Efficiency

Definition

Efficiency is solving a problem expeditiously, and using the least number of steps. Efficiency in healthcare is solving a health problem expeditiously, and using the least number of appointments, tests, and interventions. The way a practice solves problems and how efficient they are, is fundamentally dictated by their reimbursement model.

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The Fee-For-Service Model

By far the most common reimbursement model in the United States - from primary care, to "wellness clinics", to neurosurgery - is the fee-for-service model. Whether it is your . Healthcare professionals are directly reimbursed based on the number of appointments and additional goods and services they can upsell. This incentivizes inefficiency in several ways:

Mandatory Office Visit For Billing

Since insurance reimbursement typically requires a face-to-face encounter, the system incentivizes physicians to require an office visit for every minor issue. This is a significant waste of patient time; many clinical concerns—such as reviewing stable lab results or assessing a dermatologic rash—can be resolved more efficiently via secure messaging, photography, or telemedicine.

Offload to Specialists

The fee-for-service model disincentivizes a primary care physician from taking the time required to solve a problem. A physician receives the same small office fee whether they diagnose a complex issue or simply issue a referral. This creates a "referral-first" culture where common problems - such as back pain, fatigue, or hypertension - are offloaded to specialists to avoid medical-legal risk and time-consuming diagnostic work.

The Bias of Specialty Care

Offloading to specialists not only delays diagnosis and treatment, but exposes patients to the bias of the specialist. While specialty care is vital, specialists are professionally, financially, and legally incentivized to diagnose and treat more aggressively. With respect to common medical problems, this exposes patients to further unnecessary visits, as well as invasive testing and aggressive treatments.

Neglect of Continuity of Care

Efficiency requires a thorough review of a patient’s medical history and rigorous coordination to ensure "one hand knows what the other is doing." However, the fee-for-service model does not reimburse a physician for the hours spent retrieving records, synthesizing data, or overseeing the execution of a plan. Because only the "encounter" is billable, the system rewards repeating a test rather than the more efficient, but non-reimbursable, task of finding, analyzing, and coordinating the previous result.

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Engineering a Practice For Efficiency

The Concierge Medicine model, based on an annual fee, rewards me for solving your problems - and solving them efficiently - not for the number of face-to-face office visits I rack up. I want to make the best use of your time.

Eliminating Billing-Driven Friction

We eliminate the office visit when its only purpose is to trigger an insurance claim. If a blood test can be reviewed over the phone, we do it. If a blood pressure reading can be texted or a rash can be evaluated via a high-resolution photo, we proceed. By employing technology and telemedicine, we prioritize your time and resolve issues without unnecessary logistical friction.

The Internist as the Primary Solver

A good interninst can handle the majority of your problems. In fact, the majority of medical problems are common. They make up a short list that includes: headache, backache, fatigue, respiratory infection, cough, nausea, diabetes, and high blood pressure. An experiencing Internist can handle these problems. In actuality, because I see fewer than four patients a day, I have more time to thoroughly examine an issue than most specialists do. This ensures that diagnosis and treatment are precise, timely, and free from the unnecessary risks associated with over-specialization.

Reducing Overdiagnosis and Overtreatment

By having the time to apply critical thinking and evidence-based standards to your case, I can filter out the "medical noise" - the unnecessary tests and treatments that the standard system often generates. In this model, efficiency is achieved by doing exactly what is necessary, and nothing more.

Continuity of Care

Real efficiency is build on documentation, cordination, and communication. Because my practice is not volume-driven, we invest the necessary time to retrieve and synthesize your entire medical history and manage every step of your clinical plan. By ensuring that no detail is lost and no test unnecessarily repeated, we reach a definitive clinical conclusion in fewer steps. (Read more about Continuity of Care here)