How often do you get a checkup? Are you satisfied with the care you are getting? In an era of connected health devices like the Apple Watch or FitBit, detailed online health resources like Web M.D., or virtual online visits (telemedicine) does the annual physical even make sense anymore? We take a behind-the-scenes look at how healthcare laws and insurance reimbursements are changing the doctor-patient relationship and how you can get the most out of your annual physical exam.
In an era where major political fights are taking place in Washington over the future of healthcare, it’s easy to overlook the role the doctor-patient relationship plays in ensuring your optimal health.
From the perspective of many patients, the annual doctor’s visit can seem like an expensive interruption in our daily lives, one without a lot of apparent benefits. When you add up the inconveniences, including taking time off work, paying for parking, hassles with insurance and co-pays, long wait times in a sterile waiting room where you try to dodge germs from sneezing sick people – it’s no wonder many of us are completely exasperated by the time the receptionist says “the doctor will see you now.”
But will he or she? You’re ushered into a small examination room, only to wait in your underwear for a further indeterminable amount of time for what appears to be a doctor’s assistant arriving to ask you an impossibly long series of questions about your health history.
Then, finally, your doctor suddenly pops in – for a minute or two — but by this time, the detailed health questions you wanted to ask have disappeared from your mind. By the time your recall them, the doctor has waved a curt goodbye and gone off to visit the next patient.
Let’s replay this scenario from the point of view of the physician to get a better understanding of what’s happening behind the scenes.
Frustrations from the Physician’s Point of View
If you as a patient are frustrated with the healthcare system, you haven’t heard the half of it.
As most physicians will attest, they didn’t spend years at medical school to practice medicine in this hurried fashion. They would like nothing more than spending 30 minutes, if not longer, with each patient.
Yet, in the past twenty years, the economics of lower reimbursement payments from insurance companies and government programs like Medicare/Medicaid have driven many primary care doctors to respond by dramatically increasing the number of patients they see each day to make up for the reimbursement shortfall. As a result, it’s not uncommon for some physicians to see upwards of 20 patients during office hours.
This rapid whirlwind of patient encounters is accomplished with the help of what are euphemistically called ‘physician extenders.’ These include Physician’s Assistants (PAs), Advanced Practice Registered Nurses (APRNs), and Nurse Practitioners (NPs) — all of whom to a greater or lesser degree (depending on which US state you are in) can diagnose illnesses and prescribe medications under the authority of the physician in charge. ‘Scribes’ are another new category of physician extenders — they dutifully follow the caregiver, writing down all the patient’s chart notes and entering them into the electronic medical records systems, insurance reports, etc.
But you say, “Don’t doctors make a lot of money already? Why do they need to make more?” While that may be true for many specialists, such as dermatologists, radiologists, and anesthesiologists, the reimbursements for your friendly local general practice doctor or internist have gone down steadily over recent years — to the point that some solo practitioners are heading for the exit door.
In fact, as reimbursement rates have gone down, the frustration of solo practitioner doctors has gone up. Many who were close to retirement age hung up their stethoscopes for the last time and retired early. Other primary care doctors have banded together into larger physician groups, or have left their independent practices behind entirely to become employees in hospital systems, where, even though they still have to see more patients than they’d like, they don’t have to shoulder the responsibility for acquiring and managing a large patient population. Fewer young doctors graduating from medical school envision their future as an independent physician operating their own individual practices; instead, they are joining healthcare groups as employees from the start.
Among the remaining solo practitioner physicians, quite a few are pursuing new business models that help raise their compensation income, such as converting their patient populations over to what is known as Cash Pay (no insurance is accepted, patient must pay the visit fees directly) or Concierge Care, where patients pay an annual ‘subscription’ fee (typically between one and two thousand dollars a year) in order to remain part of the doctor’s practice.
The Ideal Patient, from the Physician’s Point of View
So, given this situation, what can you as a patient do to help make the situation (in which everyone can be frustrated) work better so you can receive the best possible healthcare from your doctor?
Let’s pose the question to the physician: “Can you describe an ideal patient? What do they do right?”
In many cases, the answer is simple: physicians want their patients to be fully engaged and well prepared for their visits. They want them to treat the relationship like a true partnership that is dedicated to achieving good health.
Specific Recommendations to Get More Out of Your Doctor Visits
Primary care physicians are extensively trained in medical school to carefully observe and examine patients for signs of normal growth and aging, as well as to identify symptoms or changes that warrant more careful investigation and monitoring — or even quick intervention when urgent problems are uncovered, such as uncontrolled high blood pressure, heart disease, or unexplained internal pain.
That long history form that you fill out when you visit? It’s a critical aspect of the physician’s training to perform a “Review of Systems” to gather a comprehensive understanding of your health.
That health interview, along with checks of your heart and lungs for unusual sounds and blood/urine tests to determine things like whether your cholesterol is too high, if you are at risk for diabetes, if you have been exposed to infections like HIV or hepatitis — all work together to help the physician establish a baseline health record. These health records, in turn, become invaluable tools for your future healthcare— for example, if you should fall ill, having a record of your ‘healthy’ baseline will make diagnosis much easier and more accurate.
So, the ideal patient (from the caregiver point of view) actively participates in their own care by preparing carefully before each doctor visit.
Here are some tips from Dr. Gary Brewton, an award-winning Houston-based primary care physician:
- Confirm your insurance coverage before you come in for a visit. Call your doctor’s office during non-peak hours (e.g. not first thing in the a.m. nor at lunch) to verify all the details, so there are no complications after the fact.
- Ask your doctor’s office if you can get a copy of any patient history forms in order to fill them out thoughtfully at home — rather than rushing through them when you are sitting in the waiting room.
- Keep a set of notes handy with your full list of questions and concerns for when you walk into the patient exam room.
