"Simplicity is the ultimate sophistication."
Leonardo DaVinci
Health care tries to innovate but the secret is to keep it simple.
We are seeing more and more tech companies claiming to fix the broken health care system. While we agree the system is broken, we don't agree on how to fix it.
Red flag warning signs for a healthcare clinic
1. Clinic run by health tech guru or nonphysician
2. Fancy buildings with non-essential technology in prime real estate
More clinics closing
- April 2024 - Walgreens closing 1200 stores and 60VillageMD clinics
- June 2024 - Walmart Health closed all clinics
- November 2024 - Hi-Tech Forward closing as of 12/1/24
It is a common misconception for patients and employers to assume that large healthcare centers are more efficient. It's a reasonable thought. If everyone is under the same umbrella, all personnel can communicate easily and there will be availability for collaboration. While there is some truth to this, larger systems often complicate a very simple idea; patients want to see their physician. Primary care thrives on access. Patients need to be seen when they are sick and followed up at appropriate intervals. The more complicated the delivery structure, the more employees need to be involved, and the more overhead is needed to keep it afloat. This also provides multiple barriers between patient and physician. Patients often explain the frustration of "just wanting to talk to (their) doctor." Physicians learn a significant amount about administrative, emotional and financial barriers from patients when they are involved in the conversation.
DPC is simple by design. Remove the middleman and provide direct care to the patients for one monthly fee. We see more and more technology companies venturing into health care with a mission to simplify care with technology. Ironically, if you asked a physician, we would likely explain that technology is what complicates health care.
Forward launched in 2016 as a tech-enabled direct primary care business based on a cash-pay model that doesn't take insurance. In 2023, in addition to 19 clinics across the US, they created Carepods, self-serve kiosks use artificial intelligence to screen and diagnose health conditions and were being deployed in malls, gyms, and offices starting in the San Francisco Bay Area, New York, Chicago and Philadelphia, the company announced in November 2023. After 8 years in the sector, Forward will be closing for good. Imagine if that $650 million went to actual health care or student loan forgiveness for primary care physicians so they can start a practice. Simplicity is still innovation.
Artificial intelligence should be a tool to be used by your physician, not to replace your physician.
Walgreens attempted to create clinics that take insurance but on a large scale. The problem here is that the structure of reimbursement is so convoluted. Hospitals employ large staff of billers to ensure reimbursement. This ratio varies but could be as much as 1 biller per 3-4 physicians. This is a massive expense. Given primary care is reimbursed at such a low rate and now Medicare is proposing another 2.9% decrease in reimbursement, it will only get worse. Clinics pressure clinicians to charge for more. Other physicians will enter the concierge market and charge a monthly membership while ALSO billing insurance.
In DPC, we think there is a much simpler way but it isn't as exciting for tech and big business.
Let doctors take care of their patients.Big box clinics like Walmart and Walgreens tried to staff clinics with non-physicians that had limited scope and followed algorithms. As stated by Dr. Gregory Hood, a Kentucky-based internist,
However, patients typically get better care when seeing a regular primary care physician, rather than going to a clinic staffed by less-trained people, said Dr. Hood. “Putting providers in these clinics, with limited scripts to follow doesn’t match with the diversity of conditions that come in and the variety of how they may present,” he explained. “Physicians have a higher level of training and experience than the training their clinic employees get and the algorithms they use.”
Algorithms in healthcare are dangerous but even more dangerous in primary care. Our expertise lies in the human condition and the most common diagnoses seen in various situations. We also have to know enough, see enough and experience enough while supervised in residency to recognize when we need extra help from a specialist. The only way to assure this is to give the doctor more time.
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