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Are you frustrated with today’s healthcare?

It wouldn’t be shocking if you are considering the following. The average American spends 2 weeks waiting for a doctor’s appointment. 40 minutes waiting in a lobby. 20 minutes waiting in an exam room. Then, only 7 minutes with the physician.

Given the healthcare trends over the past few years, it doesn’t look like healthcare is going to improve anytime soon. It is one of the main reasons doctors are starting to change the model so they can provide the type of care of patients deserve. We believe healthcare should be better which is why we started Anytime DRs – affordable concierge medical practice. We believe patients should have proactive care, not reactive. And we also believe that patient should be able to afford their healthcare and not be restricted on treatment options due to insurance restrictions.

We’ve included links below to articles depicting the current state of healthcare and it’s bleak future unless we do something to change it. 

Future of Healthcare Articles

U.S. Healthcare Uninsured Rises Most in Near Decade: Gallup 

This article on Reuters from 2018 states that “the number of Americans without healthcare insurance rose by 3.2 million people between 2016 and 2017 or 1.3 percentage points to 12.2 percent, according to a Gallup poll – the biggest jump in the uninsured in nearly a decade.” The only group that did not see a rise in uninsured was those 65 and older who qualify for Medicare. Young adults, blacks, Hispanics and low-income Americans saw the biggest rise in uninsured.

Gallup began this poll in 2008 and states that this was the largest jump in uninsured Americans since starting the poll each year.

TAKEAWAY – more Americans don’t have healthcare insurance.

Growth of Underinsurance Now Rampant in Employer-Sponsored Plans

In the fall of 2017, PNHP, Physicians for a National Health Program – an organization advocating a universal, comprehensive single-apyer national health program, released an article discussing how well insurance coverage actually protects consumers from health care costs. According to the article, over the past decade, premium cost pressures have led to companies to share increasing amounts of health costs with employees. Mostly this is in the form of high deductibles. And while employees are being shouldered with higher insurance costs, income growth has been sluggish leaving families increasingly pinched by healthcare costs.

Survey findings:

Estimated 41 millon adults are underinsured.

As of July 2016 through November 2016, 28 percent of U.S. adults ages 19 to 64 who were insured all year, or an estimated 41 million people, were underinsured. This is more than double the rate in 2003 when the measure was first introduced in the survey, and is up significantly from 23 percent, or 31 million people, in 2014. 

Interestingly, 56% of the underinsured adults have insurance coverage through their employers at the time of the survey. And the share of adults who are uninsured has increased over time in each coverage group.

Why are more people underinsured? One factor is higher deductibles as more people than ever before have plans with deductibles and more have deductibles that are high relative to income. Sadly, deductibles are outpacing growth in many families’ incomes. In the past, high deductibles were most common with small business employers. In 2016, the share of workers in large firms with high deductibles climbed significantly.

TAKEAWAY – Employer insurance plans have increasing premiums, co-payments and other fees results in less affordable healthcare.

Half of People in Fair to Poor Health are Uninsured or Struggle with Affordability

This is another great, informative article by PNHP posted in August 2018 about how much people are struggling with the cost of healthcare. While we absolutely have an issue with more people being uninsured, we also have a far broader problem when it comes to the affordability of healthcare which hits sick people especially hard.

Here is one striking statement from their article:

Nearly half of all people in fair or poor health — 46.4% — are uninsured or have affordability problems despite having coverage. It’s not surprising that people who are sicker and need more care would have more problems paying for it. But arguably an insurance system should work best for people who need it the most.

When people have trouble paying their medical bills it hits their family budgets. As a result many people are forced to take a second job, roll up more debt, borrow money or forego other important family needs.

TAKEAWAY – Unaffordable healthcare plans and pricey prescription medications are on the rise.

Aetna Inquiry Widens Over Ex-Medical Director’s Comments

The first line of this article posted on CNN at the beginning of 2018 provides insight into one reason medical care needs reformed. It states:

Three more states announced this week that they are opening investigations of Aetna after a former medical director for the insurer admitted under oath that he never looked at patients’ medical records when deciding whether to approve or deny care.

