The Government Proposed 10 Rules For Redesigning Healthcare by Josh Umbehr MD


Our government tends be pretty idealistic, too. In 2001, Institute of Medicine released a report called Crossing the Chasm. The paper’s goal was to lay down rules and principles that could inform possible redesigns of our healthcare system. You can download this ambitious government report here. We’ve listed out their 10 rules and explained how direct care specifically addresses them. In most cases, all we had to do was cut the government’s red tape.

1.) Care based on continuous healing relationships.
“Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.” – Institute of Medicine (IoM)

Wow! That’s ambitious coming from a 2001 report. However, offices are opening up throughout the nation offering memberships that include free visits and 24/7 doctor access via phone/text/email/social media, for less than your average monthly cable bill.

2.) Care customized according to patient needs and values.
“The system should be designed to meet the most common types of needs, but should have the capability to respond to individual patient choices and preferences.” – IoM

Direct primary care can cover 80% of what patients need. Local access to direct care, or any affordable 24/7 doctor option, has shown to reduce overall ER visits and reduce wasted spending, too. In terms of individual patient choices, direct care is in and of itself exactly that — an option for affordable, quality care. Once enrolled, patients also have the choice of switching to a wrap-around insurance plan. This involves far lower monthly rates but a higher premium. However, by making this choice patients can SPEND less overall, and get more care when they actually need it.

3.) The patient as the source of control.
“Patients should be given the necessary information and opportunity to exercise the degree of control they choose over health care decisions that affect them. The system should be able to accommodate differences in patient preferences and encourage shared decision making.” – IoM

A major hurdle in accomplishing this goal is rushed visits. With direct care, docs use the time that was allocated for billing and transcribing patient notes and spend it with patients instead. That means visits literally last as long as they need to, sometimes well beyond 45 minutes, if necessary. This time allows docs to both learn what’s really ailing patients, and ensures that patients understand what their treatments options are.

4.) Shared knowledge and free information flow.
“Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.” – IoM

This is another great example of red tape contradictions. On one hand the government wants free flowing information, while also controlling ALL information. These things are at opposition with one another. That’s why we’re reinventing the EMR for direct care practices. Our opinion is that by tracking only relevant information, we trim the fat, and make it simpler for the right parties to get the right information.

5.) Evidence-based decision making.

“Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.” – IoM

We’d argue that a force working against doctors staying up-to-date on medicine is the malaise that’s created by work days that require an extra three hours of dictation afterwards. Direct care enables your doctors to create 8-hour workdays, while staying in business. This allows them time to continually hone their skills, and practice above-par medicine.

6.) System safety.
“Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.” – IoM

As with any doctor’s office, a direct care facility is working with patient’s interests in mind. However, in the case of a private direct care practice, there is more than malpractice and reputation on the line. There’s a business to protect as well, meaning there’s additional stakes for adhering rigidly to safety standards.

7.) Transparency.

“The system should make available to patients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.” – IoM

Based on the overwhelming number of reports of Obamacare data breaches, we’re not sure the right type of transparency is being facilitated with the government’s help. Direct care makes it very clear what you get when you enroll in a clinic. In our case, $10-$100 per month gets you unlimited visits, 24/7 access via phone/Twitter/Facebook/email, and discounted labs/prescriptions. Other clinics nationwide offer similar models. Direct care patients are vocal about the quality of care. The fact is, they love it. And they have to, because our practices don’t survive on subsidies.

8.) Anticipated needs.
“The system should anticipate patient needs, rather than simply react to events.” – IoM

Direct care is anticipating what our country needs — proactive and affordable medicine. One of the biggest issues facing our country is the crippling cost of healthcare. We are pioneering a system of medicine where people don’t talk themselves out of seeing a doctor. A subscription model that’s affordable, combined with affordable insurance coverage, means patients are spending less per month, and are completely covered. More of this situation, means more preventative care. We believe this goes beyond just anticipating what someone needs today. It’s addressing what they never needed tomorrow — diabetes, heart disease, obesity…

9.) Continuously decreasing waste.
“The system should not waste resources or patient time.” – IoM

