We just wrapped up our incredible book club discussion on ‘Never Pay the First Bill‘ by Marshall Allen.

Our conversations delved into thought-provoking topics, including the current structure of the healthcare system and its impact on the doctor-patient relationship. The prevailing business dynamics have seemingly shifted the focus from patient care to the relationship between the insurer and the provider. This, as highlighted in the New York Times article ‘How to Make American Health Care Cheaper and Better‘ often results in providers prioritizing profit over quality healthcare, with the patient taking a back seat.

Fundamental changes are needed to make the system more patient-central. It almost seems now like the health and well being (including financial well being) of the patient is an after thought. Providers are incentivized to pad charges and the costs associated with that result in higher premiums or less coverage.

Insurers are stepping between the patient and the provider both before and after care is rendered. To contain costs, more and more treatments, drugs and equipment require pre-authorizations. In this scenarios it is up to the patient to navigate the byzantine pre-authorization process. Many times they give up and the care simply is not given. After the care is given, there are claim denials that have to be appealed – again, with the patient having to run point – usually to a frustrating end.

In both those scenarios, it is cost containment and revenue maximization that takes priority over the health of the patient.

The article talks about the cost of auditing claims and suggests some alternatives – to include trusted third party reviewers. One suggestion in the book club was to completely change the fee-for-service paradigm. Pay providers a salary based on historical costs. Eliminate claims altogether. Let doctors treat the patients the way they want and incentivize good outcomes through bonuses. Make the doctor-patient relationship the center of focus again.

By Matt Kochanski