An All-You-Can-Treat Buffet
A couple of years back I wrote the following article for a Las Vegas magazine. I thought I’d repost it on Turntable Health’s 2-year anniversary. Don’t forget to get ZDoggMD to come speak in YOUR ‘hood.
When I moved to Las Vegas from the Bay Area 2 years ago, my tourist-grade fanny pack was overstuffed with the usual stereotypes and misconceptions. Would I burst into flames during my first summer? Nope — it turns out a shaved head radiates excess heat marvelously. Was the Carrot Top show any good? Yup. Another pleasant surprise! And so forth.
But my greatest Vegas-induced revelation hit me while hiking in Red Rock Canyon…and I mean literally hit me. I mis-stepped while rock scrambling and cracked my freshly-shaven dome on a pretty nasty rock outcropping. I had the requisite out-of-body peaceful moment of zen, followed by a way less peaceful re-entry into my body. As a doctor, my first thought (as I blinked through the blood) was, “That’s gonna leave a mark.”
My second thought? “WTF do I do now?”
Like so many Las Vegans — and despite being an internist myself — I didn’t have a primary care doctor whom I could call. Previously, when I asked locals where they went for the best, quality healthcare, they recommended some place called McCarran*. I was pretty sure that was out-of-network.
Judging by the iPhone selfie I took after I fell, I knew I needed about three stitches and a tetanus shot. A good family doc could do that in his/her sleep (although I’d prefer they were awake). But I didn’t know anyone, so I went to the nearest ER — a rather posh-looking facility called Summerlin Hospital. They did a great job, and I got my three stitches and tetanus shot, and my wife said the scar made me look sexy. She found the face I made when I got the $3500 ER bill considerably less sexy. That’s $1000 per stitch and another $500 for a tetanus shot. Let’s just say in the ER, the House always wins.
It’s a local pastime to bash the state of healthcare in Las Vegas. And with good cause: In Las Vegas we wait longer in the ER, are far less likely to get cancer screenings and other preventative care, and are twice as likely to die of preventable illnesses.
It’s tempting to blame doctors for this, but don’t. Sure, some TV plastic surgeon may a have private jet and a manservant named Jeeves, but the docs responsible for keeping you healthy — the primary care folks — are suffering miserably, particularly in Vegas where there is a desperate shortage. In the fee-for-service mill, these docs need to see a patient every few minutes just to pay their overhead and debt, and they spend the majority of their day (and often night) doing paperwork to please the bean counters. Physicians went into medicine to alleviate suffering; instead, they have become slaves in a broken system. It’s no wonder so few medical students want to do primary care. Would you?
But the prescription to fix primary care (and by extension, the rest of healthcare) isn’t that complicated. Get rid of fee-for-service and use a different payment model. A membership model, like a gym, is one approach: one fee for all-you-can-treat access to a buffet of care, much of it preventative. Employers, health plans, or government programs could pay the fee. Incentivize healthcare, rather than just the sick care treadmill of procedures and constant referrals. A team of docs, nurses, social workers, and health coaches to support one another and focus on the whole patient, while prioritizing education/accountability via classes and group visits. Elevating the human relationship that is at the heart of medicine would improve outcomes, decrease costs, and increase access across the system. #BOOM
I’ve lived pretty much everywhere, but Las Vegas is the first place that’s truly felt like home to me. We embrace innovation and change here, and we’re not particularly fond of authority. It’s fertile ground for the true healthcare reform that can only come from a partnership between physicians and patients, not from government or industry or some bureaucrat. That’s why we built Turntable Health in the heart of Vegas. I just wish we’d been open when I cracked my head. If I was a member then, I could have gotten my stitches and tetanus shot from someone who knew me well…for no added cost at all.
In my humble opinion, to double down on relationship-based primary care is the only way to beat the House in healthcare. Are we all in?
*McCarran is the name of our airport.
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