Doctor Lets Patients 'Pay' for Surgeries With Volunteer Service

Marcia Frellick

January 16, 2020

A surgeon in Norfolk, Nebraska, has started to offer his patients a radical new way to pay for surgeries they are not sure they can afford — they can "pay them off" by volunteering in the community.

Demetrio Aguila III, MD, with Healing Hands of Nebraska, specializes in surgical management of pain; peripheral nerve surgery; ear/nose/throat surgery and allergy; and reconstructive surgery.

Dr Demetrio Aguila III

When he discusses surgical options with patients, he gives each one — without regard to income or insurance status — three choices for paying: in full upfront, in installments, or by volunteering through community service.

Most choose the first two, but three patients so far have chosen the third, volunteering, Aguila told Medscape Medical News.

The program is called M25 and is named for the biblical reference Matthew 25:40: "Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me." (Matthew 25:40b, New American Bible).

The program works this way: Patients who choose M25 are told to report to one of the two charitable organizations that have so far signed on as partners. The charity asks Aguila how many hours of service the patient would need to give to cover payment for Aguila's services, which Aguila donates for free.

The number of hours of service is set, and the patient and family or friends of the patient then work to complete the hours.

When the work is completed, the surgery can begin.

Prices Are Transparent

All prices at the clinic are transparent, Aguila says, because the practice operates without insurance contracts. Patients know exactly what their care costs, a figure that won't change after the surgery.

The two partners so far are the Orphan Grain Train, which distributes food, electronics, and clothes globally to those in need, and has its headquarters in Norfolk, and The Least of My Brethren, a charity in Omaha that helps homeless people get back on their feet. Partners provide the accountability for hours served and the infrastructure to link work needs with patients.

Part of the beauty of the program, Aguila says, is that whatever tasks need to be done — painting, answering phones, filing papers, packing boxes — can be completed by the patient or anyone the patient recruits — family, friends, students, coworkers.

Aguila, 48, said he has been getting calls from area businesses and individual people asking if they can help any patient who wants surgery by doing some of their work.

So why ask patients to do the work, if he's going to do the surgery for free anyway? Patients investing in themselves and in their community, he says, is the whole basis for the program.

"We've seen in study after study that patients who are not invested in their outcomes have poorer outcomes. As a surgeon, I want to equip my patient with every possible advantage to get the best outcome," he said.

When patients are putting in the time up front and know that others are investing in their progress as well by helping them work off the hours, they have the advantages they need, Aguila said.

The patient benefits, the charity and the community it serves benefits, and Aguila and his colleagues benefit in a different way.

He says his religious faith compels him to help others and he is simply completing medical mission work in his own backyard.

Clinic Breaks From Traditional Insurance Model

Aguila is the only provider donating his time for free. Other providers, staff, and facility costs are paid in the usual way those providers, staff, and facilities bill their patients. He is working on finding clinics who will donate facility fees and staff as well as part of the M25 program; South Omaha Surgical Center is the first to make such an agreement for some surgeries.

He said he is not tethered to insurance contracts and therefore does not have to work with constraints such as prior authorization. They do participate in Medicare and Medicaid, and patients in those programs are not eligible for M25, but the program is open to those with no insurance or commercial insurance.

Inspiration Started in Afghanistan

Aguila said his first thoughts of doing medical mission work came during the last phase of his 22 years in the Air Force.

During his last appointment to Afghanistan, he said he did more than 300 operations in about 4 1/2 months.

When Aguila returned to civilian life, he knew he wanted to make humanitarian medical mission a part of it.

Aguila said he has three objectives in this work: "One is to restore hope for people who have lost help medically; two is to restore hope for people who have lost help financially; and three is to restore hope to physicians."

He noted the high rates of burnout and suicide among physicians and the constant tug of war with wanting to 'do no harm' but often being a party to harm when patients are saddled with bills they can't pay.

First Patient Does 560 Hours

Jeffrey Jensen was the first patient to choose M25 and complete the hours. He said in a video on the organization's website that, at first, the required 560 hours felt daunting.

Then he thought, "What if I got my mom and my wife and my kids and my sister, what if I got my cousins, what if I got my Boy Scout troop, my church, the people I work with? What if all these organizations that have always asked of me and I've always been there for them, what if I asked back of them?"

He says M25 is not about the money.

"If people come together and come together to help other people, then your community thrives," Jensen said.

Mark Fendrick, MD, director of the University of Michigan's Center for Value-Based Insurance Design in Ann Arbor, said he has not seen a similar model that involves trading work hours for surgery costs.

However, he notes the underlying causes that have people searching for such solutions are evident.

He pointed to a Kaiser Health News story that showed high patient deductibles are wreaking havoc on rural patients, clinicians, and hospitals. The article notes that annual deductibles of $3000, $5000, or $10,000 are increasingly common, and in rural areas with typically lower salaries and less employer-sponsored plans, the struggles to pay are intensified.

Fendrick said that although "I love the idea that there are innovative programs in place to remove the growing out-of-pocket burden for patients who need essential care," the establishment of the Nebraska program and others speaks to the unworkable state of healthcare payment models.

"Patients should not have to have a bake sale, start an online fundraiser, or perform community service to get essential healthcare services," he told Medscape Medical News. "While volunteer work certainly provides benefits to the community and is preferable to medical debt, not everyone has time available to meet this requirement."

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