How insurance Scrooged the complete physical

Ebenezer Scrooge from Charles Dickens’ classic A Christmas Carol has become the quintessential icon of miserliness.  He embodies penny-pinching such that his actions are a detriment and harm to his workers and the community at large.  His remedy comes in the form of three ghosts representing Christmas past, present, and future who are brought upon him as a warning from his long dead business partner not to suffer the same fate.  This full spectrum revelation turns Scrooge’s heart to his fellow man and a joyous Christmas is had by all.
In it’s truest form, insurance is a valuable financial tool against unexpected hardships.  The expense of a sudden medical diagnosis can be overwhelming and it is wise to have an emergency brake in place to protect against devastation.  However, in recent decades insurance has become the clearinghouse for all medical decision making.  Patients and physicians alike must seek favor from third party payers to cover even the simplest of procedures.  As a result, the complete physical has become just another victim to the miserliness of business bottom lines.
Historically, the complete physical, often called the check-up or the yearly visit, was a time for patients to meet with their trusted physicians in a more leisurely setting to cover a multitude of topics.  The patient and physician would often begin by exploring the past medical history covering prior illnesses, surgeries, and life events that shape the patient’s current health situation.  Then a discussion of acute symptoms or nagging medical questions would be covered.  Patients would update their physician on the progress of nutritional changes or exercise habits as well as how much the ‘bad knee’ is limiting their activities of daily living.  A discussion of current medical diagnoses and the effectiveness of therapy would be covered.  Finally, the team would explore the future horizon of medical concerns that might impact the patient.  The physician would bring to bear research and recommendations of preventative steps to take to avoid such pitfalls while the patient would disclose family trends for certain illnesses for which they were worried.  Together, the patient and their physician would explore the ghosts of the past, the present, and the future health to formulate a plan of action that avoids any unwanted fates.
As insurance companies began processing complete physicals in their five digit CPT world, they began to inherently limit it’s effectiveness.  This occurred in several ways.  Lowering of reimbursement with associated increases in overhead to deal with insurance claims meant physicians needed to see more patients per day to generate the same revenue.  So appointments became shorter.  No longer could the complete physical be a leisurely consultation.  Limitations placed by the insurance companies on what procedures could be covered in the complete physical also reduced it’s effectiveness.  A diabetic who needed a physical and a discussion of his blood sugars now constituted two separate CPT codes. Occasionally, a physician could be reimbursed for both codes at a single visit but it was becoming harder to accomplish.  Physicians were incentivized to limit the scope of their visits to only what they were sure would be reimbursed.  Medicare has worked this out to as a fine art.  The Annual Wellness Exam is such an emaciated version of a complete physical that even though it carried no out of pocket expense, I was unable to convince many of my patients to continue scheduling it year after year.  They simply couldn’t see the point a visit that was so limited in it’s focus.  Finally, as insurance companies at the direction of the ACA began to offer a ‘free annual visit’ while simultaneously increasing the out of pocket cost of all other medical procedures by way of extraordinarily high deductibles, patients were incentivized to seek all their care at their ‘one free visit’ this year.  These too short visits would not allow for a discussion outside the preventative health realm and reimbursement for extra medical decision making was nonexistent.
All these factors contributed to my break from the insurance based system in order to launch Trinity Direct Primary Care, PLLC; the largest DPC program in our area.  I wanted to be able to spend whatever time was necessary to care for my patient’s medical needs whether it was past, present, or future.  In my practice, we offer one hour office visits for all new patients and for yearly complete physicals.  Most days the schedule is so flexible that if we need to extend the visit we can.  I spent 2.5 hours with one new patient recently covering all his health concerns.  The monthly membership allows us to schedule multiple visits if needed at no extra charge.  In short, whatever time the patient needs, we can provide it.  I encourage you to consider how a DPC membership improves your access to full spectrum medical care that isn’t limited in it’s scope or duration.  Call our office to set up an introductory Meet and Greet or Medical Consult appointment today.

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