Monday, October 12, 2009

High Touch Medicine: Touching the Pocketbook

If you haven't already, you're going to start hearing more and more about high touch medicine.  High touch (as opposed to or in addition to high tech) focuses less on using technology and more on things like spending time with patients, physician listening skills, and on greater pro-activity in treating chronic patient conditions.

As reported in Healthcare Finance News , Ezekiel Emanuel, M.D. recently outlined a high touch approach to medicine which he claimed may be the foundation for fixing health care in the U.S.  According to Dr. Emanuel (brother of the White House Chief of Staff Rahm Emanuel), bundling reimbursement to physicians based on ailments rather than paying for individual services could significantly reduce costs and improve care.

Basically, doctors would be paid a set amount for a patient conditions, allowing them to spend more time with each patient and focus more on preventative services and care.  Since physicians would not have to worry about how many patients they see in a day, they could proactively follow-up with patients, monitoring high-risk conditions, like diabetes, hypertension, heart conditions, obesity, etc.

Why is this a great idea?

Well, patients will love it.  Their physicians will have time to sit and listen to them, and really plan how to address their health issues.  Patients won't have to remind their doctors why they've come in,  because doctors will have time to adequately and correctly chart. 

Doctors will love this because their income will no longer be based on volume.  They won't have to average a patient every 12 to 15 minutes (or more) in order to make payroll.  And they will be able to sit down and actually do real treatment planning.

Everybody will love it -- for the first few months.  Because that's how long it will take for payors (insurance companies, health plans, and the big IPAs -- yes, they really have become payors) to begin to ratchet down the payments based on... well, on something, or anything:  evidence that shows hypertension in middle-aged males should be resolved in less time; studies that show that many  chronic pain patients don't get better, and therefore magically require less care.  The list will go on and on.  And reimbursements will go down and down.

Bottom line:  until there is some sort of insurance reform, either on the part of the insurers themselves or by the government, the profit motive at the insurer level will always put a crimp in any other reform plans.  There are ways the insurers could self-reform -- we'll talk about that another time.

One more thing:  does any of this sound like a re-worked capitation system?