The ink was barely dry on last Sunday’s column when friend Tom Diffenbach sent me an article from the previous day’s New York Times about primary care physicians who bill their patients directly and save a ton of money on administrative costs.
The number of so-called “patient-centered” practices is growing, the newspaper said, because doctors find they can spend twice as much time with patients and cut their overhead by as much as half by using new technologies and avoiding the red tape of filing insurance claims.
One Seattle physician charges her patients a monthly fee of $54 to $129, based on age, and encourages them to purchase a high-deductible insurance policy for serious illnesses. She spends 30 minutes to an hour with each patient.
The doctor who runs her clinic told The Times that patients can save 15 percent to 40 percent on health care, in large part because good primary care can obviate specialty care. The clinic has two administrative employees, but it would need one or two for each of its seven doctors, he said, if they had to file claims with various insurance companies.
Direct billing for primary care is a throwback to the days when doctors made house calls, patients generally paid in cash at the time of service, and people bought insurance to cover hospitalization and extraordinary care.
But during the last half-century of medical progress, insurance plans have evolved to cover virtually every facet of care. And that appears unlikely to change as Democrats in Congress focus on reform plans that reportedly will require every American to have health insurance, purchased either by individuals, their employers or the government.
In Harrisburg, one key issue for the state budget for fiscal 2010 is a proposed expansion of government health insurance to “cover all Pennsylvanians.”
This is not to suggest that insurance isn’t a necessity, considering the price of modern medical technology.
But it’s clear that the insurance system as it exists places an administrative burden on health care providers that drives up all prices for everyone. A recent Weill Cornell Medical College study found that primary care physicians spend a third of their revenues on interactions with patients’ health plans.
Significantly cutting administrative costs means that doctors can spend more time with each patient and see fewer of them without sacrificing income. By contrast, insurance companies and the government attempt to hold down costs by limiting reimbursements. That forces doctors, in order to maintain their incomes, to see more patients, spending less time with each, and to send them to specialists for tests and consultation that might be performed in their own offices if they had more time.
While health care industry leaders recently pledged to streamline administrative processes, there remains an inherent inefficiency for doctors and other providers of having to deal with myriad insurance plans that cover various procedures at different prices. However, uniform coverage for everyone under a single-payer system, such as Canada’s, isn’t about to happen here, unless by evolution.
President Obama says any reform package will allow consumers to keep their current coverage if they’re happy with it. That presumably includes health savings accounts, which allow consumers to accumulate money tax-free and spend as they choose on health care, so long as they buy high-deductible insurance as a backstop. Patients with HSAs might choose a “direct-practice” clinic such as the one in Seattle, so long as their high-deductible policy didn’t require the clinic to charge a certain fee and submit paperwork through the insurance bureaucracy.
According to The Times, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs. This clearly is an issue that needs to be solved, and, lo and behold, some physicians appear to be pursuing one viable solution to a part of it. Any reform plan, to be successful, must support and even foster such innovation.
But a lot of people have a lot of interest in maintaining the status quo, and they have the best lobbyists money can buy plying the halls of Congress for them.
Thoughtful consumers — and providers — will need to be assertive in making their voices heard.
Dale Davenport is the former editorial page editor, now retired: daledavenport@comcast.net.
Above article published on
http://www.pennlive.com/editorials/index.ssf/2009/06/direct_billing_could_ease_pain.html