Time Mag - Medicine is about to get personal (1 Viewer)

[E-Z Glider]

Link

Healtchare is a disaster. This article makes sense to me. Why arent we already doing this?

Highlights...

The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.

The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid. Car insurance doesn’t cover oil changes, and homeowners’ insurance doesn’t cover house paint. So why should insurance pay for your annual checkup or your kid’s strep swab?

Josh Umbehr, 33, was an aspiring primary-care doctor at the University of Kansas when, like many others, he grew horrified by the fee-for-service system. “It was crazy,” he said. “Insurance paid more for a prostate exam if it was done on a separate visit from a checkup. So the patient would have to come in twice. Medicare would pay for cleaning out earwax–but only one ear per visit. You had to schedule a second appointment for the other ear.”

Then he discovered direct care. As the son of a garbage collector, he understood the idea of one price for unlimited service. With classmate Doug Nunamaker, 34, Umbehr launched a moderately priced clinic called Atlas MD. The idea caught on enough that they recently hired a third doctor. Now they care for about 1,800 patients at an average monthly price of about $50 each.

An entrepreneurial dynamo, Umbehr paints a sky’s-the-limit future in which primary care is transformed into medicine’s most valuable role. To hear him tell it, he’s already living that dream, seeing an average of five patients per day–with other interactions by phone, text and email–while earning $200,000 to $240,000 per year. (The national average for primary-care physicians is well below $200,000.)

 

[StrikeS2k]

None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list.

 

[E-Z Glider]

None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list.

Not suggesting its the answer to all the problems, but seems like a simple solution to the primary care problems?

 

[StrikeS2k]

None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list.

Not suggesting its the answer to all the problems, but seems like a simple solution to the primary care problems?

Most people want one comprehensive solution to their health care needs, not a piecemeal solution. Clinics have been around forever anyways. This is just another iteration.

 

[E-Z Glider]

None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list.

Not suggesting its the answer to all the problems, but seems like a simple solution to the primary care problems?

Most people want one comprehensive solution to their health care needs, not a piecemeal solution. Clinics have been around forever anyways. This is just another iteration.

I guess I understand that if you're already to the point where you need lots of specialized care, but I would assume that primary care should/could be the main "healthcare solution" for most healthy people. I know Im naive on this subject, but just seems like a better solution for everyone involved.

 

[StrikeS2k]

None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list.

Not suggesting its the answer to all the problems, but seems like a simple solution to the primary care problems?

Most people want one comprehensive solution to their health care needs, not a piecemeal solution. Clinics have been around forever anyways. This is just another iteration.

I guess I understand that if you're already to the point where you need lots of specialized care, but I would assume that primary care should/could be the main "healthcare solution" for most healthy people. I know Im naive on this subject, but just seems like a better solution for everyone involved.

You asked why we aren't doing this. I tried to answer that. I'm not even sure what you're asking at this point. As I mentioned, clinics have been available forever. These are just new takes on an old concept, and they don't address our main financial problems re: health care.

 

[Doug B]

Most people want one comprehensive solution to their health care needs, not a piecemeal solution. Clinics have been around forever anyways. This is just another iteration.

Clinics have been around -- but for people without insurance, their per-visit prices even at local primary-care clinics are still too high to encourage preventative use.

 

[Doug B]

You asked why we aren't doing this. I tried to answer that. I'm not even sure what you're asking at this point. As I mentioned, clinics have been available forever. These are just new takes on an old concept, and they don't address our main financial problems re: health care.

There will be no one-bullet solution to these problems, as you are aware. What these doctors are doing is a worthwhile part of the puzzle all the same. The pricing model, IMHO, is a true innovation. Even if they weren't the very first to ever do it, if they can get the flat-fee model to spread they've done a great thing.

 

[StrikeS2k]

Most people want one comprehensive solution to their health care needs, not a piecemeal solution. Clinics have been around forever anyways. This is just another iteration.

Clinics have been around -- but for people without insurance, their per-visit prices even at local primary-care clinics are still too high to encourage preventative use.

