By PAULA M MUTO, MD FACS AND MARK R. MUTO
Editor’s note: This month’s spotlight is on an advocate of disruption in healthcare, who speaks passionately on many issues regarding transparency in healthcare, patient rights and ensuring patient access to the care they need and deserve in our forum format we call “In other words… where we enjoy giving providers the opportunity to discuss issues they would like to address with colleagues in the healthcare community.
In Other Words….with Paula M. Muto, MD, and Mark R. Muto
Healthcare is a mess. Sixty-four percent of Americans avoid or delay treatment because of not knowing the cost. The fear of surprise bills and the increase in deductibles have created, at best, a confused marketplace, at worst severely restricted networks that prevent patients access to critical services. Both patients and doctors have been held captive in a system that, by design, separates them, despite the natural alignment in priorities. Doctors want to take good care of patients and patients want to get better, but the current set of rules interfere with this fundamental relationship.
We all know the reasons for the status quo, with healthcare accounting for nearly one fifth of the nation’s economy, the incentives are obvious, and the effects cascade through society as a whole. The true cost of care is skillfully hidden, and because we assume it will be high, with trepidation we dutifully pay our monthly premiums, and even swallow additional fees when actual service is provided. Healthy, organic economic trends are stymied by workers forced to stay in unsuitable jobs and employers strong-armed into managing benefits instead of production. Add to this the loss of productivity of workers forced to take multiple steps in pursuit of care, not to mention delays in treatment, and the costs extend beyond the individual. This scenario satisfies archaic insurance requirements for managed care but offers no value for the patient or doctor.
From the insurance perspective, the needs of the patient are not paramount, because in most cases, the employer is the “customer.” Taking the patient out of the equation, makes it easier to negotiate price. As long as patients remain obedient and within the restrictions imposed upon them by their employer plan, the cost is controlled, even if that means having to travel to another state for a routine procedure. These policies may save money for a patient’s employer, but not necessarily for their spouse’s. The real price of a knee replacement goes well beyond the operating room and it is the patient, not the employer who incurs that cost. Despite this shift, there is little opportunity for the patient to decide what is best for them.
With the patients out of the equation, the response on the medical side has been a consolidation of services, shifting care away from individual practices to larger, often restricted and impersonal networks. Doctors struggling with increasing overheads and decreasing payments, have responded by retiring early or by selling their practices to hospitals or even venture capital. For the first time, over half of the physicians in the country are system employed, which means they are no longer allowed to work directly for the patient. With little autonomy, physicians have been silenced or worse, ignored. It’s no wonder 48 percent report burn out or “moral injury.” The doctor-patient relationship has been deemed irrelevant, even though 75 percent of patients consider it the most important factor in their healthcare. We have effectively separated doctors from their patients leaving them vulnerable to a standard of care determined by economics. But where do we go from here?
Technology has created a world of convenience, where services of all kinds are directly accessible to the consumer and at lower cost, because there are no intermediaries. Isn’t medicine perfectly suited for this? Restoring a personal, peer to peer relationship realigns priorities and allows the patient both control over their own healthcare choices and holds physicians directly accountable for a good outcome. Biotechnology is leading to targeted therapies and individualized care and we need a new paradigm that accommodates the future of healthcare – not its past. We can simplify the equation by eliminating the steps technology has made irrelevant and offer patients direct access to their doctor for a transparent price.
But to change the system we have to prepare for an epic battle and doctors must lead the charge. We can no longer, in good faith, sit idly by as our hospitals and societies publicly oppose any initiative that challenges the status quo. Understood, there is a vast industry built around healthcare delivery that has led to an astonishing increase in administrative costs, but we now know it doesn’t work and is unsustainable. The cost of managing care has far exceeded the cost of delivering care. Medicare for all or other reforms would require more resources and we don’t have any to spare. We need to decide who is the best steward of the healthcare dollar and it is an undisputed fact that when the patient pays, the price comes down. Allowing the patient to choose what is best for them is a fundamental right, and depends on an autonomous doctor-patient relationship.
Price transparency is an important step and one we cannot fear. Paying for care is finite, not everyone needs a billion-dollar cancer drug, advances in minimally invasive techniques have reduced the need for expensive postoperative management, and vaccinations have eliminated certain diseases all together. Bernie Sanders suffered a cardiac event, was treated, released and back on the campaign trail within a week. The price of his cardiac stent is irrelevant, because the cost of delivery was minimal. We are moving toward more efficient care, but are repeatedly being yanked backward by costly system requirements. At the very least those costs should be transparent.
We do not need a complex hierarchy to practice good medicine. We have made it infinitely more difficult for no good reason. Physicians should not be held captive by a system that no longer serves their patients. We need to act together to put the patients first by offering direct access and price transparency. Doctors have a moral obligation to just say no, step outside the current system to take care of the patient, and we have the technology to do it.
Paula Muto, MD, FACS, is a fellowship-trained vascular surgeon by specialty who also practices general surgery. Additionally, she is director of the Vein Center at Mutosurgical. She is an advocate of disruption in healthcare and speaks passionately on many issues regarding transparency in healthcare, patient rights and ensuring patient access to the care they need and deserve.
Muto is the founder and CEO of UBERDOC, a direct-pay healthcare platform. Visit www.uber-docs.com.
Mark R. Muto is the owner of Pace Systems, an IT consulting company specializing in medical information technology and patient privacy.