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Health Screening – The Business Side

Hello, Dr. Mo here with Digital Nomad Health. When I used to work at Kaiser Permanente, primary care was a health screening business where patients were fed into specialty groups, and documentation determined how much Medicare would reimburse KP. Not much has changed. That is why direct pay models are essential to ensure patient health.

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Primary Care Medicine

The current primary care model is assembly-line care for hospital groups. The patient comes in with a specific condition, which the insurance side reimburses for X dollars. If this patient is referred to a specialist, the reimbursement now goes up to 2X or 3X.

Of course, not all physicians think like this, and we aren’t in on the game. But the incentives are misaligned. If I have a patient who has a certain condition and I don’t refer them to a specialist, I will be left with an unhappy patient. After all, that’s why they are paying so much for their insurance.

Health Screening Businesses

Colonoscopies, mammograms, blood tests, and PAP smears are all screening tests that end up creating a lot of unnecessary interventions for the patient.

Are they needed? Absolutely. For the right patient, these screening tests are life-saving. But to determine the appropriate need, a proper patient-doctor relationship is needed.

The physician has to spend the time to educate the person and make the right decision. Should the screening test be a mammogram? Not always. Just because the USPSTF says it should be a mammogram doesn’t make it right – sometimes an MRI is needed.

Should an abnormal PAP immediately go to Gynecology? Does it need a Colposcopy? There is a lot more art to this than science, and it certainly shouldn’t be a business, as I’ve argued.

Building the Patient-Doctor Relationship

It’s a vulnerable place to rely on your Primary Care doctor for the future of your health. But it’s not as bad as it seems. Your doctor has trained for this all of their life and will be excited to age with you and see you prosper.

You cannot build a long-term, healthy patient-doctor relationship with a brand. A brand is beholden to its investors and hires and terminates physicians based on how productive they can be.

I have considered many times to work for someone else instead of going through the tedious process of setting up my own clinic. But I have to, first and foremost, make sure that I can work in a setting where my patient care comes first. Let everything else fall where it may.

Virtual Primary Care Brands

I am thinking of telehealth brands such as Curai, MDLive, and PlushCare – I have worked for Teladoc and Babylon in the past, so I know where their allegiance lies.

The intention of a virtual primary care brand is good – those physicians want to help patients. But the brand has to stand for something greater than profits and be willing to fight for the physicians who prioritize clinical care over regulatory hoops.

I don’t want a business to tell me if I’m doing enough health screening or if I’ve met the metrics of enough referrals, prescriptions, or testing. It’s like my refrigerator keeping track of how much junk food I had and pinging me to have more if I didn’t meet its junk food quota.

Profits in Healthcare

So what about profits? Can a healthcare business be profitable? Of course! In fact, the more you do for the patient and the more you improve their health outcomes, the more you should profit.

Healthcare profits help drive competition, which sparks innovation. But along the way, we need regulators who are looking out for the patient. Not regulators who are looking to punish doctors but those who keep businesses accountable to patients.

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