Megan M. Stock, DMD
Dec 20, 20195 min
I recently had my annual wellness visit with a physician whom I have been seeing for a few years now. She is a member of a group practice that is under the umbrella of one of the major hospital systems in Pittsburgh. While I truly like her as a person and trust her expertise, it became very clear to me at this last visit that her hands were tied in a way that hurts both her as the provider and me as the patient.
As I sat in the exam room waiting for the doctor to enter, I noticed that there were three, yes three, signs in the single small treatment room that all read versions of "Due to time constraints, if you wish to address a matter outside of ___, ___, and ___.... you may incur additional charges and/or be asked to schedule another appointment." These "acceptable" matters of discussion were extremely limited and did not even begin encompass the full scope of my physician's specialty training. I was disheartened, but not surprised, to see just how over packed the practice's schedule must be in order to warrant such signage. I felt as though I would be a bother if I had any questions or issues- I felt unimportant.
While a busy practice can be like a well oiled machine, an overly busy practice can be chaos. At this recent visit of mine, I waited 30 minutes past my appointment time to be called back to the exam room. This was after I waited in a line 3 people deep just to check into the centralized front desk where the very kind receptionist would not have known me apart from Joe Schmo. And don't even get me started on how far in advance I had to make this appointment (spoiler: it was over 2 months for an available routine appointment). Once the assistant took my vitals and went over a very brief medical history update, I waited again for the physician. As I mentioned earlier, I enjoy my physican's personality and have every confidence in her capabilities. She spent a minute or two reading over my medical history and got right to my exam. There were some pleasantries exchanged during the exam, and then... that was it! Visit over. She asked "is there anything else?" as she was halfway walking out of the room.
In fact, I did have an issue to discuss. For a moment, I actually hesitated to ask my question, unsure of if it fell into the category of "acceptable matters of discussion" or if she would have enough time to adequately address my question. In this case, she was able to quickly address my questions and I was not billed for additional services or asked to reschedule. I wonder, though, how far I set her back in seeing her next patient. Would she have time to address their concerns and questions as she did for me? I would imagine she is so overscheduled that this is a daily problem for this practice.
So how does a practice become stretched beyond its capacity in the first place and who is to blame? I place no blame on the physician in this case. I believe in my heart that she and most people who get into the healthcare field do it to make a difference for people. I believe that they care intensely about their patients and want to do what is best for them, but are often unable to provide the level of care that they wish because of a number of constraints. So if it's not the provider's fault, is it the scheduler? No. Just like most practices, this group is contracted with insurance companies that routinely pay unreasonably low reimbursements to the providers or deny claims all together. The providers are taking such a huge cut with these low contracted fees that the schedulers HAVE to keep the schedule jam packed just to pay the bills.
I know that the issue of how insurances play into healthcare is an extremely complicated subject and one that cannot adequately be summarized in a short blog. I also know, however, that insurance companies are FOR PROFIT organizations. They are in a business to make money, NOT to look out for patients' best interests. They make money by maximizing the money that they take in through premiums and minimizing how much they pay on the patient's behalf. It's simple math.
It is unfortunate then, that many patients see the insurance companies as patient advocates. Healthcare decisions should be made between the providers and the patients. Unfortunately, insurance companies have made themselves an integral player in the healthcare decision making game by dictating what services will and will not be covered regardless of necessity. For covered services, they often pay such a low reimbursement to the provider that providers will set their fees higher than necessary to make up for this gap. Therefore, patients who do not have insurance or whose plan does not cover a specific service end up paying a much higher amount than what an insurance company would be paying for the exact same service. Patients often elect to forgo recommended procedures if their insurance does not cover it because they simply cannot afford it.
So what can be done to shift the mentality away from insurance-centric medicine and towards patient-centric medicine? Don't worry, I won't get all political and give my views on universal healthcare or the like. I actually think that the answer lies in cutting out the insurance companies all together for most routine healthcare. Direct primary care is a practice model that cuts ties with insurances completely, eliminating the complicated and time consuming hoops that a traditional practice must jump through for insurance billing. By reducing the number of necessary personnel as well as other overhead, these practices are able to keep their fees much lower than traditional practices, often times even lower than what the patient's out of pocket expenses were with insurance. Most of these practices are very transparent with their pricing, even listing it right on their websites. This is quite different than the complicated world of EOBs, pre-determinations, pre-authorizations, co-pays, deductibles, "let's see what your insurance pays first", etc. There is also the invaluable bonus, in my opinion, of the time that is freed up that they can now use to spend with their patients.
This may sound a bit far fetched and is by no means a perfect plan, but there are already practices here in Pittsburgh who are following this model and so far, feedback is great! I agree that it would take a monumental shift in thought in order to buy into an idea like this, but I think that over time, people will begin to realize that this model allows for patients' needs to be addressed directly with their doctor in a clear and concise manner without undue influence from insurance companies who have no interest in making healthcare decisions that are appropriate for you, the patient.
If you are interested in learning more about the direct primary care model or finding out about some physicians in the Pittsburgh area that are thriving on this model, a quick Google search revealed Family Matters Direct Primary Care, Gentile Family Direct Primary Care, Kittridge Dermatology, and iHealth Clinic, all of whom provide this type of care. With the exception of Dr. Kittridge (whom I highly recommend!) I have no experience with any of the other practices, so I want to be clear that I am not endorsing them. But I hope and suspect that this type of medicine, or some form of it, will continue to become more prevalent as patients and doctors begin to see the benefits first hand. I know that I have some doctors to research before my next wellness check!