The US Healthcare System is Failing. Could Veterinary Clinic Business Models Offer Help?
Recently, my husband and I were packing for a quick getaway weekend in NYC. He mentioned his calf was sore and as hard as a rock.
Now, I’m no doctor, though recently, I’ve played one each time I’ve had to navigate our healthcare system. So, in an authoritative voice, I said, ‘We need to head to urgent care.’
A few years ago, I sliced my finger open with a flying wine glass (not nearly as fun as it sounds) and needed stitches. I told my husband, ‘We need to go to urgent care.’ My husband’s response was to disappear for five minutes and return with the bandaid box. WTF!? I thought you were looking for your keys! Would you use a tissue to sop up a bathtub overflow?
So, I guess I’m the doctor in the house. Or at least I play one when we need one.
Packed Emergency Rooms
Back to my husband’s malady.
After 1.5 hours at Urgent Care (pretty quick!), an ultrasound showed he had ‘extensive’ blood clots from ‘nuts to nails’ (his words, not mine), and we needed to go to the big house—our local hospital ER—where he could get a scan of his lungs and further treatment.
At the ER, we discovered a standing-room-only waiting area of unmasked people with various ailments (and attitudes) waiting to be seen. Some had been there for hours (as expected). Some had the flu. A child cried for hours with what seemed to be an ear infection. Some were emergencies, like my husband’s blood clots, but many seemed to be there with non-life-threatening issues because their doctor’s office was closed for the day.
We left the hospital at 3:00 AM (a ten-hour saga) after a few more tests, an ER doctor waking up and consulting an on-call specialist, and starting my husband on a blood thinner.
Why Do ERs Have Such Long Wait Times?
In addition to life-threatening issues taking priority (and when you’re in the waiting room, you have no idea what medical staff is dealing with in the actual ER, the number of ambulances arriving, etc.), the wait may be long due to the number of beds in the ER, hospital, and local rehabs. If a patient occupying an ER bed is waiting to be admitted, they tie up that ER bed until their hospital bed becomes available. The bed they’re waiting for may be unavailable because rehab doesn’t have a bed for the current occupier to transfer to. This impacts patients further in the ER queue, who don’t get to see a doctor or nurse post-triage until an ER bed is freed up. Whether you have a sore throat or a major blood clot, you need to be in an ER bed/patient room to see a doctor/nurse, with few exceptions.
Why are people referred to hospital Emergency Rooms instead of Urgent Care facilities for non-life-threatening issues such as colds, flu, ear infections, a couple of stitches, etc.?
Many hospitals and rehabs don’t have enough beds—supply and demand don’t jive. ERs and hospital floors are often understaffed as well. Yet, the healthcare system is facing additional cost cuts. Before more cuts are made, shouldn’t we consider fixing the complex systemic issues that, if corrected, would have a significant positive impact?
What if we pretend people are widgets and the healthcare system is a complex manufacturing process (take the human element out since we often feel like a number anyway)? Could we leverage Just-in-time (JIT) techniques from the manufacturing industry that have been used for years to lower costs, improve efficiencies, and improve customer service? Is there any processes that could be leveraged?
What’s Happened to Primary Care?
After a hospital visit, you’re told to follow up with your primary care provider. My husband saw his primary care doctor the day after our whirlwind tour of the ER, who was surprised about the situation, given that he had given him his annual physical the week before.
Gone are the days when an annual physical meant your primary care doctor spent time with you discussing your general health, completed paperwork, AND gave you a comprehensive physical touch exam. Today, a doctor sees a patient every 10-15 minutes based on the time the insurance industry has determined is appropriate. Annual physicals are perhaps a half-hour, with half the time spent updating your record on the computer. Lots of primary care doctors are no longer giving comprehensive annual physicals.
Medical appointments are like tweets—quick and minimal—even if there’s a serious issue. Parking your car and walking into a building often takes longer than the appointment. Will the next step for efficiency be the drive-thru? Would you like assistance with those stitches or just the DIY fix-it kit for $200? Thank you for your payment. Please drive through to the next window.
When are doctors going to be allowed to be doctors? They’ve gone through years of education only to have insurance companies determine:
How long a patient/office visit is
What tests require pre-approval or will be denied
When a patient is ready for rehab or must be released from the hospital
Portal Pain
Most patient-doctor interactions are now through online portals, which can be problematic if you are not computer-literate (like my older relatives).
When a doctor or office doesn’t respond to a question posted via the portal within a few days, how many of you have consulted Dr. Google? She’s fantastic, and I’m grateful that what she posts online is always 100% accurate, truthful, and up-to-date.
