I recently had a discussion with a few friends about how our healthcare system works and what changes could improve patient care. For the non-medical people I was speaking with, preventive care was a major topic. They said the same thing that most doctors would say, which is that it seems cheaper to educate patients and steer them towards a healthier lifestyle than to wait until they develop the diseases that are a result of unhealthy choices.
None of this is groundbreaking stuff, however the second part of our discussion was much more interesting. I explained that while many physicians incorporate preventive care and lifestyle modification into their practices, these are not things that are easy to bill for and as such they are not always a top priority. I’ve heard many doctors, mainly primary care physicians, talk about the need to change the way doctors are reimbursed so that preventive measures becomes a larger component of patient care, but the fact remains that it is much easier to prove that you have provided a procedural service than an abstraction like counseling a patient. So the barrier to changing reimbursement becomes how to quantify what sort of counseling is being done and also verify its quality. In a perfect world we could be on a honor system and trust that when a provider says he has counseled his patient he has done so in a thorough and effective manner, but in reality the process of ensuring that this advising is substantive and effective is much more difficult.
So I pose the question to you the readers. How can we accurately measure preventive counseling services in a manner that makes it feasible for payers to reimburse providers with confidence that the service has been rendered appropriately? I’m curious to see what solutions others can come up with.
