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A Better Path for Primary Care

June 28, 2018
By

I have complained about the stupidities and excesses of the American health scare system for over 5 years now on this blog. Today, I present a concrete, novel, disruptive solution.

I have created an entirely new way for family physicians (and internists) to document, code, and bill for their work. It’s the SENTIRE system and the website is at www.sentirecare.com.

My system has 3 major features:

  1. A bill for an office visit looks like the patient went to Target.  One concern, one small fee; five concerns, five fees added up.
  2. I have created codes, fees, and supporting software for non-office visits: phone exchanges, emails, text messages.
  3. The patient pays just $50 per year to have nearly 24/7 access to their family physician and an annual review of their preventive needs.

More details:

My fees for straightforward simple issues are much cheaper than a typical conglomerate/hospital system clinic or urgent care. For example, I have a friend whose daughter had a sore throat. A hospital-system clinic charged them their cash price of $120 for the visit and the throat swab. In the SENTIRE system, I would only charge no more than $60 for the same service. My fees are also much cheaper than common Direct Primary Care practices. $1000 $1600 per year for primary care (or more in some cases) is a rip-off for most patients.

On the other hand, a patient who wants to talk about 6 things in a visit will be given the time and effort required by her family physician to do a good job with each issue. The visit won’t be rushed, won’t be tethered to the tyranny of the 15-minute visit. The visit could be 30 or 40 minutes or more. I call this a fee-for-thinking system approach.

And yet on the other hand, I believe that a lot of primary care issues can be handled over the phone. My  non-medical friends commonly ask me, “Why is it that when I call my doctor to get a refill, they tell me I have to come in to be seen first. I think that’s stupid.’  I think it’s stupid too, but the reason it happens is because CMS/Medicare doesn’t allow doctors to bill for non-office visits, and all the large insurance companies have adopted the same rules. In the SENTIRE system, many issues can be handled over the phone in a few minutes, which will generate a $30-$50 bill, depending on how long the conversation takes. This saves patients from missing nearly a half day at work or home.

The $50 yearly fee does two things. First, it buys the patient the right to call/text/email his or her family physician any time, and the physician will respond (or call partner in the physician’s group). Second, it serves as the trigger for the physician to review the patient’s chart for their annual preventive needs, which can mostly be managed over the phone (order mammograms [if the patient wants one], cholesterol tests, vaccines, etc.).

The opportunity for a system like SENTIRE that is growing in the U.S. is that because no one in this country is seriously dealing with the exorbitant cost of healthcare and the payers have unilaterally decided to pay less  for insurance premiums, there has been an explosion in the last 5 years of high-deductible health insurance plans. This is bad for patients, but creates a space, that has never existed at any other time in my career, for a disruptive new approach for the relationship between a patient and her family physician. Health insurance in America is rapidly becoming only for catastrophic care. If a family has a $5000 annual deductible, then that means in most years they will pay for primary care out of pocket (except for the free preventive stuff required under Obamacare, as it exists currently). This is the space SENTIRE fills. The fees are transparent and available to all on the website.

I have opened a part-time practice to test the model and modify it accordingly. Of course, what I really want to build is a network of family physicians and internists using the system. Any family physician (or internist) in American can use the system now. They can sign up on the website and it is free to do so. I have a series of explanatory videos for patients and physicians, and a series of training videos for physicians. These videos are available at the SENTIRE website and on a dedicated youtube channel (About 5 more training videos will be added in the near future. They have to be re-shot. I think I broke the camera the first time).

If you have any questions, let me know at american@healthscareonline.com. I look forward to your feedback.

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