Maybe It’s Cheaper to Pay Your Doctor

B By PAULA MUTO, MD, FACS

Our healthcare system is a disaster and getting worse by the day. No one seems to be satisfied, patients complain about the cost, doctors complain about paperwork, employers are tapped out and politicians try to avoid the subject.

The only folks who are benefiting from the broken system are the ones in the middle who have created multiple layers of complexity that have siphoned off the majority of the healthcare dollars into a giant black hole. The problem is individuals and employers seeking health care plans feel they have little choice and, therefore, humbly agree every year to another price increase, to pay for the “rising costs” of pharmaceutical, hospital and specialty care. Clearly, there needs to be better options.

While technology has moved the practice of medicine from the hospital to the office, to the patient’s home, the established healthcare system has not modernized to meet the new requirements. Hospital workflows have become increasingly burdened with a bureaucracy designed for corporate compliance rather than patient wellness. Doctors have had to constantly adjust and conform to protocols that impede, redirect and distract from properly implementing treatment in a timely manner. That is why the job burnout rate is so high and patient satisfaction so low.

It took a pandemic to push us into the future, allowing us to reprioritize care, adopting new technologies while streamlining others. Outpatient joint replacements, for example, are now becoming the new standard, and with improved outcomes, and telemedicine has emerged as an important addition to nearly every practice. In short, doctors have found new ways to work around the system and they are taking their patients with them.

There is no price transparency in healthcare. No one ever claims to know the exact price of services, although the balance sheet clearly shows what insurers haven’t paid. Fee schedules are exaggerated to give insurers a chance to bargain. However, spoiler alert: It’s actually much cheaper just to pay a transparent fee for a specific service. It’s expensive to bill, collect and obtain authorizations, and nowadays many patients have such high plan deductibles that they are paying out of pocket anyway. More and more often, paying with insurance can cost more, especially when it comes to medications. Patients should demand to know the price, and many doctors now oblige, and it would behoove hospitals to do the same.

The consumers drive demand and healthcare is no different. Buying insurance no longer guarantees a doctor’s time; on the contrary, it limits it. But going to a doctor doesn’t cost as much as a premium. With the advent of telemedicine, good doctors can see their patients more efficiently, lowering the cost for both the office and the patient. Hospitals can also change the equation by offering better access through price-transparent models. There are a number of places where patients can find affordable options for pharmaceuticals, imaging and specialty care, including surgery. Primary care physicians have been the first to see the value in direct pay models, but now every specialty is joining the movement. Employers are discovering medical cost-sharing plans that save companies—big and small—millions of dollars, and as more physicians participate, the market will shift back to the patients. Even the government sees the benefit in direct pay models.

The innovations in medicine in the past decade have been remarkable, but physicians and their patients can’t take advantage of all of them because of an archaic system built on principles that no longer apply. The best care is always found nearby, but when an employee works in another state, then what happens? The costs have not and will not be controlled by restrictive insurance networks. Coverage will always be necessary, but in a direct-pay world, the majority of encounters can be paid for out of pocket. In this case, less is more, and keeping people out of the doctor–patient equation saves both time and money. ■

—Dr. Muto is a general surgeon; the founder and CEO of UBERDOC, a digital health platform connecting patients and doctors; and the director of the Vein Center at Muto Surgical, in North Andover, Mass.

‘While technology has moved the practice of medicine from the hospital to the office, to the patient’s home, the established healthcare system has not modernized to meet the new requirements. Hospital workflows have become increasingly burdened with a bureaucracy designed for corporate compliance rather than patient wellness.’