1) I suspect that varies from locale to locale. These don't sound like bargains in their own right. Most of those same people aren't going to pay a monthly fee either. So we're not talking about the same demographic.

2) Most people don't do the preventative care thing anyways.

 

[Hawks64]

Link

Healtchare is a disaster. This article makes sense to me. Why arent we already doing this?

Highlights...

The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.

The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid. Car insurance doesn’t cover oil changes, and homeowners’ insurance doesn’t cover house paint. So why should insurance pay for your annual checkup or your kid’s strep swab?

Josh Umbehr, 33, was an aspiring primary-care doctor at the University of Kansas when, like many others, he grew horrified by the fee-for-service system. “It was crazy,” he said. “Insurance paid more for a prostate exam if it was done on a separate visit from a checkup. So the patient would have to come in twice. Medicare would pay for cleaning out earwax–but only one ear per visit. You had to schedule a second appointment for the other ear.”

Then he discovered direct care. As the son of a garbage collector, he understood the idea of one price for unlimited service. With classmate Doug Nunamaker, 34, Umbehr launched a moderately priced clinic called Atlas MD. The idea caught on enough that they recently hired a third doctor. Now they care for about 1,800 patients at an average monthly price of about $50 each.

An entrepreneurial dynamo, Umbehr paints a sky’s-the-limit future in which primary care is transformed into medicine’s most valuable role. To hear him tell it, he’s already living that dream, seeing an average of five patients per day–with other interactions by phone, text and email–while earning $200,000 to $240,000 per year. (The national average for primary-care physicians is well below $200,000.)

50/mth per person would be 200/mth for my family. My regular insurance wouldn't go away and wouldn't cost less. Make zero sense for me to join something like this for 2400/year on top of my insurance costs.

 

[StrikeS2k]

You asked why we aren't doing this. I tried to answer that. I'm not even sure what you're asking at this point. As I mentioned, clinics have been available forever. These are just new takes on an old concept, and they don't address our main financial problems re: health care.

There will be no one-bullet solution to these problems, as you are aware. What these doctors are doing is a worthwhile part of the puzzle all the same. The pricing model, IMHO, is a true innovation. Even if they weren't the very first to ever do it, if they can get the flat-fee model to spread they've done a great thing.

This doesn't do squat to address the financial issues plaguing our health care system.

 

[StrikeS2k]

Link

Healtchare is a disaster. This article makes sense to me. Why arent we already doing this?

Highlights...

The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.

The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid. Car insurance doesn’t cover oil changes, and homeowners’ insurance doesn’t cover house paint. So why should insurance pay for your annual checkup or your kid’s strep swab?

Josh Umbehr, 33, was an aspiring primary-care doctor at the University of Kansas when, like many others, he grew horrified by the fee-for-service system. “It was crazy,” he said. “Insurance paid more for a prostate exam if it was done on a separate visit from a checkup. So the patient would have to come in twice. Medicare would pay for cleaning out earwax–but only one ear per visit. You had to schedule a second appointment for the other ear.”

Then he discovered direct care. As the son of a garbage collector, he understood the idea of one price for unlimited service. With classmate Doug Nunamaker, 34, Umbehr launched a moderately priced clinic called Atlas MD. The idea caught on enough that they recently hired a third doctor. Now they care for about 1,800 patients at an average monthly price of about $50 each.

An entrepreneurial dynamo, Umbehr paints a sky’s-the-limit future in which primary care is transformed into medicine’s most valuable role. To hear him tell it, he’s already living that dream, seeing an average of five patients per day–with other interactions by phone, text and email–while earning $200,000 to $240,000 per year. (The national average for primary-care physicians is well below $200,000.)

50/mth per person would be 200/mth for my family. My regular insurance wouldn't go away and wouldn't cost less. Make zero sense for me to join something like this for 2400/year on top of my insurance costs.

Exactly, especially now with a mandate to have health insurance. This type of thng MIGHT have made sense for a 20 something who didn't want to spend his money on true health insurance because he felt invincible and had student loans to pay off, but now that's really not an option.

 

[mr roboto]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

 

[Doug B]

This doesn't do squat to address the financial issues plaguing our health care system.

