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BUSINESS OF
MEDICINE

SOLUTIONS:

PROSPERING AMONGST

HEALTH INSURANCE CHAOS

By Allison De Paoli

Physicians are more and more pressed for time and resources tively. It isn't necessary to see 12 patients an hour to cover your
today than ever before. There is too much paperwork, too little re- costs. DPC puts the fate of a practice squarely in the hands of the
imbursement and not nearly enough time with patients to satisfy physician, but the rewards can more than outweigh the risks:
most doctors. On top of that, an insurance company is often second • Patient care is completely in your control
guessing your decisions and trying to change the way you treat your • You know what your revenue per patient will be
own patients. • You control your schedule and care able to spend what you deem
No wonder burnout is rampant! an appropriate amount of time with each patient
Most agree that the current system is not working well for pa-
tients or for providers. The solutions require moving out of a A surgeon or other specialist’s solution might be to look to bun-
known quantity, the dreaded insurance reimbursement arrangement dled pricing or direct contracting with employers to grow their prac-
where no one seems to know what care actually costs, to a more tice. One method is to work with the employer through their Third
transparent method of practice. Party Administrator (TPA) or direct employer to physician contract
By putting the provider back in charge of how services are priced that then connects to self-funded employers. A company can nego-
and how they are delivered, the cost is disaggregated or broken into tiate with employers and providers for specific covered services.
its component parts. I know this can sound scary. However, who That way, all are billed on a bundled basis and all parties know ex-
knows better than a doctor as to what the value of their skill is and actly what the fee arrangement is ahead of any procedure. The result
how best to deliver it? is a triple win:
• The physician and facility are paid an agreed upon price at or im-
Solutions mediately after the surgery is performed
An Internist’s solution might be to look to a Direct Primary Care • The patient receives quality care and has a direct relationship with
(DPC) model of practice. If you own your practice and set your the surgeon
own fees, you can manage your time – and your life – more effec- • The employer generally pays 50 percent of the network rate
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