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Dr. Jordan Shlain, Medical Director of San Francisco On Call Medical Group. (Photo: Business Wire)

SAN FRANCISCO--(BUSINESS WIRE)--Dr. Shlain pushes back from his desk, roots around in a drawer and finally waves a check triumphantly in the air. The check came from an insurance company years ago, meant to cover a $350 procedure Dr. Shlain had performed.

"Seventy cents," he reads proudly.

The check goes back in the drawer, with the care one might afford a rare baseball card. Indeed, on that piece of paper lies all that's wrong with the healthcare system today, and all that prompted Dr. Shlain to withdraw from it and begin anew. As the country finally begins to address the growing crisis, Dr. Shlain is well into his attempt at fixing it, one patient at a time. Insurance companies and their 70-cent checks have no part in a wholesale reinvention of healthcare.

The San Francisco On Call Medical Group, a private practice founded a decade ago by Dr. Shlain, should not exist. Its governing principles should not be so starkly refreshing nor its patients inordinately grateful. Then again, the nation's healthcare system shouldn't be in a shambles and its citizens desperate for decent care.

At the heart of Dr. Shlain's practice is a fundamental restructuring: Patients pay cash, for starters, keeping HMOs out of the medical equation -- ultimately a money-saver for them, Dr. Shlain notes. Only a limited number of appointments are made, keeping the quality of care high. And because some old traditions never should have disappeared, Shlain and his team make house calls. Convenient? Sure -- but it's also good medicine. By developing an intimate relationship with patients, Dr. Shlain says, doctors can give them better care on a timelier basis, and for less money.

"The single-most important thing in healthcare is the doctor-patient relationship," he says. "The insurance companies came and disintermediated, said 'no, your relationship is with us now.' Well, not here."

Restoring that key relationship couldn't be more pressing. A recent Commonwealth Fund study found that adults with a history of serious illness or hospitalization wait longer for their doctors' appointments here in the States than in almost all other peer nations.

A problem in its own right, to be sure. But as with the human body, one affliction can lead to another -- so it is that a doctor crisis has helped give rise to an emergency room crisis.

"Doctors are so inaccessible right now, the ER has become the default place for at least some type of care," Dr. Shlain says. "But you can get very sick in a hospital. And the chain of command means there's a lot of room for error. Meanwhile it costs the system thousands of dollars for every visit, and nobody's even following up with you. I want my patients out of there."

Statistics suggest that's not a bad idea. While visits to the emergency room increase -- up 20 percent between 1995 and 2005, according to the CDC -- emergency rooms themselves are shuttering. Bad news for a country where one in four hauled themselves to the hospital at some point in the last two years, unable to get seen by a regular doctor. And of course wait times within the ER are as grim as those for physician appointments: over four hours, on average, in 2006.

Idealism is not a quality typically associated with doctors. We ask for availability and wisdom, maybe some decent magazines in the waiting room; to seek more, our culture appears to have accepted, is naive. Dr. Shlain has taken it upon himself to re-conceive medical care -- even within his own practice. Enter Dr. Jacob Leone, tasked with bringing naturopathic family medicine to On Call. Dr. Leone sees his role as not just providing a holistic approach to a patient's wellness, but involving that patient in an ongoing dialogue about different modes of care, too.

"The naturopathic methods work alongside traditional medicine to not only improve health, but to focus on prevention," Dr. Leone says.

With the country inching into another election season, healthcare reform has again come to the headlines. One recent report revealed that, per capita, we spend twice what France spends -- even with nearly 50 million citizens wholly without coverage here. As a national conversation about healthcare takes shape, the input of forward-thinking practitioners becomes vital. Ill? The doctor will see you. In that seemingly simple paradigm lies a radical approach to revolutionizing the way medicine is practiced in this country.

"I win, the patient wins, the emergency room wins because it doesn't get clogged, and the system wins because it doesn't have to cover a $3,000 ER visit," Dr. Shlain says. And the insurance companies don't have to part with their 70 cents.

Links: Dr. Jordan Shlain on the Today Show, 4.17.08: http://www.msnbc.msn.com/id/21134540/vp/24178717#24178717 Dr. Jordan Shlain's website: http://www.sfoncall.com/