here than you think. That’s especially true since there are laws that prohibit competition across state lines for insurance companies. In other words, if a company in Arizona is offering a better deal, you’re stuck with what we get in our state.
What this all means for you, and for us:
So there you have it: the three largest elephants in the room that is America’s Healthcare System. However, this article is about solutions, as well as shedding light on the real problems.
My high school swimming coach had a sticker on his briefcase that said: “Either lead, follow, or get the hell out of the way!” I think that statement is somewhat applicable here. You can follow the lead of insurance policies, or you can get the hell out of the profession.
Or you can lead.
That takes different forms. For us, we are leading in two primary ways. First, we are leading with an innovative business model that allows us to deliver top-notch care and also work with the existing insurance regulations. This isn’t intended to be an article promoting our Concierge Wellness Program, but that’s essentially our creative solution to the problem of time that we discussed earlier. For patients who want that more complete level of care and that enhanced doctor-patient relationship, we ask that you put in a little bit each month since your insurance doesn’t truly allow for that model. Second, we have developed a relationship with Bastyr University in which we guide medical students as preceptors and interns. Taking that a step further, we are actively working with Bastyr University to develop a more sustainable and consistent residency program for ND graduates, to help mitigate the experience gap that exists between new MDs and new NDs.
For you as a patient, this means that you need to remember that where you put your money defines your values. If you value comprehensive wellness care, diet, nutrition, and lifestyle care, then you need to patronize places that deliver that care. And you need to spread the word locally, and get involved politically. Spread the word about comprehensive, holistic medicine. Condemn the conventional 8-minute doctor visits that have defined our health care culture. Vote for people and policy that supports the needs of patients, and not insurance company and pharmaceutical profits.
Take action with your words, your clicks, and your dollars. AIM for health, and for a better healthcare system.