Service for Surgery

What's wrong with our healthcare system? That's the question I couldn't stop asking myself after an Air Force deployment to Afghanistan that ended in 2008. I had been thinking about the medical debt problem in this country ever since my residency days, but Afghanistan was the turning point for me. During the four months I was there, I performed more than 300 head and neck reconstructive surgeries as the only otolaryngology surgeon in the country, and nearly all of the surgeries were humanitarian. In many cases, I was able to provide better care in a more efficient manner for patients living in mud huts than I could for patients living in our nation's capital. At that point, I realized there was a real need for more affordable health care in our country, and it was a mission I was being called to fulfill. That's when I went from passively pondering the problem to actively working toward a solution.

After more than 10 years, two residencies (in plastic and reconstructive surgery and otolaryngology-head and neck surgery), two fellowships (in peripheral nerve surgery) and countless hours of planning and fine-tuning, the M25 Program was born. The program — inspired by the Gospel of Matthew 25:40 — allows patients to pay for their procedures through service hours performed at hand-picked local charities. The goal of the program is simple: To deliver world-class surgical care that doesn't require patients to incur crushing financial debt. It offers patients the opportunity to invest in themselves and their surgical outcomes, and facilitates moral and financial support from family, friends and communities.

When some people hear about the possibility of using volunteer work to pay for their surgeries, they have trouble wrapping their heads around the concept. That's understandable. As a society, we've been conditioned to believe astronomical medical debt — and the complex and often unfair billing practices that cause it — are an unavoidable part of our healthcare system. It is what it is disgruntled patients often say as they struggle to find ways to avoid going into bankruptcy to pay for needed medical care. It doesn't have to be that way. Patients shouldn't need to choose between their physical health and their financial well-being.

Patients who come to my clinic, Healing Hands of Nebraska, for sinus surgery, carpal tunnel release, nerve procedures to treat chronic pain, ear tubes placed under local anesthesia or a host of other treatments are offered three payment options:

• Lump sum. Patients pay a discounted rate up front. Because we don't have contracts with traditional insurers, we're able to be fully transparent about the cost of our surgeries. If patients have insurance, we'll submit a claim after surgery for reimbursement. Almost a third of our patients choose this option.
• Payment plans. We've partnered with a handful of third-party healthcare financing vendors that provide patients with the opportunity to cover the cost of care over a series of installments. About two-thirds of our patients decide to finance their procedures.
• The M25 Program. Patients volunteer with our charitable partners and once they complete the requisite service hours, we perform the procedure at no cost to them. About 10% of our patients have taken part in the M25 Program, which has been growing steadily despite the setbacks our clinic experienced because of the pandemic.

The M25 Program is not a charity — it's an alternative way for patients, and the communities they recruit, to invest in their outcomes. Time and again, patients tell me, "Doctor, thank you for respecting my dignity and allowing me to invest in my care instead of treating the arrangement like a handout."

I'm often asked how we draw the line on who's eligible for the M25 Program and how we calculate the volunteer hours needed to pay for surgery.

In terms of eligibility, it's simple: Everyone can seek care through the M25 Program. This is the only fair way to do it. I've found that patients end up self-screening for inclusion by asking themselves, "What's more important: my time or my money?" Patients who enter the program have skin in the game. They — along with their volunteers — have invested hundreds of hours of community service in the procedure.

The service hours aren't arbitrarily assigned. Our team analyzed factors such as relative value units (RVUs), procedure length, the complexity of the case and the expertise required to diagnose and treat the condition to come up with a proprietary formula for assigning hours.

Healthcare providers spend a lot of time talking to patients about the clinical risks, benefits and alternatives to surgeries. It's only fair we talk to them about the financial risks, benefits and alternatives as well. For the 43 million Americans struggling with medical debt — the type of debt that's responsible for more than half of the bankruptcies in this country — you can't separate a surgery's outcome from how it will impact the patient's wallet.

Price transparency is one of the cornerstones of our clinic. I'm sometimes asked why I focus so much on revealing the true cost of care. I believe it's only fair that patients know exactly what they're paying for right from the start. One of the core debates in health care today revolves around the cost of care, but cost isn't the only factor to consider — nor is it the most important. The real discussion should be about the value of care. In order to assess value, however, you must know the cost and the quality of the care provided. That's where our approach differs from so many others.

Before I opened my clinic, I got a call from a former patient.

"Doc, I need your help," she said. "Please call my insurance company for me."

"About what?" I asked.

"I just got an exorbitant bill for the surgery you performed on me three years ago!" she said.

I was powerless to help, and it was devastating to know that I was contributing to, or even causing, the financial ruin of patients I had set out to help. Thanks to the M25 Program, I never have to worry about receiving a call like that again.

Surgical professionals, by their very nature, feel compelled to help others. They want to do everything in their power to ensure people can afford life-changing surgeries, but they don't know where to start or believe changing a broken healthcare system is an insurmountable task.

If that's how you feel, I challenge you to think outside of the box — or throw the box away altogether. I can directly impact only so many patients. My ultimate hope is that the M25 Program inspires other physicians and facilities to find more innovative ways to help patients pay for surgery. We simply must find better ways to care for those who are hurting. OSM