Of course it does at least squat -- as I said, it is part of the puzzle. Especially at the personal level, which is where this is all aimed. They never claimed to be fixing every institutional medico-financial issue at all levels.

Obviously there are legion other issues going on. That doesn't mean a solid idea should be summarily discarded.

 

[StrikeS2k]

This doesn't do squat to address the financial issues plaguing our health care system.

Of course it does at least squat -- as I said, it is part of the puzzle. Especially at the personal level, which is where this is all aimed. They never claimed to be fixing every institutional medico-financial issue at all levels.

Obviously there are legion other issues going on. That doesn't mean a solid idea should be summarily discarded.

You should have told that to Obama, a few years ago.

 

[StrikeS2k]

This doesn't do squat to address the financial issues plaguing our health care system.

Of course it does at least squat -- as I said, it is part of the puzzle. Especially at the personal level, which is where this is all aimed. They never claimed to be fixing every institutional medico-financial issue at all levels.

Obviously there are legion other issues going on. That doesn't mean a solid idea should be summarily discarded.

Specifically where did I say this? All I've done is try to answer the question in the original post. Amazing how often people misquote others on this board.

 

[Doug B]

1) I suspect that varies from locale to locale. These don't sound like bargains in their own right. Most of those same people aren't going to pay a monthly fee either. So we're not talking about the same demographic.
2) Most people don't do the preventative care thing anyways.

1) The idea is to remove the price-point barriers so that more people of more varying demogrphics are more encouraged to access primary & preventative care.

2) Chicken and egg? While some people would neglect their health even in a single-payer "everythuing is 'free'" system, we can agree that chipping away at the personal financial barriers is a net positive, right?

 

[StrikeS2k]

1) I suspect that varies from locale to locale. These don't sound like bargains in their own right. Most of those same people aren't going to pay a monthly fee either. So we're not talking about the same demographic.
2) Most people don't do the preventative care thing anyways.

1) The idea is to remove the price-point barriers so that more people of more varying demogrphics are more encouraged to access primary & preventative care.

2) Chicken and egg? While some people would neglect their health even in a single-payer "everythuing is 'free'" system, we can agree that chipping away at the personal financial barriers is a net positive, right?

Show me proof that these "new" clinics are more cost effective than what has always existed. Hell, the first one mentioned in the article requires a $1000/month payment. Yeah, ok. The others require a monthly payment that most people we are trying to help re: health care reform can't afford. Unless you've got some stats to back up your claims I'm done with you.

 

[Hawks64]

1) I suspect that varies from locale to locale. These don't sound like bargains in their own right. Most of those same people aren't going to pay a monthly fee either. So we're not talking about the same demographic.
2) Most people don't do the preventative care thing anyways.

1) The idea is to remove the price-point barriers so that more people of more varying demogrphics are more encouraged to access primary & preventative care.

2) Chicken and egg? While some people would neglect their health even in a single-payer "everythuing is 'free'" system, we can agree that chipping away at the personal financial barriers is a net positive, right?

How does it address 1? People's insurance costs aren't going down, this is just an addition to that cost.

 

[Doug B]

50/mth per person would be 200/mth for my family. My regular insurance wouldn't go away and wouldn't cost less. Make zero sense for me to join something like this for 2400/year on top of my insurance costs.

I agree that they'd have to fiddle with the price points per locale/demographics, and likely offer breaks for family "membership".

And ideally (laught track here) ... conventional insurance SHOULD get cheaper as a tradeoff for not having to pay out for primaru care. But ... yeah. Well, maybe that price drop can be regulated into existence. Or maybe Enterprising Insurance Co. can undercut other companies in a no-primary-care environment (laught track here).

 

[StrikeS2k]

50/mth per person would be 200/mth for my family. My regular insurance wouldn't go away and wouldn't cost less. Make zero sense for me to join something like this for 2400/year on top of my insurance costs.

I agree that they'd have to fiddle with the price points per locale/demographics, and likely offer breaks for family "membership".

