True market-based medicine is called Direct Primary Care. Before 1950, it was called “medicine.” The nearest living relative in the tree of medical taxonomy is the solo practitioner. Over the last 25 years, massive forces have been brought to bear to eliminate the solo practice model, and bring in the industrial corporate model of medical care. You purchase a 20-patient-per-day provider for a 20 PPD slot, and maximize revenues. A clinic may have 250 PPD visits by revenue-generating-units (providers). If one of your RGU ‘bots becomes defective and goes off-line, you rent a locum as temporary RGU until the provider is repaired. Get a quality management unit to oversee the revenue generating units and report on their performance. Segregate the RGU’s by performance measures – turn them over if necessary.

That is the new model we have come up with in 25 years – and yet patients aren’t grateful! What could we do next – Black Friday healthcare sales?

The model is bad, the system is broken – but nobody wants to fix it, for more reasons than just laziness.

f a local engineering company produces micro-scale laser cut and engraved electronic parts, and the engineering company has bought a high-price eximer laser on loan to do so, the company’s business analysis team should be asking itself – how do I keep this thing turned on as much as possible in productive manufacture? How do we maximize efficient utilization? If it needs a full-time babysitter or two at the bench to keep it within spec so it doesn’t break down, well, hire the personnel!

If a medical clinic produces its maximum (and only) revenue stream when the provider is with a patient, well, how do we maximize production? We don’t load down the point of service with unnecessary crap. If you have a fancy laser, you can also use it to cut reams of paper to give crisp and attractive edges. You can produce stunning cutouts of Hallowe’en and Thanksgiving and Christmas decorations for the office. Why are you using a million-dollar laser to do that? In the same way, why does the system waste a million-dollar surgeon’s time with crap?

Healthcare sets performance expectations, and yells at the laser when it goes out of whack.

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