As a family physician in the JPS Health Network, Dr. Richard Young often sees patients with a list of heath ailments they want checked out at appointments.
But under Medicare and Medicaid payment rules, he says, before the patients get very far into their lists, he'll hit the point at which he'll stop being paid for his time and essentially will be donating his services.
It's a system that leads to rushed appointments and frustrations at times for both patients and medical professionals.
Young, 49, wants to revamp the rules for family medicine to create an environment in which doctors have more time to get to know their patients. He believes that would improve primary care and save on emergency treatment spending.
He sketched out a proposal that resulted in his being selected as the only Texan to serve as an adviser to a new federal innovation center under the Centers for Medicare and Medicaid Services.
The center was formed as part of the 2010 Affordable Care Act. It has a $10 million budget and is billed as an engine with the flexibility to rapidly test care and payment models, reduce costs and encourage widespread use of better healthcare practices.
Young, who has practiced at JPS for 21 years, was one of 73 people selected from 920 applicants.
"I pitched the concept to JPS leadership, wrote it up, sent it off and, lo and behold, it worked," Young said.
Medicare and Medicaid payment rules are complex and frustrating, he said. They work well enough if a patient arrives at an appointment with a single health issue like high blood pressure, he said.
But patients with multiple chronic diseases drive healthcare costs.
"Some people might have six things they want to talk about -- bumps on their skin, a sore ankle, all this other stuff," Young said. "The way the rules work, once you've gone over a couple things on their list, you have maxed out what you can get paid for. Doctors are not paid for all their work."
As a result, patients feel rushed through appointments, physicians are less inclined to practice family medicine, primary care becomes harder to find and more costly emergency services are needed for patients down the line, he said.
"It's time to think outside the box," he said.
More time for patients
Young envisions a system where doctors are paid to be thorough and patients are encouraged to spend more time with their doctors. Patients would be healthier and less likely to make unnecessary trips to the emergency room.
"A doctor would get to know his or her patients very well, and your patients have full trust in the doctor," he said.
He and other advisers will meet for four sessions in six months to work on strategies. A grant will compensate advisers for time and travel.
Comments by Medicare and Medicaid officials suggest they are seeking plans that follow Young's line of thinking.
"For too long, healthcare in the United States has been fragmented -- failing to meet patients' basic needs and leaving both patients and providers frustrated," Dr. Donald M. Berwick, administrator of the Medicare and Medicaid centers, told reporters when the innovation center was created. "Payment systems often fail to reward providers for coordinating care and keeping their patients healthy, reinforcing this fragmentation."
Young said the innovation center is seeking ideas to enact quickly. One reason his proposal might have been selected was that JPS, as a safety net hospital, could be in a good position to measure the outcome on a pilot project for new payment rules in family medicine clinics, he said.
Texas is one state contesting the constitutionality of the individual mandate included in President Barack Obama's healthcare plan, a case the U.S. Supreme Court could decide this summer.
Republicans in Congress are also working to overturn everything they can from the healthcare overhaul.
Young said he doesn't believe political disagreement will impede innovations.
If the proposal works, "if we can increase family care upfront and reduce services downstream in the ER, then that's something both sides would get behind," he said.
Alex Branch, 817-390-7689