The case for liberating physicians from the dictates of third-party payers
Of all the people in the healthcare system, none is more central than the physician. As I explain in my book Priceless: Curing the Healthcare Crisis, fundamental reform that lowers costs, raises quality, and improves access to care is almost inconceivable without physicians leading and directing the changes. Yet of all the actors in modern healthcare, none are more trapped than our nation’s doctors. Let’s consider just a few of the ways your doctor is constrained, unlike any other professional.[1]
Sometime in the early part of the last century, all the other professionals in our society—lawyers, accountants, architects, engineers, and so on—discovered the telephone. It’s a handy device. Ideal for communicating with clients. Yet, telephone consultations are not on Medicare’s list of about 7,500 tasks it pays physicians to perform. (At least, it’s not there in a way that makes telephone consultations practical.) Private insurance tends to pay the way Medicare pays. So do most employers.
Sometime toward the end of the last century, all the other professionals discovered email. In some ways, it’s even better than the phone. But reading and responding to emails doesn’t make Medicare’s list in a practical way, either.[2]
At a time when doctors feel that third-party payers are squeezing their fees from every direction, most are going to try to minimize their non-billable time. Because patients cannot conveniently use modern media to consult with physicians, they make unnecessary office visits. The result is more rationing by waiting at the doctor’s office, which imposes disproportionate costs on chronic patients who need more contact with physicians. This might be one reason why so many are not getting what they most need from primary care physicians and what is most likely to prevent more costly problems later on: prescription drugs.[3]
The ability to consult with doctors by phone or email could be a boon to chronic care. Face-to-face meetings with physicians would be less frequent, especially if patients learned how to monitor their own conditions and manage their own care.