And ideally (laught track here) ... conventional insurance SHOULD get cheaper as a tradeoff for not having to pay out for primaru care. But ... yeah. Well, maybe that price drop can be regulated into existence. Or maybe Enterprising Insurance Co. can undercut other companies in a no-primary-care environment (laught track here).

Yeah, that's what we need. MORE heatlh care regulations!!!!

 

[Doug B]

Specifically where did I say this? All I've done is try to answer the question in the original post. Amazing how often people misquote others on this board.

The question in the OP is thus: "Why aren't we already doing this?"

IMHO, your post (#2 in this thread) doesn't really answer that question. The primary-care price model in the OP is not more prevalent because "None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list"?

Maybe you could flesh out your thinking a bit and make it clearer, but otherwise, I think you offered up a non sequitir there.

And as far as misquoting you: I thought you were expressing disdain for the model described in the OP's article. IMHO, "disdain" is essentially summary dismissal. However, I will grant that you didn't post something like "Those doctors are idiots for using that model, and should drop it ASAP if they had any sense." I feel i can safely assume that you'd defend their right to price their services as they see fit.

 

[Jayrod]

As far as primary care physicians go, they are dying. I've been through 3 doctors in 5 years and don't have a doctor currently. They keep quitting the clinic and either go to work for an urgent care or retire earlier than planned. The current system is too difficult to maintain with billing codes and insurance companies and medicare. All of their profits are eaten up in administration.

 

[Dentist]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

I wish there were a way to do that.

Dentistry has been trying to do whatever they could for years to press for prevention... we have tried to get fluoride in water, fluoride in schools, diet education... we've tried a lot of things as a profession.

And what's nutty is that it's like one of those "no good deeds go unpunished" things... my city is one of the no fluoride cities and every time we try to put it in the people come out and tell us we're trying to poison them.

Try to put fluoride in schools and again they cry poison and over-treatment. Tell people to floss and they get pissy... push hard enough and they'll leave your practice. Tell people to stop consuming sugary sodas and Big Soda gets pissed at you and people cry that they will do whatever they want to do whenever they want to do it.

Tell people they grind their teeth despite obvious signs of it and they'll deny it and act like you're crazy... and the biteguard you suggest to preserve their teeth is like another way of ripping them off.

Prevention just doesn't sell.. no one wants to floss their teeth, eat healthy, exercise, take a multi-vitamin, or anything else...

Money has always been made in medicine by doing procedures and selling medicine, and it isn't going to change

 

[StrikeS2k]

Specifically where did I say this? All I've done is try to answer the question in the original post. Amazing how often people misquote others on this board.

The question in the OP is thus: "Why aren't we already doing this?"

IMHO, your post (#2 in this thread) doesn't really answer that question. The primary-care price model in the OP is not more prevalent because "None of that addresses the real issues of cost that are killing us. Seeing a primary care physician is probably at the bottom of the list"?

Maybe you could flesh out your thinking a bit and make it clearer, but otherwise, I think you offered up a non sequitir there.

And as far as misquoting you: I thought you were expressing disdain for the model described in the OP's article. IMHO, "disdain" is essentially summary dismissal. However, I will grant that you didn't post something like "Those doctors are idiots for using that model, and should drop it ASAP if they had any sense." I feel i can safely assume that you'd defend their right to price their services as they see fit.

I have more than one post in this thread. If you look at all of them, or at least the first few, I made clear that this model is essentially the same thing as has existed in communities for decades. You're suggesting it's different and I specifically asked you to prove this from an economic standpoint. For some reason, you ignored that request.

I have no problem with this type of health care being available. Hell, Walmart and King Soopers (grocery chain) are playing with instore clnics for flat one time fees. That's great. Too bad Obamacare is going to limit or destroy a lot of these options. I just don't see this as worthy of significant discussion as part of our overall heatlh care reform solution. It's something worth having but isn't going to address our real health care issues.

 

[Doug B]

You're suggesting it's different and I specifically asked you to prove this from an economic standpoint. For some reason, you ignored that request.

You win, I can't prove from an economic standpoint that the model is different. I agree that it has been done before somewhere. And I wasn't aiming to get into that level of debate, anyway.

