Two months ago, I reposted a 2021 piece titled I am a Decision Maker, not a Bookkeeper. Tonight, looking at the stats of my WordPress blog, I saw that a 2022 post, where I had written almost the same thing, had a couple of views. There, I wrote “I am a problem solver, not a bookkeeper”. My piece was a short review of a New England Journal of Medicine article by Christine Sinsky and Jeffrey Panzer titled The Solution Shop and the Production Line – the Case for a Frameshift for Physician Practices.
I think that title is brilliant. I also think it is depressing – when did doctors offices stop being solution shops? Because they weren’t always production lines. Rereading my piece, I don’t believe much progress has been made in shifting the framework for how a medical practice works.
One frightening thought that comes to me when I think about the healthcare climate today is that medical practices may be becoming even more like production lines than they were a few years ago. Today’s solution shops seem to a large degree to be freestanding non-provider entrepreneurs. I see them position themselves between the medical practices and the payers/insurance companies with promises to get better results or more savings by data mining, analyzing and influencing provider behaviors and performance.
I also see niche medical practices who provide specialized services, like supporting or even managing the care for patients with respiratory illness, obesity or other high Total Medical Expense (TME). For pulmonary patients, they typically provide phone support, video coaching of inhaler techniques, etc.
There are also companies that analyze insurance claims for prescription refills and send reminders to PCPs that a heart disease patient hasn’t filled their statin drug that should have run out two weeks ago. Such things lead to lower quality scores for us, even if the patient was in the hospital with a serious infection and got their cholesterol from the hospital pharmacy, for example.
Those types of middlemen, or whatever you want to call them, seem to be where the action is today, while many medical practices struggle with high costs, low reimbursements, staff shortages and burnout.