We’ve gone so far with our direct care support to design an app specifically for direct care docs. If you know anything about building apps, then you know the secret to their success is maximizing benefit while getting rid of everything that wastes time. We’re continually updating out EMR software so that direct care docs can more efficiently run their lean, affordable practices. And, ultimately, deliver better care. As for trimming waste in the practice, we have to do that to survive. Compare that with Kevin Pho’s 50 clicks to do nothing on an EMR, that he has to use by law just to receive due compensation for his work

10.) Prioritized clinician cooperation.
“Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.” – IoM

It’s not necessarily our patients’ concern, but there’s a burgeoning community of direct care supporters on Twitter (@SeanHannity and @NeuCare for starters). Besides digital support and communication, we offer free consultation on starting a direct care clinic. Students have come in to speak with us about the emerging possibilities. We attend conferences and stay afterwards to talk to interested docs about our challenges and successes. We know that as competitive as our model may seem on the outside, at the core, our work is only made possible as people’s perception of medicine shifts. In order to do this, direct care doctors and the general public need to support each other.

The fact is clear: we have known about healthcare’s problems for decades now. The reality is that, in order to survive, fee-for-service docs are forced to put up their blinders. It takes a kind of delusion to persevere as a physician in light of such turmoil — rapid patient visits, work days made longer filling out forms to be reimbursed, arguments with insurance companies over ICD-9 coding errors…. Unfortunately, fee-for-service medicine, i.e. the status quo world of hidden prices, mysterious premium rates, and a confounding deductibles/copays, seems unlikely to change. Why? Because patients are given NO power.

Direct care is different, though. In its rejection of government in providing healthcare, it addresses what the government wanted in the first place, while simultaneously empowering patients. But, the key to direct care success, is demanding it. If you haven’t yet, visit I Want Direct Care and add your name to our map. As more providers see that patients want cash-only medicine, they can take the leap towards quality patient care. Seriously, there’s a reason that a major media figure like Sean Hannity hails direct care as an answer to healthcare’s woes. Maybe that’s because it’s really real, not just some grandiose idea.

Dr. Josh Umbehr MD practices at Atlas.MD and this article can be found here

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “The Government Proposed 10 Rules For Redesigning Healthcare by Josh Umbehr MD

  1. Kurt
    April 9, 2014 at 7:38 am

    I don’t care how one sells it, nothing is going to change in this country until the patients are held responsible for their lousy health behaviors. Perhaps direct care, with direct payments might alleviate that because the people have some financial skin in the game.

    I know of a surgical group that no longer performs bariatric procedures on public aid patients because the failure rate is so high. They don’t have any “gold” invested and don’t follow the instructions afterwords.

    Any student has to be nuts to go into family practice or straight internal medicine.
    The ivory tower bastards just use computers to generate more paperwork and a fair number of patients don’t lift a finger to improve their situation.

    ABFM = Academic Bastards F***ing Morons

    Guess who is doing ICD-10? It’s the misfit Academics who’ve not worked in the trenches for years. They have their hand maidens and squires do their scut work for them.

    I heard the head of the AAFP say he quit private practice and went to academia because
    after 6 years he was “tired” of seeing the same problems “over and over”! Well doh! Why do you think there is an obesity and diabetes epidemic in this country? Ya, thinks none of the Docs are mentioning this to people? Yes it’s hard to diet but very few people get a grip and deal with it. Maybe if it cost ’em more to smoke and E.S.D. (not ElectroStatic Discharge, Eat Shit and Die) some might start to change their tune. Stop blaming Doctors and blame the patients responsible. I cannot indoctrinate a non-compliant diabetic in 15 minutes. Get diabetic instruction from certified educators covered.
    (It’s not currently)

    Enough, whatever BS pablum they are feeding med students, I hope they see through it
    and stay away. Nothing will change unless the “audience” is coerced into receptiveness of modest change.

    At least I had 22 years of a reasonable practice with some leisure time. Now it’s work until 10pm for shitty pay to be a slave to a computer.

Comments are closed.