It has been 6 months since my practice fully embraced digital medicine. Whenever possible we give patients the option of being treated without coming to the office. Several times a week we review text photos of medical conditions from rashes to pink eyes and respond with treatment plans. On a daily basis we treat high blood pressure and diabetes through secure email. Patients whose blood pressure was poorly controlled due to difficulty coming to the office are now perfectly controlled. Being busy is no longer an obstacle to care and patients are responding.
Thinking I am on to something, I have been sharing our new policy with other doctors. Everyone is interested in the idea but most don't think we are charging enough for the service. Our $120 a year annual fee leads to the conclusion that they would lose money if they adopted a similar practice. My reply that patients deserve this more convenient option is not persuasive.
I expected hesitancy and reluctance from my colleagues but one doctor’s response caught me off guard. When I told him that I was only requiring compliant hypertensive patients to come to the office once every two years he replied, “Sure, but you still have them come in for their annual physicals, right?”
I replied with a puzzled expression, “No, people don’t need physicals every year.”
“I know they don’t,” he said, “but we get paid for annual physicals.”
“But why bring them into the office if they don’t need to be there?” I replied, still not following his logic.
“Because we make money and it doesn’t cost them anything!”
“It costs them a day off of work!” I replied.
After a few more minutes of debate I gave up. We have completely different views on the business of medicine. I walked away from the conversation with a new understanding of the problems our society faces as we try to address increasing health care costs. Doctors and hospital groups talk about lowering costs but want to make as much money as they can. If they get paid to do something most of them are going to do it, even if it is useless.
It is easy to point fingers at doctors, but they are responding to basic economic instincts. They do what they get paid to do. Which means a large part of the blame should falls on those who pay for medical care. Insurance companies and government programs are a large part of the problem. Misguided wellness programs require healthy young patients to come to the doctor once a year and pay doctors handsomely for the visits. Obamacare requires insurers to offer physicals every year at no cost to the patient. Doctors know a cash cow when they see one and willingly go along with the program.
While willing to spend millions on unnecessary visits for healthy young people, most insurers do not pay anything at all for digital care. Many patients also fail to see the value in the service. When confronted with our annual fee over half of our patients were unwilling to pay the equivalent of $10 a month for the service. Modern healthcare access is not worth as much as their monthly Netflix or latte expenditures. Physicians who want to make a good living are left forcing patients to come to the office unnecessarily, because that is what they get paid for.
My hope is that my pilot projectwill eventually catch on. As my patients tell their friends about the benefits of digital care perhaps the demand for such services will go up. If it does, other doctors may eventually follow. Even if they don’t, I will continue to provide these services to my patients. Having seen the benefits of this care for my patients I am convinced it is the right thing to do.
Thanks for reading and for sharing with others. To read more about our digital access plan, you can read the explanation on my office blog. Comments and questions are welcome.
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