Fly-By Medicine Sucks

Patient Centered Health Care vs Conveyor Belt Health Care

By Bill Rusteberg

Doctor Jones lives next door to Doctor Smith. Both are primary care physicians. Jones has a patient base of 700 while Smith is doing much better with a patient base of 4,000. Jones is much happier than Smith. And his patients are much happier, and healthier than Smith’s patients.

How is this possible?

Jones has developed his practice into an employer sponsored medical home for a primary care centric health plan while Smith continues doing what he’s been doing since residency –  providing medical care with emphasis based on volume rather than on management of care. Jones is practicing what we call Patient Centered Primary Health Care while Smith is practicing conveyor belt health care.

There are three methods to implement a Patient Centered Primary Care Plan. All produce lower ER visits, fewer specialists visits, less radiology ordered, fewer hospital days per 1,000, significant Rx cost reduction (as much as 80%) and increased patient satisfaction.

So why don’t more health plans adopt this strategy? (Answer below)

Compared to Patient Centered Primary Care Plans, traditional group health plans continue to produce opposite results with longer wait times, more tests, higher unit costs and lower patient satisfaction.

Consumers often see their primary care physician for a fly-by five minute visit often after a two hour wait and almost invariably leave with another prescription they may not need (but will surely cure them of the need of a dreaded lifestyle change  – “Don’t mess with my Grandmother Doc. Don’t tell me she’s killing me! I love grandma’s enchiladas!)”.

Or they seek a back surgery referral from Aunt Myrtle who had her surgery 20 years ago and is doing just fine these days. “Go see Doctor Hodad, he’s the best there is” says Myrtle. Dr. Hadad is an ear, nose & throat specialist but dabbles in spines on weekends. He owns the Durable Medical Equipment company next door. His highest volume demand is for wheelchairs these days. Just so you know.

Traditional plans continue to thrive because consumers can pick and choose their providers of choice. “I don’t like your primary care health plan because I won’t be able to see Dr. Hodad (Hands of Death & Destruction) anymore! Or, “I get my referrals from my friends, and I trust my friends and I love my grandmother!” Consumers don’t like to be told where to shop. They also don’t like to be told their grandmother is killing them.

Meanwhile, most primary care physicians working on fee-for-service hate their jobs. Smith certainly hates his. To earn a decent living docs like Smith have to see as many patients as they can and order as many tests as they can get away with. And if patient Mary asks for a prescription for the purple pill she saw advertised on TV, why not? We want her as a loyal patient don’t we? Smith is almost always happy to oblige.

I’ve experienced conveyor belt health care in deep South Texas where sitting in a waiting room for hours past my scheduled appointment I would watch the doc moving from examining room to examining room at ten minute intervals. Wow, this guy must see 40-50 patients a day! How on earth can he really be taking care of all these folks in the best possible way?

Once I thought I was really lucky when I checked in for a scheduled visit. The waiting room was nearly empty. Anticipating a quick wait before I saw the doc, I decided to chat with the receptionist. “Looks like there won’t be a long wait today to see the doc! I said.

About that time several vans pulled up to the clinic entrance and out poured a slew of vintage nursing home residents. The room filled quickly and the typical two hour wait ensued. So I spent the time counting the number of times the doc. would enter and leave each examining room while seriously contemplating a change in doctors.

So I ended up firing the doc in favor of visiting a local day and night walk-in clinic. I certainly enjoyed the quicker service there. But then I was informed they were going to perform a multitude of tests including an electrical physical.

Enough Already! I don’t need an electrical physical, whatever that is. You’re loading up the bill and I only saw the doctor for a scant three minutes. I can’t stand, nor afford, fly-by health care anymore!. There must be a better way!

And there is…………………….

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