According to Dr. Jay Ken Iinuma, medical director for Aetna in Southern California from March 2012 to February 2015, he did not look at medical records in which nurses reviewed records and made recommendations to him. Aetna claims that Dr. Iinuma’s comments were taken out of context. They state that, “Medical records were in fact an integral part of the clinical review process during Dr. Iinuma’s tenure at Aetna, consistent with his training.” Dr. Iinuma later stated that he meant that while didn’t review the entire medical record, he did review the pertinent parts of the medical record or the parts that were sent to him claiming that doctors don’t always submit the entirety of a patients record.

“California physicians are increasingly concerned with the growing trend of for-profit insurance companies adopting policies that restrict access to care while their profits soar,” said Dr. Theodore M. Mazer, president of the California Medical Association.

Health insurers making decisions on approval or denial of medical care without fully reviewing a patients record is extremely troubling. And everyone should be as concerned as Dr. Theodore Mazer. Health insurers exert a good amount of control over patients’ access to vital medical care and yet we have one stating that he made decisions without fully reviewing patient records.

TAKEAWAY – Health insurers have admitted to making decisions without reviewing patient records. Expect increased rationing of diagnostic testing and treatments.

2017 AMA PRIOR AUTHORIZATION PHYSICIAN SURVEY

This survey was done in 2017 by the American Medical Association (AMA) to review prior authorization physician survey. Here are the general findings of this survey.

  • 64% reported waiting at least 1 business day for prior authorization (PA) decision from health plans
  • 30% reported waiting at least 3 business days for prior authorization (PA) decision from health plans
  • 92% reported that treatments that require a PA delayed a patient’s access to necessary care
  • 78% reported that PA can at least sometimes lead to treatment abandonment
  • 61% reported a significant negative impact regarding the overall impact of this process on patient clinical outcomes
  • 92% reported that PA can have a negative impact on patient clinical outcomes
  • 86% reported that PA burdens have increased over the past 5 years

TAKEAWAY – Prior authoriziation techniques to continue increasing with no patient benefit.

Cost-Sharing Payments Have Far Outpaced Wage Growth

Between 2006 and 2017, the average deductible for people with employer-provided health coverage rose from $303 to $1,505. We find that, between 2005 and 2015, average payments for deductibles and coinsurance rose considerably faster than the overall cost for covered benefits, while the average payments for copayments fell. Overall, patient cost-sharing rose by 66%, from an average of $469 in 2005 to $778 in 2015. Wages, meanwhile, rose by 31% from 2005 to 2015. Sure health insurance coverage continues to pay a large share of the cost of covered benefits, patients in large employer plans are paying a greater shrae of their medical expenses out-of-pocket and at a time when their wages aren’t increasing at the same rate.

TAKEAWAY – Patients are seeing a major increase in deductibles and out-of-pocket expenses at a time when wages have been largely stagnant.

How to Brave the Declining Reimbursement Rates Nightmare

Wondering why your doctors might seem like they are spending less time at each of your appointments? There’s a reason and you can’t really blame them.According to a report released by CareCloud and QuantiaMD in 201465% of physicians see declining reimbursement rates as the top issue negatively affecting practice profitability. One of the proposed solutions – increase your patient base. Make up the loss by treating additional patients.

Even though there are additional recommendations they make to help offset the decline in reimbursements, many doctors are having to increase the number of patients they can squeeze into every day simply to keep their doors open. For patients this means rushed appointments and lower quality care. Most doctors I speak with state that they would love to spend more time with each patients providing the high quality of care everyone deserves but simply can’t as insurances reduce reimbursements.

TAKEWAY – Physicians experiencing a decline in reimbursement rates from insurance are having to find ways to make up the monetary gap such as fitting more patients into their already packed schedules.

Secret Deals Drive Higher Prescription Drug Costs

Your financial wellbeing is not the first priority when it comes to prescription medications. Drug makers and pharmacy benefit managers (PBMs) like CVS Caremark benefit when the medicine price is high. PBMs negotiate discounts with manufacturers on behalf of insurance carriers and businesses, trade unions and school systems that provide health care benefits to employees.

So what does that mean. When a drug company negotiates this 30 percent rebate to PBMs the next day it raises the medicines price by 30 percent. PBMs are demanding bigger rebates which means pharmaceutical companies have to raise prices to pay for them. Drug makers, long thought of as the bad guy, are trying to redirect the focus to PBMs. However, the PBM industry denies the connection and states in a 2017 industry-funded study, “drug makers raise prices even when rebates are low in major drug categories.”

