Continuing my discussion of the findings in our recently published study on the ways family physicians deliver better care at a lower cost than a multi-ologist model, today I will talk about how family physicians actually talk their patients out of expensive wasteful tests and treatments.
I saw this occur multiple times while I was developing my improved primary care billing model for CMS — more or less once every half day in the family physician’s clinics I observed — where a patient or family member would suggest an expensive test or treatment might be a good idea, but the family doc said there was no good reason to pursue it. For example, a patient said to her family doc, “My CPAP technician said I need a new CPAP machine and a new sleep study.” The family doc asked her a few questions, then said, “You don’t need a new machine or a new sleep test.” The patient was comfortable with this conclusion, best I could tell.
Think about it. He made no extra money for saving the greater system several thousand dollars. He did not get a cut of the insurance money that wasn’t spent. Plus, he took on a little bit of malpractice risk by denying her the fancy new machine, given that a potential jury would most likely be comprised of people who assume more is better and newer is better. If she is found dead in her sleep in the next few years, whether or not it had anything to do with her CPAP machine or her underlying chronic condition that mandates its use, he could be dragged through the medico-legal system for not ordering the latest greatest gizmo.
He talked her out the unnecessary test and treatment just because it was a core value of his. For my CMS work, I kept track of all the times the family docs talked patients out of stuff. I estimated that they talked patients out of $2 worth of stuff for every $1 of revenue they collected, which translated to about $6 of savings for every $1 of personal income.
I’m not suggesting that family docs should receive commissions for denying patient requests. But it’s about time policy makers and payers better appreciated this highly valuable personality traits of family physicians. It’s a hidden source of savings that doesn’t appear on an insurance company analysis or Medicare report, but it happens everyday.