A friend recently described his experience trying to establish care with a new physician. He wanted to learn about the office and called to ask if the doctor would call him back. The front desk person told him the doctor would be willing to do so but there would be a $25 charge. Taken aback, the prospective patient decided to look elsewhere for care.
This scenario raises two questions: Why was the patient surprised, and why did the doctor’s office ask for the fee?
Answers to both questions can be found in the way Americans access healthcare, i.e., through some form of insurance that handles payment. In this model, Americans have grown used to paying additional charges for healthcare, typically in the form of a co-pay that is seen as part of the payment for care. In my friend’s case, however, no care was being delivered. The fee was more of a convenience or service charge. This is something new. Even with options to buy the bronze, silver, or gold plan, the differences are largely related to coverage for care rather than higher levels of service. In large part related to poorly managed expections by the healthcare industry, many patients pay at Motel 6 rates, but expect to be treated as if they are at the Ritz.
How Physicians See Additional Charges
From the physician’s perspective, the additional charge is becoming unavoidable. Rising costs and diminishing reimbursement have put a lot of offices under financial pressure. The end result has been diminishing patient access in recent years. Most offices are booked weeks if not months out, and when you do get the appointment, it’s often rushed, leading to a poor experience.
Unfortunately consumers see only one side of the coin here. When you ask patients about the current state of health care, they say it’s all about the money now; doctors don’t really care. This has not been my experience. Although physicians are undeniably some of the most highly compensated workers, most Americans forget that the job requires literally decades of education. More importantly, whether you agree with physician compensation or not, doctors take their patients’ experience very much to heart, especially when it’s bad. But, harried and overwhelmed with the requirements of the electronic medical record system and the demands of the insurance companies, doctors have felt the squeeze too.
The Medical Concierge
Still, change is on the way. In response to very large patient panels (most offices need 4000 or 5000 patients to be economically viable), a new type of medical practice referred to as a medical concierge, has been developed. The patient is asked to join this practice and pays a fee upfront. This can vary between $1500 and $10,000 a year depending on the level of service. In exchange, the doctor is able to limit the number of patients in the practice and provide a much more responsive, personal relationship. This includes being immediately available for questions and concerns via cell phone. There are variations on this model, but all predominately address the primary care market at this time.
Sounds great, right? But not realistic. The fact is that unless you have chronic illness requiring frequent care you’re unlikely to be willing to pay the surcharge.
Healthcare: Change the Packaging, not the Product
But let’s think it through a little more. It may be the healthcare packaging not the product that needs to change.
The product of American healthcare—”care”—is perhaps the best in the world. However, the packaging—access and how it’s bought and sold—leave a lot to be desired. This problem is not insurmountable. The offer for a return phone call in exchange for $25 is just one early example of a new business model. The Medical Concierge is another. With the mainstreaming of other medical communication technologies such as texting, secure email and video, doctors could offer even more enhanced levels of service. There’s only one hitch: doctors need to find a way to make up for the time spent on these currently uncompensated activities.
Doctor Compensation and Archaic Reimbursement Models
I spend a lot of my time in the telemedicine space. This area has been shackled by archaic reimbursement models, limiting the type of care that can be reimbursed. Still, the same telemedicine tools that have been traditionally used for remote care could also be used to provide enhanced access and an improved patient experience. It’s just a question of figuring out how to pay for this opportunity to bring providers and patients together.
As we’ve seen, buying a higher level of healthcare service will not solve the healthcare crisis in America. As it is, the vast majority of the underserved are struggling to pay for their health insurance, and middle-class consumers are dissatisfied with their plans. It’s time to explore these new service models. After all, we make choices about how to spend our time and money all the time. We may choose to go to a better restaurant or purchase a more expensive car knowing there is a less expensive alternative. I would hope that as the tools discussed here become more commonplace, they also become more widely available to and affordable for all segments of our society.
Healthcare is not a commodity in the usual sense of the word. Many see it as a right. But however you look at it, healthcare is a crucial service. Perhaps it’s time it borrowed the best practices of the service economy.