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The Pendulum Swings Back

The Pendulum Swings Back

I’ll never forget what my aunt told me back in 1997. She was living in Palm Springs, CA with my uncle, a respected doctor. I had just told her that my wife, soon to be graduating from her residency in Philadelphia, was about to join her first Internal Medicine practice. I was bursting with pride, eagerly anticipating the words of wisdom from someone who’d seen it all after years of being the office manager at my uncle’s medical practice.

She said “don’t do it.”

Don’t go into Internal Medicine was her advice. She patiently explained how wonderful it had been for them during their early years. Doctors like my uncle were free to do what they wanted when they wanted to it. They could spend as much time with patients as they saw fit and make decisions unilaterally based on what they thought was in their best interest. They also made money hand over fist.

But as time had passed things had slowly & inexorably changed for the worse; they were now both at their wits end. Insurance companies were burying them under mountains of paperwork, making them see an ever-increasing number of patients every day, and even dictating which procedures were OK to run on their patients. Time and care had now diminished, as had the money train: There were times when patients would literally make their co-pays in pennies.

The pendulum had swung.

It’s unfair to portray insurance companies as the bad guys, though. Initially they were doing their part by playing parent, admonishing naughty doctors who over-treated their patients or provided inappropriate care. Costs were contained…for a while. But that greater good was undone with increasing red tape, as doctors (and patients) balked at their “bean counter” overlords interfering with their medical decisions. The bureaucrats capitulated—but it was a Pyrrhic victory. Since physicians were still seeing an assembly line of patients each day they resumed over-treating them. It was easy to do in a health care industry that was becoming inundated with new technologies such as MRI, EKG and ultrasound procedures. The system that was now in place rewarded doctors’ overtreatments, while offering none for rejecting it. And in a litigious society physicians and their patients concurred that it was better to do medical overkill than do too little.

However, studies have now shown the opposite to be true.

Over-testing, over-diagnosis, and over-treatment do have harmful effects. For example, back surgeries are one of the biggest unnecessary procedures for those who have pain. Not only could that operation result in damaging physical repercussions as well as financial ones, it also is—considering the alternatives that could actually remedy most patients’ root cause of pain—a total waste.

A report released by the Institute of Medicine in 2010 found that waste accounted for 30% of health-care spending: $750 billion dollars a year.

Insurance companies have taken notice of this staggering figure. They have come to the unsurprising conclusion that it is the quality of care that drives down costs, not quantity. When doctors see less patients per day they can assess the appropriate course of action to be taken—instead of hastily sending them off for a bevy unnecessary procedures.

It’s just not that unnecessary care is eliminated. That may solve the insurance company’s fiscal problems, but it doesn’t help the patient. No, it’s that unnecessary care is replaced with necessary care. That’s the key.

If patients get the attention and remedies that they need then back end costs for the insurance companies are significantly reduced. That’s the tangible result that eliminating waste brings. Recognizing this new (old) paradigm, insurance companies are now actively financially incentivizing doctors to take their time in properly diagnosing and accurately prescribing treatments for their patients.

In short: Physicians get back the time and the financial compensation that they deserve; patients receive the specialized care they require; insurance companies see increased revenues. Everybody wins.

It’s early days yet, and much work still has to be done. But Auntie will be happy to know that, slowly, the pendulum has begun to swing back.

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