Flip No. 25

Shift to a payment system that values communication

New payment models move away from volume-based payment.

By Flip the Clinic

This flip is one that surfaced during our research—and it seems worth exploring—but we haven’t gotten much further than the big idea. We’re putting it here as an early test. We’d love your feedback. What might we consider when thinking about this flip? Who is already exploring this idea? What is a new and creative approach to this problem? Let us know in the comments section. If there’s enough to develop the idea, we’ll give it the full flip treatment.


  • reneewalker

    I think it is important for clinicians and patients (consumers) understand what they are paying for. Often times doctors provide treatments or diagnostic tests with little or no understanding of the cost. Even worse, patients have little to no understanding of what the actual cost of anything is. Even if a consumer understands that their insurance pays for 80% of lab tests – we never know the bottom line until AFTER the procedures. So, insurance pays 80% of what? AS the consumer, I pay 20% of what. What is the actual cost of services? For that matter – what is the actual cost of the doctor visit? Every other item I pay for, I understand the cost and the value – but health care does not work that way….and I wonder why?

    • Michael Painter

      Renee–three cheers for you–I completely agree. Everyone from consumers and patients to health professionals needs to understand the cost and price of their health care services. Granted it’s hard right now to get that information–but we all need to push for it, so eventually it will become the norm–not a crazy, outlandish question in health care. Consumers really need to know and understand–at the time of the decision or transaction what their out-of-pocket expense will be–so they can make an informed decision with their clinician–totally agree. We need to push for that information–and then for ways to get that information into the hands of the folks who need it when they need it.

  • http://batman-news.com Wyatt Hendricks

    A good starting point woould be to pay for telephone consults between clinicians and patients. While CPTcodes were created for this activity, Medicare, Medicaid and virtually no third party payor will pay claims for this. The reasoning by payors is that they only pay for one on one / face to face medical care.
    The current state of “TELEMEDICINE’ requiresthat the patient be present at an approved facility, i.e., a doctor’s office. What is the point of that?
    Clinics and physician practices have no direct economic incentive to be more “available” or to utilize any technology that would enable that.
    Ultimately, until Medicare/CMS changes the policy, no one else will because they all take their lead from CMS.

    • Michael Painter

      Wyatt–more great stuff. I wonder if there’s a Flip in your comment that’s worth proposing… Consider it.

  • http://batman-news.com Wyatt Hendricks

    Get rid of the patient “CHECK-IN” window.It’s purpose is to isolate the patient and insulate administrative staff. It is a defacto “BARRIER TO COMMUNICATION”.

  • http://batman-news.com Wyatt Hendricks

    Get rid of the waiting room. It is an extension of the check-in window and is more aptly called the “HOLDING AREA”.

    • Michael Painter

      Wyatt-Great comments–I (and more importantly others) agree with you. See the conversation over at Flip 19, How do you redesign the clinic? Some examples of clinics doing just what you suggest here..

  • Wyatt Hendricks

    Get rid of the practice of giving patients forms to fill out. Instead repurpose the check-in clerk to “Patient Advocate”. Have them invite the patient to join them at their desk and make the collection and entry of patient demographic and billing information an interactive conversation.

  • T SS

    for family docs: I plan to bill like other professionals- by the hour rather than by appointment type. There was a flip about bartering and that aligns with my model also. No fees to join a club, no hidden costs. I am the same person during a pap as during a consultation or blood pressure check.(vaccines extra). I set my fees based on the current “urgent care” visit copay in our area -$75/15 minutes, $150 /30 min etc. I will opt out of medicare and will be out of network with insurance. I start this in January- will keep you posted how my clinic experiment goes. So far the patient response has been tremendous and lots of high fives. They want the time with me and are planning to put away in their flex spending to get that hour twice a year.

    Ala cart pricing just like ordering “#1 super sized ” and knowing you won’t be charged for the napkins and ketchup