Many of you know I am very passionate about the practice of medicine and am quite vocal about how to improve our national health care system. There is one question that seems to be brought up consistently by my audience: How has the Affordable Care Act affected your practice? Furthermore, some people will ask, I have insurance so doesn't that mean I am covered?
So, to clear the air on what is truly happening since the enactment of the ACA, I will attempt to explain it in simple terms in this blog post.
Prior to the Affordable Care Act (ACA) being enacted on March 23rd 2010, physicians and economists have been yelling at closed ears about how expanding coverage is not the only solution to this mess. The 2 major problems in addition to coverage is ACCESS and COST of health care. Simply put, here is how the ACA impacted these key components of our health care crisis:
COVERAGE: Although we have now insured an estimated 10 million of the 43 million who were uninsured, 18% of the US population uninsured down to 11%, we have accepted narrow provider networks, higher premiums, higher deductibles. The complexity of insurance products have increased, causing even more confusion as to what consumers are actually buying. In addition, there is confusion as to who is in your network and many consumers realized they have to travel significant distances to get care.
The Commonwealth Fund found that the rise in premiums for employer-based plans had slowed in several states but they continue to rise faster than median income. Therefore, as wages stayed stagnant, premiums continued to rise.
Finally, many providers do not participate in certain networks or insurance plans given their poor reimbursement.
COST: Insurers can decrease or maintain a premium by shifting the out of pocket costs to the consumer, co-pays, and deductibles. Medications continue to rise in cost by double digits. Medicare premiums continue to rise and out of pocket expenses on average are $5,400 annually for the 65-70 year old, but increase substantially as we age given increased hospitalizations.
The cost of medical devices and hospital stay continue to rise. Why do we have to negotiate these costs each time we review our hospital bills, which are full of vague charges? I have done outcomes research studies in a hospital setting where we try to show cost savings with a medical treatment. To estimate and create a line item cost of a single unit blood transfusion is impossible.
ACCESS: Lack of understanding of networks, physicians not being part of poorly paying insurers, and the simple fact of increased demand with a decreasing supply of physicians has led to delayed diagnoses and even death.
So, how has the ACA affected my direct primary care practice? Single answer: it has helped me from a business standpoint as our solution is even more significant and patients enjoy their freedom. The ACA has made it harder for those who are in the "donut hole" and their states have not expanded Medicaid to get any type of care other than our practice. In effect, our practice is saving the ER and the hospitals from ever increasing accounts receivables to writing off large amounts as charity care.
From the PATIENTS PERSPECTIVE:
Our practice provides accessible primary care services, urgent care visits, and affordable services whenever they need it. In addition, this relationship in the long term will prevent illnesses that cost Americans thousands of dollars. Finally, patients are empowered with resources to take care of themselves, they have transparent imaging, laboratory, and pathology pricing. They can CHOOSE to use their insurance for any ancillary service if they want and compare cash pricing to what the insurance companies will cover.
From the PHYSICIAN PERSPECTIVE:
The ACA has increased the red tape and regulations on medical practice. For example, on October 1, 2015 ICD-10 came into effect. The previous ICD-9 had 17,000 codes and this newer version has 141,000 codes! Think about the direct costs of software update, hiring more staff, and the indirect costs of training, lost revenue from inefficiency and slowed practice. Since we do not contract with insurance carriers, these nuances have no effect on us.
The ACA has caused more physicians to leave the practice of medicine. There is an estimated deficit of 124,000 primary care physicians by 2025. Our practice has become more attractive where physicians can be sole owners of their practice and join Health Suite to share its resources and all of its community resources.
Finally, the ACA motivated us to seek more partnerships to save our patients up to 95% on imaging, medications, and pathology for being our members.
Bottom line: Practices like ours will soon be paired with high deductible plans, as they are in Washington state. This is low cost and high value for consumers. So, spend the time to look at our practice, talk with us, talk with our insurance brokers, save thousands of dollars for yourself or your company by pairing the right insurance product with our practice.
Some good resources:
NY Times article
2015 Milliman Medical Index
Essay by Patrick Ishmael
More employers shifting cost to employees
Primary care has lost its appeal over the last few years. If you look at healthcare delivery from a distance, you will notice that there is this unnecessary rise in specialty care. Almost every organ is specialized! I am all for it, but boy does it get confusing as there are so many people who get involved in one's care. In the meantime, the average primary care visit has reduced to just about 7 minutes. So, how can a primary care physician go through each concern in an efficient manner? The current situation is leading to a tremendous about of physician burn out.
According to helpguide.com the following are signs that are concerning for burnout:
Not sure about you, but as a physician, I can say almost every physician I know meets this criteria. The last bullet point definitely touches on the control insurance companies have on the care we provide. Healthcare is the only business in the world where a third party decides what the customer will get and for what price, regardless of what the physician advises. This leads to tremendous frustration for the patient and their physician. The average wait time to see your primary care physician is 2-3 weeks nationally. Moreover, the cost of medications and hospitalizations continue to rise.
Finally, think about this: Do you understand everything that your insurance policy covers or not covers?
We pay such high premiums for a product that we barely understand. Why do we allow this to happen? When we go out to eat, buy merchandise, or purchase any other service we focus on the details and know exactly what we are getting in return. Now that we are required to have health insurance by Federal law, we are mandated to go to the marketplace to purchase these confusing products. It is only after an illness, major surgery, or hospitalization that we realize what kind of a coverage or lack of coverage we actually have.
Is it me or is this just crazy?!
