Book by retired Detroit Lakes physician outlines how he would improve health care for all Americans

Retired Detroit Lakes physician Dr. Robert "Bob" Koshnick firmly believes that patients should be in charge of their own health care.

"Putting patients in charge of their own health care is the best way to reduce the cost . . . while improving quality and satisfaction among patients and providers," says Koshnick in the introduction to his new book, "Patient-Directed NIMBLE Healthcare: Reduce Health and Financial Disparities in the U.S. with Tax Credits for Direct Primary Care and HSAs," which he self-published this past summer.

"Most health care systems in the developed world are primary care-based," he continued. "The United States is not."

"We (i.e., the United States) should have direct primary care — take the government, insurance companies and other, third-party intermediaries out of it," he explained in a recent interview.

Instead, as is outlined in his book, what Americans have is a specialty and hospital-based, fee-for-service system, which is "very inefficient," Koshnick says.

Doctors are paid on a production basis, which gives them incentives to do more — i.e., order more tests, prescribe more medications, perform more surgeries, etc. At the same time, this fee-for-service system causes patients to avoid going to see their doctor due to financial worries, which may cause a dangerous delay in getting the care they need.

"Delayed access can impact quality of care, because treating medical issues sooner often leads to more successful outcomes," explains Koshnick in his book.

He also feels more attention should be paid to preventive care, and especially, getting patients to voluntarily give up bad habits such as smoking, drinking and eating to excess, etc.

"More people die from chronic (long-term, recurring) disease, not acute disease," he said. "Primary care provides incremental improvement — they deal with all these chronic health issues incrementally, over time."

This form of care also lessens dependency on emergency room care and hospitalization, Koshnick explained.

Koshnick's book is divided into seven chapters, with each of the first six devoted to his personal health care philosophy, NIMBLE — an acronym based on the following principles:

• Nourish character, with a direct primary care system that provides accessible care through a cost-transparent contract between patient and provider, and the use of health service accounts;
• Intake wisely — i.e., being responsible for what we put into our bodies, and the role that the community as a whole should play in that responsibility;
• Maintain health through preventive care and healthy behavior;
• Be responsible, with a transparent system of health care pricing and fairness;
• Live intentionally, with reduced administrative costs and waste and a reduction in unnecessary defensive medicine by changing response to medical error disputes;
• Energize America, through accelerated use of telehealth, engaging patients in their own healthcare, and expanded community capacity to address obstacles to overall health.

The seventh, conclusory chapter brings all of these different principles together to explain how health care costs might be reduced, and access expanded. Koshnick says he believes in his vision for a healthier America, which he built gradually, through his years in medical school, residency and family practice, concluding with his retirement in 2018.
"I'd like to see health care in America transformed," he said, to a system where "independent, direct primary care providers would be acting solely on behalf of their patients."

The first step, he added, is to show people that direct primary care "is something they should want" — to create "a movement where the population at large came to understand that being in charge of their own health care is, in the long run, going to reduce prices considerably, improve care overall, and increase both patient and provider satisfaction."

His book is now available on Amazon .