A Health Care Choice You Didnt Know You Could Afford
[Music]
i’ve often heard people say
that kidney stones are as painful as
delivering a baby
and my wife and i would often debate
whether this was true or not so we
decided
let’s duke it out she got pregnant and i
got a kidney stone
actually two to be precise but i soon
realized i had made a terrible mistake
in this challenge
and it wasn’t that my wife was right
which for the record she always is
but these kidney stones cost me four
ultrasounds
three cat scans and a surgical procedure
yeah ouch but then as i looked at the
bill
something struck me i had paid over a
thousand dollars for a cat scan
and over 250 dollars for an ultrasound
and this was despite having a health
plan
that cost over two hundred dollars
a month so you can see that
the pain from these bills started to be
a lot more painful
than the actual stone and speaking of
stone
i did not intentionally cause my stones
to occur
if that were the case we’d be having a
very different kind of conversation
today
so here’s a real shocker i am part of
less than one percent
of doctors throughout the country that
practices a unique form of primary care
where i help my patients get cat scans
for
350 dollars and ultrasounds for 150
whether or not they have health
insurance and without any paperwork
hassle
so something literally doesn’t add up
but the cost of procedures
isn’t the only issue with our medical
system today
there is so much administrative burden
and bureaucracy
that sucks away a ton of time and money
25 of health care spending in our
country
which can be up to 900 billion dollars
is considered to be waste in our system
you know in the traditional system when
you get sick
you go to your doctor if you’re lucky or
nearby doc in a box
and you’re immediately greeted with a
stack of papers
which pretty much could be your
autobiography
questions about your anxiety questions
about whether have you have enough food
on the table questions about
your history so why are you asked all
these questions
about poverty work stress
family life well it turns out that only
11
of our health is determined by the
medical care we get and yet as a country
we spend over 3.2 trillion
dollars on health care most of which is
not going to the people working in it
so what are these other factors well the
biggest
is individual behavior followed by
social circumstances
genetics and biology and your
environment
so it begins to make sense why we want
to get to know about you
as a person why we want to know whether
you have enough
food on the table or whether your job is
so stressful
that you may want to leave it perhaps it
might influence
which medication you’re likely to take
or which test you may push
off or not so while these questions have
a great purpose in theory
to determine your whole person health
they’ve unfortunately become
deeply embedded in a financial model
one where if the box is not checked
it doesn’t count and if it doesn’t count
it doesn’t generate money so back to
your office visit
you complete your stack of papers and
you begin
the waiting game you wait
you wait and you wait
and you’re finally seen only to spend a
few minutes with your doctor
studies show that the average amount of
in-person face time
patients spend with their doctors is
between eight to 12 minutes
and yet sometimes they spend over two
hours
between traveling and sitting in waiting
rooms
for those precious eight minutes
so in these eight minutes you were told
you have strep throat
you needed antibiotics and you had to go
to the pharmacy and by the way
you’re carrying some excess weight so
you need to lose weight eat healthier
exercise more
the end and this cost you 120
so let’s put all this together right so
health is determined by so much more
than medical care itself the biggest is
individual behavior
you’re asked a lot of questions which
are important
but you only have eight minutes with
your doctor so you get through the
current issue at hand
in the long term perhaps more important
things such as
addressing your lifestyle challenges or
your eating or exercise
is pushed aside because there isn’t
enough time
because your doctor has to see 22
other patients that day and this cost
you
over a hundred dollars now many of you
can probably relate to the scenario i
just described
what if i told you that there are over a
thousand
doctors across the country that could
have probably given you that visit
for less than ten dollars if you’re a
member of their practice
and that they could spend an hour face
to face with you
exploring your challenges with your
health
and that whether you had health
insurance or not you could choose
to have that type of care
health insurance is a way of paying
for care it does not necessarily give
you access
to good care now think about every other
way you use insurance
you know car insurance you use for a car
accident not to
replace your wipers or rotate your tires
or for an oil change
homeowners insurance you use if a tree
falls on your house
not to your driveway or clean
your gutters or repair a faucet
so why do we use health insurance for
things
other than catastrophic events for say
primary care
which is often the lowest cost
service in health care
in a model known across the country as
direct primary care or dpc
for short doctors like myself operate
outside of the insurance world to give
you care
that is accessible doesn’t break the
bank
and doesn’t discriminate based on health
insurance
here’s how it works think amazon prime
or gym membership
but to your doctor’s office for a low
monthly
membership subscription fee which often
costs
less than a cup of coffee a day you get
an
all-access pass directly to your doctor
it includes things like in-person visits
telehealth
email texting phone calls all without
any copays
it also includes tests like ekgs or
breathing tests
at no additional cost doctors get to
