HMRx Healthcare Advisors

We understand the rigors of practice management and we offer customized solutions that best fit our clients’ needs.


The approach to medicine we all know became the predominant model about a century ago. Prior to Osler’s . . . the “Father of Modern Medicine” . . . work in the late 19th century and Flexner’s 1910 report, medicine was delivered via typically competing and rarely complementary models of homeopathy, naturopathy, chiropractic, and other modalities still in existence today as relatively minor players.

Allopathy emerged as the prevalent form of delivery. The term allopathy comes from the Greek terms for “other” and “disease” or an approach to care based on treating opposites. So, you’re suffering from bacteria and you’re treated with anti-biotics. Vaccines are anti-gens that stimulate the production of your body’s anti-body defense. An irony: the term “allopathy” was coined by Dr. Hahnemann, a leading advocate for homeopathy (or treating likes).

This approach worked very well as the scientific community developed treatments for large scale infectious diseases. And allopathic physicians (under the powerful American Medical Association) incorporated ever-improving surgical protocols and diagnostics developed by industry. More modalities lead to higher costs with employer-sponsored group medical insurance as a significant response during WWII. [Why in WWII? That’s for another discussion.]

All was going well for decades. Employers were able to offer workers health insurance, employees had good medical coverage, insurers had good profit margins, and physicians were compensated accordingly.

The problems with health care delivery weren’t particularly noticed until after the mid-1960s with the emergence of Medicare and Medicaid. The cost of health care rose 2,500% between 1965 and 1995 while inflation rose prices by only 500%. Health care as a percentage of Gross Domestic Product rose from 6% to 14% during those 30 years. And that’s when the public noticed.

There were various responses prior to the mid-1990s including Medicare’s Diagnosis Related Groupings and other Prospective Payment initiatives, and Nixon’s HMO Act in the early 1970s. However, those did little to stem the rising tide of spending closing in on 20% of GDP and $4 trillion per year in the near future. Hillary Care (aka the Clinton health care plan of 1993) intended to reduce the prominence of the prevailing fee-for-service (or pay to play) model where health care providers were compensated based on quantity.

This assumed quantity equaled quality, and that may have been valid during the early allopathic years. However, we are a great society of innovators and routinely find technological solutions to problems, no matter how nominal or catastrophic the problem. Quickly there were modalities available to mechanically lengthen lives and to treat infirmities that we did not realize needed treatment in prior times. At one end of the spectrum, the number (and cost) of childhood vaccines skyrocketed with older adults becoming the new market segment to promote immunization. At the other end, 5% of the population consumes 50% of our health care dollars on a wide array of interventions.

A series of divergent approaches has arrived recently with the same goal of decreasing cost while increasing access and quality. Unfortunately, most of those approaches have failed. Just ask your medical provider if implementation of electronic medical/health records or increased regulatory reporting measures or shared savings or quality (core) measures has achieved desired results. Chances are they will answer to the negative if they have time to answer at all.

Innovative technological solutions from industry may have a higher probability of success. Wearable medical devices and telehealth are both in their respective nascent stages.