By Dr. Jeff Gold, Gold Direct Care, Boston, MASS.
FEBRUARY 3, 2016 – For a state that prides itself on providing superior healthcare services for its citizens, Massachusetts is emerging as the state that no other state wants to emulate. No matter how much policymakers tinker with the state’s delivery of healthcare, we have the distinction of being one of the costliest systems in the nation – if not the costliest.
And as Governor Baker rolled out his fiscal 2017 budget this week with a projected $635 million deficit hanging over us, it was quickly evident that the cost of state-funded healthcare continues to be a voracious budget consumer.
The more complex the system becomes with highly structured programs and sophisticated cost containment efforts, the more expensive it gets. A 19 percent increase in the cost of the MassHealth program for low- and moderate-income patients in 2014 (much of which was triggered by the unintended automatic enrollment of an additional 379,000 new members at MassHealth) now threatens the viability of other necessary state programs.
Experts don’t agree on how to fix our health care system, but the most frequently cited cost drivers are the cost of prescription drugs; overutilization of our hospital emergency rooms for non-emergency primary care; escalating prices for medical procedures; and unnecessary diagnostic tests.
What health care experts agree on is that the fewer primary care physicians there are in proportion to the number of specialists, the higher the rates of mortality from heart disease and cancer. That decline in the number of primary care physicians also correlates to a higher number of low-birth weight babies and higher mortality. A health care system once focused on prevention has given way to one built on expensive intervention.
Patients who spend time with their primary care physician are more likely to be diagnosed for diseases and are less likely to use an emergency room for primary care. They tend to be healthier and better able to avoid preventable and expensive healthcare crises.
When we opened the first direct primary care practice in Massachusetts a year ago, we stepped off the hamster wheel that most primary care physicians experience every day. As direct primary care physicians, we have reduced the number of patients we see by two-thirds, which allows us to spend as much as an hour or more with our patient. We don’t accept insurance so we don’t spend a third or more of our day charting notes for insurance reimbursement.
Many of our patients have high-deductable insurance policies that cost less so they can afford the average monthly $75 fee that we charge. Instead of seeing 25 patients a day, direct primary care physicians typically see no more than 10. What they get is our undivided attention and a thorough assessment of health issues and lifestyle concerns.
A study by the health policy journal Health Affairs of an emerging direct primary care practice in Washington State found that the Qliance direct primary care practice they studied was nearly half the cost to the patient when they purchased a low-premium, higher deductible plan. A nonsmoking 53-year-old man who would have paid $11,068 for a one-year $1,000 deductible plan instead bought a higher-deductible plan costing $5,532 annually (plus another $828 for his Qliance membership) for a total of $6,360. Even with the more expensive $2,500 deductible plan, the annual cost was about $4,000 less.
The appeal for primary care physicians is a manageable day where we get to spend time with our patients and use our diagnostic skills to keep them healthy. In other words, we get to practice medicine and be the doctors we wanted to be while our patients have our undivided attention.
Massachusetts has yet to join about 15 other states that have filed or passed legislation that define DPC practices as outside the scope of insurance, but the move toward a direct primary care system is inevitable as policymakers begin to understand that our assembly-line healthcare system is largely benefitting insurance companies, pharmaceuticals and large hospital systems. Patients and their primary care physicians seem to be the least regarded part of this system.
The essential relationship between a doctor and patient is based on time spent, not technology. It is obvious that we need a course correction when a highly respected national medical journal thought it needed to study – and report – what we already knew, that “patients want their physicians to look at them — not their computer screens — while in the exam room.”
Sometimes the best solution to a complex problem is actually the simplest.