Achieving Obamacare Goals without ObamaCare

Many believe that the free market is the best solution for effectively solving our health care problems, instead of government intervention. Concierge medicine offers up the private concierge doctor as a solution for primary care access and quality of care. John Goodman takes a look at another free market solution presenting itself in the growing confusion surrounding the implementation of Obamacare.

By , April 22, 2013. National Center for Policy Analysis (NCPA) Health Policy Blog.

When 21-year-old Mike Kelly (not his real name) set out on his bicycle one evening in Durango, Colorado, he had no intention of ending up in a hospital. A collision with an automobile changed those plans. Fortunately, Durango is a ski mecca where broken bones are almost a way of life. With all that practice, doctors there have evolved their practice into a sort of natural center of excellence for treating bone injuries.

In Mike’s case, however, another set of doctors came into play. Mike and his family are clients of PinnacleCare, a “health advisory” firm in Baltimore, Maryland. Within 30 minutes of Mike’s arrival at the emergency room, the staff of PinnacleCare was on the phone with the ER doctors in Durango — discussing treatment options and transferring Mike’s medical records.

Communication is a big problem for everyone in medical emergencies. The doctors want to know what drugs the patient has been taking; if there have been any recent surgeries; etc. The patient may be in no condition to tell them. The ER might have important information and the family naturally wants the ER doctor to tell them what is happening. But a federal law (HIPAA) prevents such communication unless the patient signs a waiver and even then ER doctors aren’t fond of talking to families when a patient needs attention. PinnacleCare solves this problem. They already have the waiver. They have the electronic medical records (EMRs). They can provide the kind of doctor-to-doctor communication that is most needed. And then they can talk to the family while the ER doctors do their work.

As Mike’s parent’s (who were at home in Virginia at the time of the accident) explained, “It’s like having a family doctor helping you instead of a strange doctor in a strange land.”

In Mike’s case, there was important information the ER team needed to know. One month earlier Mike had come down with mononucleosis and as a result his spleen almost burst. So the PinnacleCare doctors requested a FAST test (sonogram) on the spleen right out of the shoot. Then there was an option on treating Mike’s broken leg — he could have a rod or a cast. Either choice involves a tradeoff. PinnacleCare is in the business of providing second opinions, and these opinions come from doctors who have no financial interest in over-treating or under-treating or in any of the options under consideration.

After Mike was discharged, PinnacleCare found a physical therapist to attend him while his leg healed. When Mike was able to return to his home in Virginia, the agency found a therapist to continue the care and an orthopedic doctor to oversee his recovery. They emailed his Colorado medical records to the Virginia doctor and discussed Mike’s treatment plan with him.

Through it all, the Kelly family never had the difficulty so many other patients have — getting answers to questions. In fact, the Kellys have the cell phone numbers of the PinnacleCare staff!

Now let’s recap how many problems were solved in this one case.

There is (1) the problem of agency, (2) the problem of incomplete information, (3) the problem of asymmetric information, (4) the problem of uncoordinated care, (5) the problem of no electronic medical records, (6) the problem of lack of transparency, (7) the problem of poor doctor communication to the patient, (8) the problem of poor patient communication to the doctor, (9) the problem of the availability and reliability of second opinions, and (10) the problem of shopping for care in the medical marketplace when undergoing the trauma of accident and injury.

Do you know how many forests have been felled to produce enough paper for all of the articles and books that have been written about these 10 problems? Yet what I’ve just described is an entrepreneurial solution to all of them — without any pilot program, without any demonstration project, without any ACO and without spending any taxpayer money. Imagine that!

READ THE FULL STORY for the complete analysis of how free market solutions are solving the core issues Congress attempted to solve with the Affordable Care Act.

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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