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Healthcare Access on the Decline

Healthcare access is at an all-time low. It’s not about to get better if we factor in some of the upcoming economic changes. This spells some opportunities for physicians I’ll address in this post.

Cost of Care

The cost of healthcare hasn’t gone up too much – at least not directly.

But copays, wait times, and out-of-pocket maximums have gone up.

The number of physicians previously readily accessible has declined. Older doctors retired or stopped seeing as many patients.

Healthcare access isn’t just being able to get in to see a clinician but it’s affording the visit, having the time to schedule the visit, and how long you wait to see someone.

Previously the cold and flu season was a cough and congestion and we’d get a flu test. Now it’s a chest x-ray, blood test, COVID-19 test, and a long discussion about comorbidities.

Displacing Patients

Patient displacement happens when the primary care patient decides to get herbals and vitamins instead of getting care. The urgent care patient waits to see their primary care doctor which means a more complicated visit for that PCP.

Those with less access will flood the ERs which displaces those patients all over the place. Chaos has been the norm of the system in the past few months.

I had a major venous bleed in the urgent care today and after the fire department arrived we had to wait for 2 ambulances diverts before we got an ALS to transport the patient to a trauma center.

Healthcare Access in the US

It’s not just the access and the cost of care. Healthcare access is going down because physicians aren’t motivated to kill themselves in the clinic or ER.

Reimbursement rates went down and patient complaints are on the rise. The simple visit is now complicated by all sorts of new diagnoses and the inability to plug a patient into a specialist.

This doesn’t affect the super-rich. My buddy an his family are on the Patron Program. At $150k each donated to their local private hospital group they are greeted by a private concierge and taken care of immediately.

The destitute are left to fend for themselves. No cavalry is coming to the rescue. And we haven’t even hit inflationary numbers in the economy or experienced the wave after the economic stimulus from the recent pandemic.

Opportunity for Physicians

With healthcare access this bad, there is an opportunity for enterprising physicians. Solid businesses are built in such socioeconomic conditions. It takes creativity but no heavy lifting is necessary.

Timely access to care is the product you want to sell. The end result is patient engagement.

1. Virtual Clinical Access

Providing patients with access is the product that is up for bids. It can be virtual or in-person. The virtual model still needs some convincing to let the patient know that you can do almost everything for them in that setting.

2. Staffing Agencies

Staffing is quite complex and credentialing is becoming absurd. So many medical groups are so risk-averse that it’s impossible to get anyone hired.

Virtual staffing agencies don’t exist and PAs and NPs are still quite underutilized.

3. Same-day Clinics

There are ERs, urgent cares, primary care clinics, and specialty clinics. But there is no real same-day clinics.

The same-days don’t seem to know what to do with themselves. They will do minor lacerations which throws the doctor behind by 2 hours and then it’s no longer good access.

A walk-in style clinic should get you in and out in under an hour. Crack that code and you’ll collect a lot of money very quickly.

Medicaid factories, unfortunately, are the ‘successful’ version of this style of care.

4. Asynchronous Visits

Chronic issues don’t need acute interventions. But the patient does need to get the ball rolling. Asynchronous visits allow for immediate evaluation and ongoing management.

The state medical boards and regulators are reluctant to allow this. But many states allow it and there are appropriate ways to get around the legal requirements.

5. Cost Sharing

People are having a hard time affording their care. There is such a fear of an unknown bill and such scrupulous collection practices that it’s preventing healthcare access.

There is an opportunity to spread the cost of care among a group of individuals and negotiate a better price with the clinicians. Obviously, such health-sharing plans exist but they are quite naive still.

6. Medical Second Opinions

There are 2 versions of a second medical opinion. The first is a high-end product which requires a lot of time and back and forth with the client.

Another version allows a brief evaluation in order to help the patient decide if they need a particular test or treatment or procedure. This one is quicker so it generates less income per consult.

Asynchronous visits are a great way to accomplish this.

7. Pill Mills

This is more controversial only because we like to think of ourselves as a noble profession where patient health trumps all other interests. For the rest of you who are practicing medicine in the US, read on.

Ro is a great example of a pill mill. The goal is to select a few easy diagnoses and come up with a streamlined method of getting medication to that consumer.

It works. That’s why Ro hasn’t been shut down and 30 other companies just like it have popped up.

8. Health Coaching

When you pay $1,000 per month for health insurance but can’t get in to see anyone you quickly lose faith in western medicine as a model for health.

Alternative healthcare models such as herbalism, functional medicine, integrative, or holistic medicine, and health coaching are becoming more popular as means to getting access to care.

9. Self-Diagnostics

There are some great medical devices selling on which can be used for self-diagnostic purposes.

From continuous blood pressure monitors to CGMs to cameras that go wherever you’d like them to go, these are ways a person can feel more in charge of their health.

10. Medical Tourism

When I first decided to move to Spain many told me that I would never find a country as great as America. Perhaps true but to each their own. I rather enjoyed the clinical care I received in Spain.

Medical tourism is a solid way to ensure healthcare access. There are plenty of good doctors in other parts of the world. The problem is the logistics of getting there, negotiating prices, and making sure other ancillary services are also up to par.

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