Moving away from dependency on payor models

I posted this on medscape discussions today

http://boards.medscape.com/forums/.29e29ae4/25

Having worked online with individual clinicians in small practices to help solve the daily workflow issues around communications, information management, etc I have been able to meet (albeit “virtually”) people who have pursued all ends of this spectrum of “concierge, micropractice, boutique, patient-centered” care models. Rather than starting from the current broken paradigm of “third-party” centered healthcare and trying to patch some level of sustainability around it, what has impressed me about the micropractice clinicians is that for the most part they have decided that THEY will determine what the practice of medicine will look like for them and their patients, what hours they spend doing it, how they are reached when needed, how their patient-colleague relationships are defined, and how they will structure their office/overhead/added fees and services in order to achieve that goal.

It is, I believe, a more “creative” as opposed to “reactive” approach, regardless of which specific version (ie no staff, part time staff, pay for email, holistic services, etc) is sought or to which he/she might migrate over time. The EMR systems these docs select are more likely to be chosen by THEM, based on their perceived needs and interests, rather than by someone else in a hospital or larger group model. And therefore the EMR and communications systems approaches they seek will be unique. (not necessarily applicable to all others, but will also evolve to meet the needs of this type of model).

So it has always seemed to me that we would all be better off if leaders of both physician, consumer, healthcare, payor and governmental organizations would just convey a common message to all patients……”your physician is likely a highly accountable hard working, well trained person who is dealing constantly with incomplete information and partnering with you to make complex decisions in a timely manner. You can expect to partner with him/her also in determining what type of “model of care” will work best for you and you should just expect that healthcare is no longer something in which every “service” provided by such a professional, is adequately compensated by a third party. The nature of that service, its timeliness, severity, complexity, and the number of people and hours it takes to deliver it…is partly determined by your role, needs, the environment, and the business/service climate in which this professional functions. In any other industry you would expect to be participating in the payment model that determines what level and type of service you receive..just like a lawyer or accountant or even rental cars…so please expect the same from your doctor.” i.e…..please dont ask your doctor to apologize for being treated like the truly accountable professional that he/she is.

This is not about trying to patch together approaches that fill in the reimbursement gaps of different insurers really, even though that is a near term strategy for many. It is about acknowledging that any process whose outcomes depend on the active involvement of professionally trained people in their own businesses can only sustain itself with an economic model that matches who creates the need, what is needed, who supplies the service and what it costs to provide it!!

AJB