Nevertheless, on a personal level ... that kind of pricinf model is new TO ME. Nobody around me is offering something like this a working around the entrenched insurance system. What I thought the model in the OP described was a clinic offering a flat-fee price point so low that users didn't really care that they were already paying for insurance.

For instance: on my health plan, I used to pay $25/visit for urgent-care visits. I used to go a few times a year, and so did my family. A few years back, that fee was byumped up to $75/visit (would love to know why?). Guess what? We stopped going to those places altogether. It's either have to wait a day or two to go to the GP, or just skip the visit altogether. I'd love a $50/visit, no-insurance option locally. Kicking upper respiratory infections, for instance, without prednisone and antibiotics is doable, but it's slow and annoying.

Note: I did not read the article in the OP and did not see the $1,000/mo clinic. Yeah, at that price point, few are helped. Agree there.

 

[Sand]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

Prevention is largely behavioral. Need to provide significant incentives or punishment for smoking, excessive BMI, etc. Considering the state of our people we have a highly effective system - its just that a large part of the populace destroys itself with their behavior.

We need to tie insurance cost to the consumer to prevention.

Although the system in here has significant merit in that a huge cost to the GP is paperwork. It is a massive drag on their operations. It is so bad here (probably everywhere, but I know here) that those independent offices are closing and coming under the umbrella of a big hospital. The clinics are breakeven, at best, even with the consolidation - the money is in the referrals for specialists and diagnostic tests.

 

[StrikeS2k]

Note: I did not read the article in the OP and did not see the $1,000/mo clinic. Yeah, at that price point, few are helped. Agree there.

Is this a Tim alias? I knew he couldn't stick to one thread!!!!

 

[Jayrod]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

I wish there were a way to do that.

Dentistry has been trying to do whatever they could for years to press for prevention... we have tried to get fluoride in water, fluoride in schools, diet education... we've tried a lot of things as a profession.

And what's nutty is that it's like one of those "no good deeds go unpunished" things... my city is one of the no fluoride cities and every time we try to put it in the people come out and tell us we're trying to poison them.

Try to put fluoride in schools and again they cry poison and over-treatment. Tell people to floss and they get pissy... push hard enough and they'll leave your practice. Tell people to stop consuming sugary sodas and Big Soda gets pissed at you and people cry that they will do whatever they want to do whenever they want to do it.

Tell people they grind their teeth despite obvious signs of it and they'll deny it and act like you're crazy... and the biteguard you suggest to preserve their teeth is like another way of ripping them off.

Prevention just doesn't sell.. no one wants to floss their teeth, eat healthy, exercise, take a multi-vitamin, or anything else...

Money has always been made in medicine by doing procedures and selling medicine, and it isn't going to change

Kansas City doesn't have fluoride in the water? I'll be darned. Had no idea.

 

[E-Z Glider]

Link

Healtchare is a disaster. This article makes sense to me. Why arent we already doing this?

Highlights...

The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.

The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid. Car insurance doesn’t cover oil changes, and homeowners’ insurance doesn’t cover house paint. So why should insurance pay for your annual checkup or your kid’s strep swab?

Josh Umbehr, 33, was an aspiring primary-care doctor at the University of Kansas when, like many others, he grew horrified by the fee-for-service system. “It was crazy,” he said. “Insurance paid more for a prostate exam if it was done on a separate visit from a checkup. So the patient would have to come in twice. Medicare would pay for cleaning out earwax–but only one ear per visit. You had to schedule a second appointment for the other ear.”

Then he discovered direct care. As the son of a garbage collector, he understood the idea of one price for unlimited service. With classmate Doug Nunamaker, 34, Umbehr launched a moderately priced clinic called Atlas MD. The idea caught on enough that they recently hired a third doctor. Now they care for about 1,800 patients at an average monthly price of about $50 each.

An entrepreneurial dynamo, Umbehr paints a sky’s-the-limit future in which primary care is transformed into medicine’s most valuable role. To hear him tell it, he’s already living that dream, seeing an average of five patients per day–with other interactions by phone, text and email–while earning $200,000 to $240,000 per year. (The national average for primary-care physicians is well below $200,000.)

