A different primary care model 2

This topic is becoming my hot topic of the fall. I wrote recently – Why primary care payment needs a different model. As I have continued thinking about this issue, I provide these interesting links.

Heart of darkness: Inside the paperwork jungle of health insurance

She may be on to something. Some doctors too have accused insurance companies of boosting their profits through a claims process that is unnecessarily difficult. Not far from where Yogi lives, Dr. Val Jones joined a small practice where the doctors do not even take insurance. They charge a simple, relatively low fee for each service, and that’s it. Why? In part because the doctors grew tired of seeing patients struggle with baffling insurance paperwork while both their health and wealth were on the line.

“They don’t know why they’re getting these questions asked,” Dr. Jones says, “they don’t know what the forms mean. And…their compensation is dependent on it.”

Dr. Jones does not believe the insurance industry set out to cultivate the paperwork jungle, it just grew over time. But now that it is there, she suspects they are making so much money off of it, that there is no real incentive to clear it up. And Wendell Potter agrees. He is a former insurance industry executive who readily says one way insurers make money is by allowing confusion to reign. “And people often just give up,” he says, “and don’t pursue payment when a claim has been denied or been paid inappropriately or not adequately. And the same it true with doctors and hospitals.” He believes billions of dollars are at stake.

and

Can Qliance Revive Primary Health Care?

I was down visiting Qliance after reading “How American Health Care Killed My Father” (Atlantic Magazine, September 2009). In it, David Goldhill wrote something startling to me: “The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year–$654 and $583, respectively.” He also mentioned, approvingly, that “Qliance Medical Group, for instance, now operates clinics serving some 3,000 patients in the Seattle and Tacoma, Washington, areas, charging $49 to $79 a month for unlimited primary care.”

The Qliance fee scale is graduated for age–I’d be looking at $768 per year for primary care, which, other than an appendectomy back in high school, is all I’ve ever needed in life to this point. Last year I paid over $3,200 in health insurance premiums on Costco’s small business insurance plan. I saw my doctor once, for a physical.

and this quote from a comment to my previous piece

Outpatient visits should all be directly paid for with health savings accounts or insurance cards that can be run like a credit card. The best doctors would get the requested fees, and the poorly rated doctors would get lower office fees. This would represent an open market healthcare system. Patients could negotiate their MRI/CT prices and the benefits of brand versus generic drugs. Put the cost controls in the hands of the patients with a finite amount of money, and healthcare costs would decrease.

Currently the insurance companies have scared the population into not wanting any alternatives or changes. If the new public plan is adequate and designed similar to Medicare, millions of people will endorse the plan. This means a decrease in private insurance companies and a decrease in overpaid insurance company executives.

The more I consider insurance and primary care, the more difficulty I have developing a concept of how paying for individual visits through insurance can work. The more I consider cash only or retainer practices, the more they make sense.

I hope that more policy wonks will think carefully about this issue. We clearly need an insurance system for hospitalizations and outpatient surgery. Many patients would save money through a combination of one of these primary care options, a health savings account and high deductible catastrophic insurance. Insurance does make sense for hospitalizations.

This plan would draw physicians to primary care, because the job becomes desirable and enjoyable. It could allow better physicians to make more money because patients are willing to pay more. It would decrease ER visits, because good primary care decreases the need for many ER visits.

More of the money we spend would go to the physicians and their practice than currently, because the insurance company would not get a cut. It could make Medicare much simpler if all primary care were paid in a lump sum each month, without offices having to pay for administrative billing hassles.

Perhaps someone has a good counterargument to this rationale. I am eager to debate this issue, so please challenge my thinking. Of course, if you agree, I would like that also.