Having worked in the health care field some years ago, and having been married to a physician and witnessing the beginnings of much of the current health care misery, I've remained interested in the state of health care services. I also have a chronic condition that requires daily medication and regular checkups; thus, I'm able to observe changes that take place as a result of insurance and government mandates to physicians' offices. It isn't a pretty sight.
I don't think anyone needs to be told that the health care situation is getting worse. HMOs, PPOs, IPAs, and other insurance schemes dictate who can be seen by whom, how often and under what circumstances, and what kinds of therapies can and cannot be used. The result is that the people most knowledgeable of and most invested in a successful outcome -- the physician and patient -- often have little control over an individual's choices for medical care. Government-mandated plans are no better.
Private insurance and government agencies require specific forms, procedure codes, and extensive documentation, all of which add to the paperwork burden for a doctor's office. In addition, billing has become much more complicated and expensive; insurance companies may choose to audit a claim, or question a diagnostic code. Sometimes they stall on paying a claim. All this adds to the cost of a doctor's practice, in the form of people to handle all this paperwork, the supplies themselves, and countless hours spent on the telephone trying to straighten out the inevitable snafus.
The result is that often, physicians aren't happy. Most went into medicine to help individuals, and are genuinely caring individuals. Being clocked and second-guessed by some managed-care flunky who -- maybe -- has a bachelor's degree is an affront to their skills. To work harder and harder yet not be doing any better is mystifying and frustrating. For some specialists, the risks associated with certain procedures and patients -- and the abysmal payment rate of government agencies and some insurers -- have caused them to limit their practice to less risky procedures and patients. Some doctors, particularly older, more experienced ones, and more principled doctors, have become so disgusted with the medical system that they've simply dropped out. The cost of this loss of expertise and dedication -- both to patients and to the generations of younger physicians to whom they would have passed along their wisdom -- is incalculable.
Patients aren't happy, either. Insurance premiums keep rising, yet the level of coverage declines. Lists of "approved physicians" may mean that a trusted family doctor cannot be seen any longer -- or if he is, the entire cost is paid by the patient. Increasingly complex insurance forms mean more of the patient's time is spent on busy work. Paperwork snafus and delays in payment by insurance companies mean mountains of paperwork from just one office visit, and a confusing mass for the person to try to work through to figure out if the bill has been -- or ever will be -- covered.
I've often wondered why we can't simply go back to the old days, when fee for service was the norm. "Fee for service" means that the doctor has a set fee for an office visit and procedures, and the patient pays the fee at the time service is given. It's just like going to a restaurant and paying the bill after eating the meal -- you receive the service and pay for it right then. When I've asked nurses and doctors why medical care can't return to a fee for service structure, I've gotten various responses, but all of them have been a variation on the theme, "Oh, we can't do that."
Those people appear to be wrong. In Washington, a couple of doctors have shown that fee for service works, and are offering their experience and ideas to health care providers and patients across the country. Their approach is called SimpleCare; it was born of their frustrations with the endless bureaucracy and cash sinkholes of bad insurance companies and government programs. (The Heartland Institute has published their story, which contains more information, and details on the program.)
SimpleCare is "100 percent bureaucracy free", meaning that the doctor and patient are in control of the relationship. One obvious advantage is much less paperwork -- which means more time for the physician to spend with the patient instead of padding the medical records. Dr. Vern Cherewatenko, one of the SimpleCare founders, stated that the "patient-to-paperwork ratio" for his office reversed, from 1:7 minutes to 7:1 minutes. More time with the doctor means more time getting the attention a sick person needs. Without having documentation concerns on her mind, the doctor can focus on the patient more, and deliver better care. But it gets even better. With less overhead needed for administrative work and supplies, the cost of seeing a patient drops dramatically for the physician. So, the patient gets charged less. Because the patient pays fully and immediately, the doctor's collection rate is higher, and there's no waiting and guessing whether insurance will pay, and if so, how much.
Better health care and financial advantages to both the patient and doctor. What's the catch?
There seems to be none. Although some physicians are concerned that this system isn't legal (in large part because it doesn't use the confusing CPT codes that insurance and government require), it is completely legal. A SimpleCare doctor may continue to accept insurance (Cherewatenko's office rid itself of the worst companies, but does accept some insurance -- and charges those patients a higher fee, because of the higher costs they incur) if he or she desires. Patients with no insurance no longer have to worry as much about being able to afford health care, because all they're paying for is the health care -- not bloated bureaucratic overhead. With a base of cash-paying patients, the physician's office has a solid, dependable revenue stream.
The SimpleCare plan is offered under a non-profit organization, the American Association of Patients and Providers (AAPP). Patients and physicians can join for a nominal fee. Doctors get information and ideas on how to implement SimpleCare to best suit their office situation, plus a listing on the SimpleCare web site, to help patients find them. According to Dr. Cherewatenko, patients need to show the SimpleCare card to get that price (but the cost of membership is usually less than the savings on the first office visit). In addition, they also get a quarterly newsletter, as well as membership in a national pharmacy program that offers SimpleCare prices. (More services are in the planning and implementation stages.) By joining the AAPP, individuals also show their commitment to making substantial changes in the health care system--changes for the better that are long overdue.
SimpleCare should not replace all insurance, Dr. Cherewatenko warns. "Health care is not expensive. Insurance premiums are expensive. ... Insure yourselves for a major catastrophe, or severe medical costs. Do not insure yourself for a hangnail, sore throat or common cold. It makes no sense." By doing this, you pay less for basic health care, and still have coverage in the event you need it for a major illness or surgery.
SimpleCare is spreading across the country, and enjoying great popularity as it does. Dr. Cherewatenko estimates that the retention rate for AAPP membership for physicians is around 95%. New physicians are often recruited by patients who've heard of SimpleCare. If you'd like to see SimpleCare come to your area, visit the web sites above, and let the doctors, pharmacies, and other health care professionals you use know about it. SimpleCare seems to me to be an excellent step in removing bureaucrats and their associated costs from the doctor-patient relationship, and placing the responsibility for good health care back where it belongs--in the hands of the doctor and the patient. As Dr. Cherewatenko told me:
"There is a national association that needs your help. Help us help you. There are caring doctors left in America but they are getting put out of business from too much hassle, and administrative costs. You cannot afford to have these doctors throw in the towel and they cannot afford to stay in business. Let's consider going back to the future."
Here's a list of financially sound health care practices that Dr. Cherewatenko recommends:
Get your doctor and your health care providers to learn about the value of SimpleCare for both you and them. It is truly a win-win scenario.