In Healthcare, You Get What You Pay For

In Healthcare, You Get What You Pay For

Healthcare is expensive. And it is likely to stay expensive for many years to come. Yet, most of us have absolutely no idea why healthcare costs continue to rise so much. The most obvious reason is that the cost for even the most simple of services, like a visit to your doctor for a sinus infection, is wrapped up tightly in a complex relationship among doctors, insurance companies, pharmaceutical companies, and the federal government, each of whom “takes their cut”. Then, it takes a team of experts with enough advanced degrees to decorate the entire face of the Hoover Dam with diplomas to determine both value and cost for the service! What should be as simple as paying about $50 to your doctor for sitting in the same room with your doctor for 30 minutes to talk, get examined, discuss treatment options, and have all your questions answered, has ballooned into a cascade of copays, claims, deductibles, networks, HMOs, PPOs, EOBs, ACOs, prior authorizations and appeals. Lions and tigers and bears… Oh My!

Most recently, our patients have begun to rebel. Many have begun to make the same kind of choices in getting healthcare as when they need to have to pay for other professional services, like electricians, plumbers, and automobile mechanics. First, they are beginning to seek out the doctors and other agencies who are willing and able to deal with their concerns directly, promptly and efficiently, without having to wait for appointments, assignments and approvals from health insurance companies. Second, they are learning to value the doctors and other healthcare professionals who dedicate ample and sufficient time to address their concerns accurately and thoroughly. And third, out patients are taking on with increasing responsibility and accountability the need to shop around to find the best prices for needed healthcare services. In short, it is very apparent that many of our patient are cutting-out “the middle man”, where most of the hidden costs of healthcare are perpetuated.

The key to success in this emerging healthcare system is the elegance and simplicity of the doctor-patient relationship. When prioritized and strengthened, the doctor-patient relationship will restore our system of healthcare in America.

Michael J Lucherini MD MS

Dr. Lucherini specializes in Internal Medicine and Pediatrics. He practices at Summit Medicine and Pediatrics in Mesa, AZ, and is a Pioneer in Direct Access Medicine. His opinions expressed herein are personal and do not necessarily reflect the opinions of his staff, his patients, or his colleagues.

© 2015 Summit Medicine and Pediatrics
All Rights Reserved

Doctor or Provider… What’s In a Name?

Doctor or Provider… What’s In a Name?

My last name is not easy to pronounce: ‘LOO-kher-EE-nee’. In fact, most of my patients now call me “Dr. Mike” in large part out of fear of embarrassment that they might slightly mispronounce my name and end up insulting me. Although I can now laugh with candor when hearing a new variation on the butchering of my name spoken for the first time by a new patient, I do remember being a child growing up in a Boston suburb, having to suffer through my friends calling me everything from “Mike Linguini” to “Michael Looney-Tuney” to “Cuckoo-Lucherini”. (Over time, however, I learned to appreciate the rhythm and musicality of the last example!) No matter… back then, it was all part of growing up and a rite of passage to adulthood that most of us have experienced, and, as expected, it has all gone away. But today, whether my patients choose to use my first name or my last name, they always accord to me the title of “Doctor” before they use it. In my profession, that’s the most important part anyway, right? “Doctor Mike”. I like it. And I earned it. Well, doctor, not so fast…

There is a rather insidious effort within the health insurance industry and certain government agencies, whether purposeful or unintentional, to diminish this most noble and well-earned title for most of us doctors in the healthcare industry. Among many administrators, policy-makers, lawyers and bureaucrats, it has been common within the last several decades to refer to doctors as providers. Providers? Let’s see… Like a church volunteer who spends his afternoon handing out socks to provide warmth to the homeless on a cold day? Or like a girl scout who provides assistance to an elderly man as he crosses the street? Or perhaps like a farmer who grows grain to provide wheat to the bakers who in turn provide bread for us to eat? Well then, if, in this broad sense, doctors, as well as church volunteers, girl scouts, farmers and bakers, are all considered providers of some definition and measure, why is it true that only we doctors are now routinely referred to as “Providers”? Beyond the possible explanations of political correctness, laziness and a genuine effort to insult or dehumanize doctors, I have never been able to understand the logic and reasoning behind this effort, which is now spilling over in large measure into the healthcare industry as well. The new reality is that a doctor, who is in the practice of medicine for his/her patients, is now considered by the health insurance companies and related government agencies to be, first and foremost, a provider of healthcare for their contracted clients. Help! Not only have I been insulted, I’ve been kidnapped!

Unlike the innocent, creative contortions and rhymes to which my last name was subject as a child, I find the subtle redefinition of my purpose in healthcare much less tolerable. I simply refuse to be called a Provider. I am a Doctor. And although I find myself with increasing frequency having to correct my colleagues (often in mid-conversation) in both the health insurance and healthcare industries, I’m glad to note that my patients still have, in overwhelming numbers, the courtesy and common sense to call me “Doctor Mike Lucherini” and not “Provider Mike Lucherini”… whether or not they mispronounce my name!

