When I was growing up, my doctor was Dr. Pomerantz. He knew me and I knew him. I can't say the same for my current PCP – And yes, times have changed, but it seems today that the importance of the personal relationship between the physician and the patient is in for a long overdue comeback. The transaction of individual care services desensitized the entire care system and the switch to payment for groups of services, whether in simple or more complex bundles, is forcing the delivery system to adapt to more comprehensive patient management than a single office visit or treatment. And if it were just the payment system shifting, it's not clear that the relationship part of the interaction between provider and patient would improve. What will complete the shift is the back to the future element of cost-sharing. In the days of indemnity plans, patients and their physicians would often talk about the cost of treatments, and their respective pros and cons. I got to know Dr. Pomerantz because, as a child, I suffered from significant allergies and the choice was between being inoculated over time by taking weekly shots, or risking recurring allergy attacks and trips to the ED. I didn't have the "money talk" with my doctor, but my parents did, and that was a routine discussion. Over the ensuing years, the talk of money between patient and provider became taboo, spurred by ever more generous benefits and increasingly exorbitant prices. Not counting the vendors who self-servingly push the message that there is no price tag to well being. Of course, there is.
What this means to you – Doctors are now worrying about patient cost-sensitivity, but they shouldn't. They should welcome this return to being concerned not just about the effectiveness of the physical treatment provided, but of the overall well-being of the patient…body, mind and wallet. With the emergence of various transparency tools, including web sites like Medibid, patients are understanding their choices and acting on them. They will do so on their own if met with resistance from their physicians about discussing the cost of various treatment alternatives, and they will likely start looking for another more willing doctor. Ironically, all these choices and selections might lead to a very different model of delivering care than the "one stop fits all" ACO because docs in ACOs might be conflicted with giving advice on finding a lower cost alternative at a competing facility. And that could explain some of the findings from Larry Casalino's recent paper on the effectiveness of small and medium-sized practices over larger ones. In these smaller practices, doctors often know their patients and the patients know their doctors. Conversations about activities of daily living, finances, and treatment choices come more naturally and yield better overall outcomes. To some extent, we're coming full circle, and in this particular instance, that's not a bad thing. Now if only I could find a new Dr. Pomerantz….