- If you are visiting a new doctor, make sure you bring your medical records (or a signed release authorizing the doctor to request them on your behalf).
- Bring detailed copies of any prescriptions you are taking, including dosage instructions (or bring the actual medications with you).
- Don’t try to make the physician guess everything. If you think something is wrong, and you don’t bring it up, it’s not legitimate to say, “Well the doctor didn’t ask me about it, so it’s not important.” The ideal patient takes control of their own healthcare by acting as a full partner with the physician.
- There are other metrics that physicians use to identify the ideal patient. The ideal patient takes all their medication as instructed, reports back to the doctor (via phone or secure message) when something seems wrong, and avoids going to the emergency room when a doctor’s visit would accomplish the same thing.
Why the Emphasis on Compliance and Avoiding the Emergency Room unless it’s an Emergency?
You may not realize it, but in an effort to reduce healthcare spending, the government is curtailing payments for specific tasks (known in the trade as ‘fee for service’) in favor of paying physicians for good patient ‘outcomes.’
As part of this switch, some physicians (Cash Pay and Concierge physicians are excluded) are coming together to form what are known as ACOs (Accountable Care Organizations). Members of these ACOs get additional incentives (e.g. annual bonuses) by improving patient outcomes.
On the other hand, these bonuses paid to physicians are at risk if too many patients get sick and/or visit the Emergency Room when a regular visit to the doctor was deemed sufficient.
Successful Wellness Visits, from the Physician’s Point of View
It’s becoming more common to call our annual visit to the doctor a ‘wellness checkup.’ It makes sense, doesn’t it? Isn’t it true that the healthcare system should focus on keeping us well, rather than treating us after we are sick?
True enough. But the term “wellness” means something very specific to a physician, the healthcare system as well as the insurance companies or government agencies paying the bill. From their perspective, activities under the wellness banner are limited to a list of authorized tasks, particular tests, specific vaccines, etc. that help prevent patients from getting sick.
No more. No less.
What is the importance of making a distinction between ‘wellness’ and regular ‘healthcare?’
For the physician, it has to do with how they will get paid. Every little task in our healthcare system gets ‘coded’ into specific categories — and the coding determines the reimbursement rate.
For the patient, you need to know that anything outside a specific wellness benefit is no longer categorized as ‘wellness’ — it’s just plain healthcare. That means it’s subject to the normal rules of insurance, such as deductibles, co-pays, co-insurance, etc. For example, if you have high blood pressure, screening for diabetes is a covered “no cost” wellness benefit, the treatment of diabetes itself is not.
Similarly, if you intended to have a ‘wellness visit’ but you ask for treatment of a known existing condition, the visit will be most likely be coded as a regular healthcare visit, subject to any co-pay or deductible.
Wellness Benefits Established Under the Affordable Care Act (ACA)
The Affordable Care Act (also known as Obamacare) established quite a few consumer-friendly “wellness” benefits that insurers are required to provide at no cost to the patient (as long as they are delivered by a doctor or other provider in your network).
- Abdominal aortic aneurysm one-time screening for smokers in certain age groups
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease for men and women on certain ages
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults over 50 (colonoscopy)
- Depression screening
- Diabetes (Type 2) screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- Hepatitis B screening for people at high risk and from regions with high Hepatitis B prevalence
- Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
- HIV screening for everyone ages 15 – 65, and other ages at increased risk
- Immunization vaccines for adults — doses, recommended ages and recommended populations vary
- Hepatitis A
- Hepatitis B
- Herpes Zoster
- Human Papillomavirus (HPV)
- Influenza (flu shot)
- Pertussis (whooping cough)
- Varicella (chickenpox)
- Lung cancer screening for adults 55-80 at high risk for lung cancer because they are heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
Of course, the future Affordable Care Act is up in the air, but these wellness benefits will stay in place for 2017 at the very least.
So if you haven’t ever had some of these tests, such as a blood pressure reading, diabetes screening or a colonoscopy exams (if you are over 50), or if you haven’t had these critical vaccines (especially Hep A and B, and Pertussis) now is a good time to make a doctor appointment and have your wellness exam.
“Common Things are Common”
What other health issues will the physician look for during your annual physical?
Typically your physician will try to identify common, conventional sources of health problems first.
To borrow a phrase used in medical school, it’s because “common things are common.”
In this case, the number one “common thing” to look for is evidence of heart disease.
Over 600,000 people die of heart disease in the United States every year, making it the leading cause of death for both men and women. (Cancer is now a close second.)
The high mortality rates from heart disease makes it very important to keep your weight under control through regular exercise, eating a balanced diet, minimizing alcohol consumption (maximum 1 drink a day for women, 2 for men), and quitting smoking altogether.
Doing these things can help protect you from heart disease by:
- Reducing the incidence of high blood pressure, which can cause a heart attack or stroke.
- Reducing the incidence of cholesterol*, which can cause a heart attack or stroke.
- Reducing the incidence of Type 2 Diabetes, which can cause a heart attack or stroke.
If you can’t control these three things through exercise, diet, alcohol moderation, and quitting smoking, your physician may have to prescribe medication.
* Not everyone will be able to control their cholesterol through diet and exercise.
Your Health Matters to Us Here at Formaspace
Now that we’ve looked at the ins and outs of annual physicals, do you think you or your employees would benefit from enhanced wellness programs at work, including onsite annual physicals exams?
We’re curious to get your feedback.
We’re also always looking for ways our furniture products can make your life easier, healthier, and safer at work.
From our ergonomic, power lift Sit-to-Stand desks, which keep you on the move throughout the day at the office, to our highly-customized packing workstations designed for high-speed throughput at shipping and transit centers, Formaspace stands apart in our commitment to your good health and your good business.
For more information, contact your Formaspace Design Consultant today.