What drives insurance companies or pharmaceutical companies is different than what drives community doctors and their patients, and doctors need to be aware of how to treat with cost and collaboration in mind.
Results of a new national survey commissioned by the Physicians Foundation reveal that nine out of 10 U.S. adults express high levels of satisfaction with their primary care physician. That’s extremely good news.
“This shows that the patient-physician relationship is excellent,” acknowledges Rip Hollister, MD, a practicing primary care physician and a Board member of the Physicians Foundation. “I mean, 92 to 95 percent—you can’t get that much agreement out of any group of people anywhere.”
However, patients who responded to the survey also cite “increasing concern and frustration with their ability to manage rising healthcare costs and medical debt.”
“That’s really kind of ironic,” Hollister notes, “because this is the Affordable Care Act. People are now saying we’re not sure at all if it’s affordable.”
As a result, patients say they are not adhering to treatment plans, avoiding routine check-ups or opting not to take prescription medication. For physicians who, more and more, are being reimbursed through a value-based care model, this scenario affords them an opportunity to capitalize on the strength of the physician-patient relationship.
What is value? That definition will vary depending on whom you ask. What a physician or patient defines as value is much different from that of an insurance company executive.
“Value’s a great sounding word, but it becomes sort of meaningless when you give it to a patient,” Hollister says. “What they value is the relationship with their doctor, their ability to communicate and to spend time, and collaborate and develop care plans.”
And while the recent survey indicates that 79 percent of patients believe physicians impact the treatment options available to them, even more—83 percent—say health insurance companies have a greater impact. Hollister says that physicians control treatment options by thinking about the quality of patient care and how well that individual is, and the cost efficiency of getting well. In short, respecting the patient, their resources, and their family’s resources.
That, he says, is a different equation than what drives insurance companies or pharmaceutical companies: “It’s pretty clear to me that they’re about profit.” And that focus, Hollister says, has become a hindrance for physicians.
“What we’re finding more and more in the exam room, if you will, is sort of additional entities,” he says. “And they’re becoming more and more intrusive.”
Not about care
Hollister says he regularly has insurance companies who want to visit his practice to teach him how to properly diagnose.
“But they’re not talking about diagnosing a disease state,” he says. “They’re talking about improving the severity rating so they get more money from Medicare. Which doesn’t benefit the patient. The C in ACA is for care, but to me it doesn’t seem like it’s about care. It’s about insurance.”
Hollister explains that over the years he and his staff have been able to quantify their quality metrics in a way that satisfies the insurance companies. That’s good, because it helps them get reimbursed which keeps the practice afloat.
“And you really have to quantify a lot more per patient to get reimbursement,” he adds. “So, its not that reimbursement for a CPC code has dropped. It’s that we have to do more to demonstrate we’ve done it.”
And the bar, he says, just tends to go up.
Capitalize on relationships
Hollister says that, despite some of the hurdles, there’s a lot physicians can do to keep patients in adherence with treatment plans while easing their frustration over their ability to manage healthcare costs.
“I’ve been in my community for about 25 years, and during that time I’ve developed relationships with ancillary providers,” Hollister says. “Physicians have done this in the past, and it continues to be a very important thing to direct patients who don’t have that understanding to appropriate healthcare providers and ancillary providers.”
For example, Hollister has generated relationships with labs for drawing blood. The service might be covered, but “covered doesn’t mean it’s paid for” if the patient has a high deductible. The lab charges the patient a price that’s been negotiated with the insurance company, but that’s still high.
“What I do in my practice is I negotiate a price with the reference lab that is much less, and the reference lab bills me,” Hollister says. “And what I do, prior to getting a lab done, is I pass that benefit along to the patient so that they end up paying much less for the lab.”
Hollister refers to this alternative payment model of care as direct primary care.
“I think physicians understand the big difference we make in what healthcare is going to cost a patient, and proactively go out and find ways to save them money,” he says.