Humans are motivated by, and make decisions based on, incentives. And, currently, incentives for patients and physicians are misaligned. There is a great need for a system that allows for the incentives of patients and physicians to be aligned.
Physicians need a business model that will allow them to maintain the stature and significance of being a physician, be in control of their time to actually enjoy life, make a large impact on the lives of their patients, and make some good money in the process.
The word physician actually means “one who is skilled in the art of healing.”
It is sad, but very few physicians are actually using their skills “in the art of healing” (Which is probably why physicians allow insurance companies and hospital administrators to call them “providers”.) While we all want patients to get better, this will not fully happen unless a platform is built for physicians to actually go beyond being a “provider” to actually do what they feel is important: the art of healing patients.
How can we marry the idea of regenerative medicine as a process with the fact that most physicians, in a time of personal reflection, do truly want to be physicians, not providers? The first thing we need to do is connect the economic incentives of patients to the economic incentives of the physicians.
If a third party pays for treatments, there is no skin in the game (relationship) – for any of the three parties.
It is hard to align the economic interests between two parties – patients and physicians – when neither party has a say in what things cost. There is no incentive for patients to “shop prices” because patients get treatments based upon what their insurance company will pay for.
Conversely, physicians have no incentive to keep costs down because, frankly, the model does not require them to do so. (While this is painting with broad strokes and Obamacare was supposed to provide incentives for physicians to try and keep prices down, in reality, physicians are perversely incentivized to do the opposite by ordering more tests than may be necessary to avoid frivolous lawsuits.)
Without considering quality of life for physicians (which is impossible to do), there are three ways currently being employed to try to advance the field of regenerative medicine:
- Hope insurance eventually covers the high costs of treatments
- Convince people to keep paying high prices
- Lower prices (“race to the bottom”)
Have insurance pay for the treatments. For the time being, regenerative medicine treatments are not covered by insurance. And this will continue to be the case until insurance companies have enough data to show “evidence” that covering the costs of regenerative medicine treatments are an acceptable risk. There will come a day when insurance will cover regenerative medicine treatments, but it won’t be for some time.
(In fact, there is currently a movement away from insurance-based medicine that is not directly connected to the regenerative medicine. The Direct Primary Care model is a fast growing model that allows patients to pay physicians directly. Disruption will only come when the patient-physician relationship is enhanced, protected, and treated as sacrosanct.)
Convince patients to keep pay high prices. Let’s forgo all of the reasons why a patient would pay and assume that they want a better quality of life. Let’s also assume that patients believe that they can achieve that better quality of life through regenerative medicine treatments. We must also assume that there is a limit as to what an individual will pay for a particular treatment, just as there is a very limited number of patients that are willing – or able – to pay “whatever it takes” for a better quality of life. The field of regenerative medicine will not advance if the prices for treatments remain as high as they are. The high price tag on regenerative medicine treatments is one of the biggest complaints against, and obstacles for the advancement of, the field of regenerative medicine and those who practice in the field.
Lower prices for treatments. This would be very good for patients and their pocket books, but the physician would continue to feel like a rat in a cage on a wheel simply running in circles.
Because physicians, physician groups, or hospital groups would have to make up the lost revenues from lower prices with an increased volume of patients and a continuously declining supply of doctors. Good for the bottom line, but physicians are already stretched to the max as it is.
This only exacerbates one of the biggest complaints of patients toward physicians, in general, let alone the field of regenerative medicine: a general lack of time that patients actually get with their physician.With eight (8) minutes being the average time a physician spends with a patient, it’s no wonder this is one of the biggest complaints. Especially when most of that eight minutes is spent with the physician staring at a screen or talking in technical jargon, lack of satisfaction abounds.
It is incredibly difficult, if not nearly impossible, to develop and build a real relationship between a patient and their physician in the current environment. While patients desire a real relationship with their physicians, it will never happen because there is no incentive for the physician to maintain that relationship. It is a “one and done and ‘next’” transaction. It is not intentional – it is a human behavior outcome in light of these incentive arrangements. Physicians do not seek to intentionally reduce patient interactions – it just happens in these conditions. Patients can receive care in this model – we just get more of the same in terms of the problems of modern health care. This includes limited access to physicians, increased costs, etc.
It’s not the doctor’s fault. But it is, ultimately, their responsibility.
“Many problems in society come from the interventionism of people who sell complicated solutions because that’s what their position and training invites them to do…They pay no price for the side effects that grow nonlinearly with such complexities.”
(Nassim Nicholas Taleb)
Today’s doctor is incentivized to see as many patients in a day that he or she can. The doctor has been “institutionalized” in their thinking that this is the only way to make a living.
Those doctors who believe they have overcome this notion of being driven by the “almighty dollar” and work for an institution that pays them a salary have been incentivized by the “safety” of a salary. With this, the institution, knowing its fixed costs, drives the doctor to see more and more patients because the doctor, as “provider,” has to comply with the wishes of his or her employer.
It has become apparent that the current economic model is not efficient, and will soon no longer be effective, let alone sustainable, given the staggering statistics shared in the Solution for Physicians section of this website.
It is quite apparent to those who will look and consider that the complexities in and around the field of regenerative medicine are incredibly similar to the complexities facing financial resource management.
In fact, to carry that analogy a bit further, the current service “providers” offering procedures with products are just like the commission-driven product salespeople in the financial industry. They are selling complex products to people who probably need them. But the people are not completely sure what, exactly, they are getting, let alone, understand the ins and outs of the product or procedure. This causes even more cognitive dissonance because patients are at least more informed than they have ever been in the past, thanks to “Dr. Google.”
So, how does RHM align the economic interests of patients and physicians?
By spending time with, and giving advice to, patients. RHM Physicians are compensated based upon the value that they add for each patient, not by how many patients they see.