provide
excellent care coordination by directly
working
with other doctors that take care of you
and bypassing
the layers and complexities of our
health care system
and there’s more doctors may offer lower
cost
labs at up to 90 percent lower the cost
lower cost imaging such as cat scans and
ultrasounds
and lower cost medications often times
dispensed right in the office
and there’s more depending on the type
of practice the doctor may offer
acupuncture or integrative medicine
by taking down these artificial barriers
that increase the cost of care
doctors get to not only give you great
care but help you save money
so let’s see how dpc work for john you
know john is in his 60s and he has a
form of
blood cancer that’s chronic but still
weakens his immune system
he does a lot of work with plants and he
noticed one day that his finger
was swollen so what did he do he sent me
a text message
thirteen text messages and four pictures
later
we determined that you know what we
needed a video visit so i can get some
more information
five hours later that same day john and
i had a video visit
which lasted about 10 minutes because i
knew him pretty well
toward the end of the visit we decided
you know what i really needed to see
this in person
and that he’d come in the next day so
john came in the next morning he didn’t
wait
which is reassuring because it minimized
any exposure for him
he came right in examined his fingers
and we decided
he needed antibiotics and then something
really
funny happened you know john’s wife was
also a patient of mine and had been
struggling to really understand
their direct primary care model of care
texted him
a question can you get the antibiotics
from the doctor she asked
now i can’t tell you how excited that
made me feel i was like yes she gets it
so john walked away that day antibiotics
in hand that cost him three dollars
over the next three days and through the
weekend john and i exchanged
19 text messages and three picture
messages
until his infection had resolved and
this entire
experience cost him three dollars
the strange thing about direct primary
care
is that those of us who do it are
incentivized
to work for you let’s think about that
for a second
who does your doctor work for you
their employer or in some way
the insurance company that ultimately
gives the money that
pays their salary what if your doctor
was not incentivized to refer within
their organization
or that they didn’t have to worry about
the number of patients they saw per day
and that you truly felt like you had a
partner who had your best interest in
mind
with minimal conflicting factors
the answer is not hypothetical it’s the
reality
at over a thousand three hundred
practices
across the country so now you’re asking
yourself
why doesn’t everyone do direct primary
care well some
argue that if every doctor that normally
takes care of
two to three thousand patients suddenly
went into direct primary care where we
take care of
300 to 500 patients that the primary
care shortage
in our country would get worse
the reality for us docs is that the job
of a primary care physician
is so under appreciated and overburdened
that many dread going into it
perhaps by changing the model we’ll get
more docs
and more access and i’ll be honest
as a direct primary care doctor i have
to do a lot more than medicine
i have to coach i have to care
coordinate i have to keep accounting
i have to negotiate test prices for my
patients i have to network
and it may not be for everyone but as a
patient
direct primary care clearly has its
benefits
studies have shown that employers can
save up to 40 percent
on health care costs by offering direct
primary care
they’ve also shown a decrease in cost
from demand for health care services
a 41 reduction in emergency room usage
and a 20
reduction in hospitalizations all while
having savings
with medications and labs that are
provided
at lower cost the satisfaction rate
remains high because the service
provider
the doctor is focused on the client
the patient but let’s remember that
direct primary care is a piece
of the puzzle the primary care piece of
it which really
should be your gateway to your
healthcare experience
it doesn’t replace the need for care
outside the scope of primary care for
say
hospitalizations due to heart attacks or
other life-threatening events
or labor and delivery or complex
conditions that
really need to be co-managed with a
specialist
but when you need to use other parts of
the health care system
your direct primary care doc is right
there
by your side helping to make that
experience as smooth
as possible and while i said that
primary care is a piece of the puzzle
it’s probably the most
important piece where eighty to ninety
percent
of your health care needs can be met by
your direct primary care doctor
at a fraction of the cost with much less
waiting time
much more time with your doctor and a
far more
personalized experience
now let’s be clear i am not blaming the
doctors
in the traditional system but i am
questioning
the system as a whole i’m questioning
the system
that doesn’t educate us patients and
doctors
about the choices that we have i’m
questioning a system
that is building artificial barriers so
that doctors and patients
can’t have relationships i’m questioning
the system
that is wasting billions of dollars of
your hard-earned money
on things like billing coding and
checking boxes
and i’m questioning the system that
isn’t solving the fact
that in eight minutes we cannot help you
work
on the most important determinants of
your health
but there are choices out there direct
primary care
is one of them it may not be for
everyone
for my patient john it made a difference
if you didn’t know it existed well now
you do and i hope that as you look at
your health
you remind yourself that you have
far more choices and decisions
you can make thank you