Michael J Lucherini MD MS

Dr. Lucherini specializes in Internal Medicine and Pediatrics. He practices at Summit Medicine and Pediatrics in Mesa, AZ, and is a Pioneer in Direct Access Medicine. His opinions expressed herein are personal and do not necessarily reflect the opinions of his staff, his patients, or his colleagues.

© 2015 Summit Medicine and Pediatrics
All Rights Reserved

Healthcare Heal Thyself… Everyone Else, Just Get Out of the Way!

Healthcare Heal Thyself… Everyone Else, Just Get Out of the Way!

So, who’s to blame for the current state of healthcare in America? Well, this is certainly a very simple question, but it seems that over the last several decades, the answer has become increasingly complicated and controversial. Imagine for a moment asking this question in a room filled with a group of patients, doctors, health insurance executives, and politicians. If you find it easy to envision a sudden burst of finger-pointing among the parties, followed by a burst of nervous laughter as each person realizes that someone else has rather forcefully and conclusively laid blame squarely in the corner of the healthcare universe belonging to someone else, then you understand precisely why healthcare in America remains a broken and abused industry. The room, along with the rest of the country, is filled with confusion and chaos, and causes most to suffer headache!

Perhaps, in the interest of advancing the argument toward clarity and order (and getting rid of the headache), it would make more sense to ask another kind of question: Who’s NOT to blame for the current state of healthcare in America? Aha! Now the experts and blame-gamers in the room don’t know what to do. Without moving an accusatory finger, they’ll ask themselves, “Should I point to myself? Or should I let someone else off the hook?” And now we see that it’s a whole lot easier for one person to accuse others of flaw, fault and folly than it is to take responsibility for their own. You might imagine a little less nervous laughter in the room associated with this type of question as each person grapples with the notion that their corner of the healthcare universe may actually bear some responsibility for the mess. In my opinion, this is the first real step toward progress in fixing healthcare, and it’s a very tall step indeed.

So, you patients, you doctors, you health insurance executives, and you politicians… stop blame-gaming and start pride-taming. Take responsibility for your own actions—personally and professionally, past and present—in your little corner of the healthcare industry. Change what you should and must before expecting others to do the same, and lift the integrity of the industry one patient, one doctor, one health insurance executive and one politician at a time. It’s a difficult pill to swallow, but one that is necessary in order to realize a cost-effective, patient-centered process of healing healthcare in America!

Michael J Lucherini MD MS

Dr. Lucherini specializes in Internal Medicine and Pediatrics. He practices at Summit Medicine and Pediatrics in Mesa, AZ, and is a Pioneer in Direct Access Medicine. His opinions expressed herein are personal and do not necessarily reflect the opinions of his staff, his patients, or his colleagues.

© 2015 Summit Medicine and Pediatrics
All Rights Reserved

What’s Wrong with Healthcare in America? A Doctor’s Opinion

What’s Wrong with Healthcare in America? A Doctor’s Opinion

I will always believe that medicine is actually more about doctor-patient relationships than about dollar-payment reimbursements. For example, it is easier for a patient to value what is said in a 30-minute discussion with the doctor over the need for treatment of a newly-diagnosed cancer than what is paid to the doctor for the same 30-minute discussion. That’s because the practice of medicine starts and ends with humanity… a look, a smile, a reassuring touch, and time spent together without pressure to move on in the day. Yet, for many decades, payments to doctors for these looks, these smiles, these reassuring touches, and this extended time given to patients have been negotiated, filtered and executed through the prism of budgetary constraints, resource allocation, utilization efficacy, and cost-control measures put forth by public and private health insurance companies. What had been an industry rooted in humanity has transformed into an industry mired in bureaucracy. Yuk! Time for the doctor to step in…

I have thus far diagnosed the healthcare industry in America with government regulatory hypertrophy, hyper-dollarism, physician overuse syndrome, bureaucratic incompetence, and patient give-a-darn deficiency. I recommend immediate implementation of a comprehensive strategy for simplification of the system, including induced political coma followed by multiple health-insurance-ectomies, a 10-year federal government flush, and an extended common sense infusion therapy.

I welcome all other “professional” opinions on this case.

Michael J Lucherini MD MS

Dr. Lucherini specializes in Internal Medicine and Pediatrics. He practices at Summit Medicine and Pediatrics in Mesa, AZ, and is a Pioneer in Direct Access Medicine. His opinions expressed herein are personal and do not necessarily reflect the opinions of his staff, his patients, or his colleagues.

© 2015 Summit Medicine and Pediatrics
All Rights Reserved