Primary care does not need to be expensive and for that matter, health care in general should not be so expensive. Furthermore, in my journey in building a practice to help my clients the most, I have partnered with some incredible companies. I have learned that medications, laboratory, and pathology do not have to cost so much! So, why the high premiums?
Our vision at LiveActive Primary Care is for our clients to be worry free when they join. Every little service does not cost extra. We want your primary concern when you walk through our doors is, "I joined. Now let's take care of me." That attitude excites us! We will align resources with community partners at discounted rates to improve your quality of life.
Direct primary care decreases our panel of patients to less 1,000 patients! Compare that to the average 2,500 to 5,000 patients in a traditional practice! This means more time for you!
Benefits of direct primary care include:
My partner in our Health Suite 110 is an outstanding physician and a board certified Family Medicine physician. The two of us make a great team to provide you excellent care! Give us a try and we will be honored to be your personal physician for years to come!
We hope to grow the Health Suite 110 with more physicians. We would love to have a "Med/Peds" physician - this is someone who is trained in Internal Medicine and Pediatrics. We are also interested in Family Medicine or Pediatric Medicine physicians. If you or know someone that is interested, please give us a call!
We are so close to purchasing our space and next step is the complete build!! Contractors and our architect have put together some designs and we are moving forward with our vision to provide the best and comprehensive care possible.
In the meantime, please do not hesitate to give us a call as we can make house visits until our clinic is built. We are also available to provide care at retirement homes, assisted living, and any independent living arrangement. So get started today and we will waive the home visit fee until our clinic is built!
Call (913) 667-0787 or email us at info@LiveActivePC.com.
Did you know that the practice of internal medicine can be traced back to ancient India and China? In fact, the term Internal Medicine originates from the German term Innere Medizin. This term was popular in the 19th century and was brought to the United States from American physicians who trained in Germany in the early 20th century. The term Innere Medizin was used to describe physicians who combined the science of laboratory to patient care.
Internal Medicine physicians specialize in adult and geriatric medicine. So what defines "adult?" Well, nowadays that can be as young as 14 years old as kids are reaching adult weight of 50-70kg. In the past when I was in training we used to say anyone older than 16 or 18 years old. But, given the size of the average American, this definition has changed. I am comfortable seeing anyone who is "adult" weight. Therefore, I picked 14 years old as my starting age. You can twist my arm to see 13 year old folks...
The American College of Physicians defines Internal Medicine as the following:
"Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness."
So our favorite question is "why?" This used to drive my parents crazy when I was young. I was that annoying little one that always popped his head up and asked "why?"
It is a lot of detective work and we love looking at data and forming hypotheses. We do not zone in on one diagnosis, but have a list of possibilities and eliminate each one as more clinical information becomes available. I feel like this is being lost in today's "hamster wheel" medicine where everyone is rushed and the average exam time is 7 minutes.
We treat ear infections, eye infections, headaches, post stroke care, post heart attack, high cholesterol, diabetes, adrenal issues, thyroid issues, copd, asthma, pneumonia, skin infections, depression, anxiety, any mental disorder, arthritis, urinary tract infection, prostate issues, trouble urinating, impotence, diarrhea, constipation, any gasterointestinal diseases, arrythmia, heart failure....I think you get the idea.
If the illness is beyond the scope of internal medicine or a special procedure is needed, a referral is made to a specialist.
We are skilled in suturing, skin biopsy, skin tag removal, cautery, joint injections, some do botox injections and liposuction, and various other small office procedures.
In addition, the major skill is prevention and early recognition of disease or pathology. So, coaching clients through current guidelines for screening for breast cancer, colon cancer, heart disease, high cholesterol, and much more is critical in the care of our community.
This is what excites me about my new practice! As a hospital physician I treated post stroke care, acute heart attacks, head bleeds, severe infections with multi-organ failure and all that was gratifying. But, there were some cases where I would sit with my head in the palms of my hands thinking, "if only she had an internist or the internist had more time in taking care of her, or her medications would be affordable...if only..."
I'll be honest, I did cry at times for my patients because many times it is not their fault. The system has failed them and they suffered such a catastrophic event that will only cost the system and more importantly the individual significant dollars.
Thus, prevention, wellness, and being a coach is as, if not more important, than treating an acute illness. So when people ask, "why do I need an internist?" I usually tell them, "well you can get one when you get terribly sick in the hospital with a large bill or you can get one now and prevent a catastrophic event if possible." More importantly, life is about building relationships. The sooner you find an internist you like and can partner with, the better you will feel and likely live healthier. Statistics show that people do better with a good support system regardless of what the issues they are dealing with - medications are not always the answer.
Sometimes people just need to talk. In my model, I will have time to listen. Maybe the anxiety or panic attacks you are experiencing is because of an acute issue you are dealing with. Does it make sense to prescribe an anti-anxiety medication in 7 minutes of hearing your story or does it make more sense to listen and see if we can work out a solution together and only prescribe if needed? I argue that these quick visits are leading to unnecessary prescribing, imaging, and laboratory - this all drives rising costs for everyone.
I have passion for science and am amazed at our progress. But I also understand that there are things in this world that we still do not understand. Sure, not everything is in our control. But, I believe with the knowledge and technology that we have today, prevention of disease and the management of disease is not only our responsibility but it will allow us to take care of each other. As I tell all care-takers, you have to take care of yourself before you take care of others. We have to be there for each other and more importantly be healthy when we stand together; or else we both fall.
Living healthy does not have to cost so much nor should it be a burden.
So, join my practice and let's do this together! Let's live life to it's fullest and I will be honored if I can be your internist in this journey we like to call life!
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."