The PBMs’ leverage comes from their power to create preferred drug lists, called formularies. The PBM decides which drugs an insurance plan will cover. Because there are often multiple medicines that can accomplish the same goal, sometimes competing drugs are excluded from a formulary altogether.

Because manufacturers want their drugs included, there’s an incentive for them to offer PBMs large rebates. PBMs often make formulary decisions based on the products that are generating the most rebates, and “that may or may not be the best choice for the payer or the patient,” says Thomas.

While consumers might get a lower insurance premium because of PBM negotiated rebates, they’re getting a raw deal at the pharmacy counter because out-of-pocket costs are often based on the original price set by the manufacturer, before rebates and discounts are factored in. Those discounts come after the drug is purchased.

Ultimately, we have these two groups pointing the finger at each other while consumers are stuck paying inflated drug prices that make getting the medications they need difficult.

TAKEAWAY – Drug and medication prices will continue to increase and soar.

Physician Burnout is a Problem at 83% of Healthcare Organizations

Titled “Immunization Against Burnout,” the report by Swensen et al. featured responses from 703 healthcare executives, clinical leaders, and clinicians from hospitals, physician organizations, and health systems that are part of the NEJM Catalyst Insights Council. And an incredibly high percentage reported physician burnout as a problem.

“There is broad agreement on the need for more face-to-face time between clinicians and patients and less time spent on the electronic medical record and documentation,” authors stated. “A little over half of survey respondents recommend offloading clerical tasks to scribes, pharmacy technicians, or population health facilitators.”

TAKEAWAY – Physician burnout, early retirement and suicide to increase.

“If you have good thoughts they will shine out of your face like sunbeams and you will always look lovely.” – Ronald Dahl

About Anytime DRs  and Dr. Shawn Dhillon, M.D.

Dr. Shawn Dhillon, M.D., DAASEM, DNBPAS, is the chief medical officer, founding member, and managing partner for Anytime DRs. He is also board-certified in both internal medicine and electrodiagnostic medicine. Dr. Dhillon set out to create AnytimeDRs to provide convenient and affordable concierge healthcare access, anytime, anywhere, and to everyone. He is a strong proponent that concierge healthcare should not just be available to the wealthy, but also to the general working public.

References

Mills, David. “Why You Have to Wait Longer to Get a Doctor’s Appointment.” Healthline, April 12, 2017.
https://www.healthline.com/health-news/why-you-have-to-wait-longer-to-get-a-doctors-appointment#1

Abutaleb, Yasmeen. “U.S. Healthcare Uninsured Rises Most in Near Decade: Gallup.” Reuters, January 16, 2018.
https://www.reuters.com/article/us-usa-healthcare-uninsured/u-s-healthcare-uninsured-rises-most-in-near-decade-gallup-idUSKBN1F523O

Collins, Sara R.; Gunja, Munira Z.; Doty, Michelle M. “Growth of Underinsurance Now Rampant in Employer-Sponsored Plans.” PNHP.org, October 18, 2017.
http://pnhp.org/news/growth-of-underinsurance-now-rampant-in-employer-sponsored-plans/

Altman, Drew. “Half of People in Fair to Poor Health are Uninsured or Struggle with Affordability.” PNHP.org, August 20, 2018.
http://pnhp.org/news/half-of-people-in-fair-to-poor-health-are-uninsured-or-struggle-with-affordability/

Drash, Wayne. “Aetna Inquiry Widens Over Ex-Medical Director’s Comments.” CNN, February 16, 2018.
https://www.cnn.com/2018/02/15/health/aetna-investigations-widen/index.html

2017 AMA Prior Authorization Physician Survey.
https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc/prior-auth-2017.pdf

Claxton, Gary; Levitt, Larry; Long, Michelle; Blumenkranz, Erik. “Cost-sharing payments have far outpaced wage growth.” PNHP.org, October 4, 2017.
http://pnhp.org/news/cost-sharing-payments-have-far-outpaced-wage-growth/

Serafini, Marilyn; Barrett, Randy. “Secret Deals Drive Higher Prescription Drug Costs.” Tarbell.org, May, 24, 2018.
https://www.tarbell.org/2018/05/secret-deals-drive-high-prescription-costs/

Monica, Kate. “Physician Burnout is at Problem at 83% of Healthcare Organizations.” EHR Intelligence, May 4, 2018.
https://ehrintelligence.com/news/physician-burnout-is-a-problem-at-83-of-healthcare-organizations