50/mth per person would be 200/mth for my family. My regular insurance wouldn't go away and wouldn't cost less. Make zero sense for me to join something like this for 2400/year on top of my insurance costs.

It's not going to save you money on day 1, but its a better long-term solution (ie: insurance prices would/should go down eventually) than what we have now. It would be great to be able to call or email a doc for a simple question, prescription, or advice. As it stands now, there's no incentive for a doctor to do this. Its counter-productive and a tremendous waste.

 

[James Daulton]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

Maryland has taken the first step to attempting to "solve" healthcare cost. For all hospital services (Inpatient & Outpatient) the hospital receives a certain amount of dollars. If volumes go up or down, the hospital needs to provide services within these budgeted dollars. Once the fiscal year is over, if the hospital's volumes increase and the increase was due to "good volume" (basically all diagnosis the state doesn't relate to services that should have been handled in an earlier admission or were the hospital's fault) and the hospital will get something like a 40% of their average cost per admission increase. Volume decreases or bad volume and the hospital will lose those dollars.

Basically, the state is changing the hospital's incentive from increased utilization to lower utilization. The hospitals are responding by closely aligning with primary care docs to get ahead of people's care and to help keep them from becoming really sick in the first place. This is where we as a society should be heading, education, wellness, and prevention.

 

[Sand]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

Maryland has taken the first step to attempting to "solve" healthcare cost. For all hospital services (Inpatient & Outpatient) the hospital receives a certain amount of dollars. If volumes go up or down, the hospital needs to provide services within these budgeted dollars. Once the fiscal year is over, if the hospital's volumes increase and the increase was due to "good volume" (basically all diagnosis the state doesn't relate to services that should have been handled in an earlier admission or were the hospital's fault) and the hospital will get something like a 40% of their average cost per admission increase. Volume decreases or bad volume and the hospital will lose those dollars.

Basically, the state is changing the hospital's incentive from increased utilization to lower utilization. The hospitals are responding by closely aligning with primary care docs to get ahead of people's care and to help keep them from becoming really sick in the first place. This is where we as a society should be heading, education, wellness, and prevention.

Good step, to be sure.

And, as the corollary, we found out what not to do. Vermont just tried single payer until they figured that just healthcare year 1 was a bigger number than their entire budget. Whoops. That ended quick. Nice object lesson.

 

[Dentist]

The biggest issue with healthcare is that docs make money when people are desperately sick. We need to find a way to tie compensation to prevention instead of services needed after preventative measures have been ignored.

I wish there were a way to do that.

Dentistry has been trying to do whatever they could for years to press for prevention... we have tried to get fluoride in water, fluoride in schools, diet education... we've tried a lot of things as a profession.

And what's nutty is that it's like one of those "no good deeds go unpunished" things... my city is one of the no fluoride cities and every time we try to put it in the people come out and tell us we're trying to poison them.

Try to put fluoride in schools and again they cry poison and over-treatment. Tell people to floss and they get pissy... push hard enough and they'll leave your practice. Tell people to stop consuming sugary sodas and Big Soda gets pissed at you and people cry that they will do whatever they want to do whenever they want to do it.

Tell people they grind their teeth despite obvious signs of it and they'll deny it and act like you're crazy... and the biteguard you suggest to preserve their teeth is like another way of ripping them off.

Prevention just doesn't sell.. no one wants to floss their teeth, eat healthy, exercise, take a multi-vitamin, or anything else...

Money has always been made in medicine by doing procedures and selling medicine, and it isn't going to change

Kansas City doesn't have fluoride in the water? I'll be darned. Had no idea.

not KC, a suburb of KC with about 100K people in it

 

[Doug B]

Note: I did not read the article in the OP and did not see the $1,000/mo clinic. Yeah, at that price point, few are helped. Agree there.

Is this a Tim alias? I knew he couldn't stick to one thread!!!!

The detail given in the OP was sufficient to form a specific opinion about a $50/mo option. What's the problem?