Some office staff are excellent, while others are deep black holes. How often have you looked independently for a specialist even though you have a primary care doctor who, theoretically, should coordinate all your care but lacks the time or the staff to get back to you quickly? With my husband’s blood clots, we waited almost two weeks for his primary care doctor to give us the specialist he should follow up with. I already had a few names based on my research before we heard back from the primary care doctor.
That’s because I play a doctor occasionally (get your minds out of the gutter, please), but I’m not one in real life.
Hate social media? Think it’s B.S.? You realize that writing, posting, and reading a physician’s online reviews is a social media activity. Who hasn’t checked out the 5-star doctors first? So, in theory, that means that social media influences the healthcare you get. I can’t wait to see how AI will make all this more interesting.
Now That’s Special ($$)
Don’t get me started about insurance programs, particularly Medicare Part B plans. For those who haven’t begun Medicare, be aware that it is neither free nor as good as most employer plans. I could do a series of posts on Medicare, but I probably won’t because it irritates me too much. Here’s some of what I’ve experienced:
A Tier 3 drug I once paid $30/quarter for now costs me over $300/quarter under Medicare. There are no other options that cost less.
In 2024, Medicare Part B was $179/mo, but that’s just the baseline. Depending on your income before retirement, there’s a good chance you’ll pay a lot more.
I had three MRIs in two days. BCBS Advantage Plan approved the MRIs but paid ZERO of the charges. This comes down to the amount allowed for the MRI (pre-negotiated with BCBS) and the copay your plan may have for scans. My copay, $350/day (whether I had one or ten scans daily), was more than the negotiated price totals for each day (but not a lot less). It’s a good racket. You think the insurance company supports you by ‘approving’ the scan, but you are paying the full billed amount. How can a provider price an MRI at $1200 and an insurance company’s negotiated amount for that MRI be $179?
Primary care copays are $25, and specialist copays are $55. I promise every appointment except your annual physical will be with a specialist.
Yikes! I’m on a roll!
The Reality of Our Healthcare System
According to the ‘Mirror, Mirror’ report by The Commonwealth Fund, the U.S. healthcare system ranked lowest among the ten countries surveyed (Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States).
It’s the organization’s eighth report since 2004, focusing on five performance areas:
access to care (U.S. is #10)
care process (U.S. is #2)
administrative efficiency (U.S. is #9)
equity (U.S. is #9)
health outcomes (U.S. is #10)
And just to be clear, #10 is the worst, and #1 is the best. The U.S. remains in a class by itself, and that’s not a compliment, as you can see.
The system is failing everyone—patients, families, doctors, and medical staff. The only ones winning are the insurance companies and their investors.
BUT THERE’S HOPE!!
Amid this healthcare mayhem, I had a phone call with my sister that sent us both into tear-filled laughter. She said, ‘Next time, just bring him to a vet.’ It was funny for sure, but did this idea have merit?
Can We Leverage Another Care System That Seems to Work?
My pets get better treatment at their vet than I and others have recently experienced with our healthcare system.
So, it begs the question, ‘Should we leverage the ways veterinary clinics and hospitals run and the processes they use that seem to work well?’
A Potential Solution
Imagine a world where people go to the vet because it’s cheaper, faster, and offers better care than the U.S. healthcare system. Could their system become a human healthcare option?
Scenario I
Patient: "I need a checkup, but my deductible and copays are insane."
Friend: "Just go to Dr. Doolittle down the street. There's a $50 flat fee, and they give you a treat afterward."
At the vet’s office:
Vet: "Looks like you’ve got a sprain. We’ll wrap that up and give you some painkillers."
Patient: "Wow, that’s it? No $350 imaging scan copay?"
Vet: "Nope. Also, your nails are a bit long—want a complimentary clipping?"
Patient: “That’s awesome! A solution to my fall in the park, and I get a free pedicure!”
Insurance Company: "You went to a what for treatment?"
Patient: "Yeah, I went to my local vet. They saw me on time, plus the vet complimented me on being a good patient (you’re a good boy!)."
Scenario II
Receptionist: "No insurance? No problem. The vet can see you now."
Patient: "Already? I just walked in!"
Receptionist: "Yup. We’re more efficient than the DMV and most human healthcare options."
Vet: "Yup, that’s an infection. Here’s your prescription, and we tossed in some free dewormer—just in case."
Patient: "I don’t think I need that."
Vet: "Better safe than sorry. No extra charge."
Conclusion
Maybe veterinary clinics and hospitals are not the best fit for humans.
But here’s the saddest part: If this were an option for real, people would consider it.
