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What has happened to our health care system?
Physicians are now called “providers” and patients are “consumers.” Primary care doctors are buried with insurance paper work, checking the appropriate boxes, and using the right billing codes. Add to that, they face declining compensation and patient loads of almost 3,000 each. Physicians have lost opportunities for meaningful interaction with their patients, and the physician-patient relationship has eroded. There are not enough hours in the day, and too many regulations prevent doctors from practicing the profession they thought they had entered.
According to the “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” 81 percent of physicians describe themselves as either over-extended or at full capacity. Almost half plan to take steps that would reduce patient access to their services. These measures include cutting back on patients seen, retirement, part-time work, closing practices to new patients and seeking non-clinical jobs. This comes during a period in which the ranks of Medicare and Medicaid patients are dramatically increasing as baby boomers qualify for Medicare. Also, millions of new patients insured through the Affordable Care Act are now expecting to be seen by a primary care physician.
The concierge model is showing early signs of success.
One of the options for physicians when they cut back on patients is the emerging practice model called “direct primary care” or “concierge medicine.” In 2005, this model was offered by only 146 physicians, but it now boasts more than 5000. Many of them are under 45 and seeking more satisfaction in delivering care.
A concierge physician charges a retainer for patients who want to be part of his or her practice. The retainer allows the physician to substantially reduce the patient load. Average retainers vary from practice to practice, but at one of the largest concierge networks, membership fees range from about $1,650 to $1,800 a year. Patients relying on a direct primary care practice physician can generally expect all primary care services to be covered, including care management and care coordination. This care comes with same-day appointments, available around the clock and seven-days-a-week.
Office visits are at least 30 minutes, basic tests are provided at no additional charge, and patients enjoy phone and email access to their physicians. Some practices may offer more services, such as house calls, free EKGs and medications at wholesale prices. Practices can elect to continue to accept Medicare and Medicaid or opt out of all types of insurance reimbursements, giving them more freedom to practice without following the mandates that come with insurance paper work.
One of the arguments critiquing concierge medicine suggests that it conflicts with social justice by creating greater disparities in our system. This criticism is countered by advocates who claim that concierge physicians have not only more time for their patients, but also for volunteering.
MDVIP, a collective direct primary care group with practices in 43 states and the District of Columbia, opened a clinic for more than 600 Medicaid patients who receive the same services as those who pay a retainer fee for concierge medicine. MDVIP also allows concierge physicians to offer scholarships and fee waivers to the approximately 10 percent of their patients who cannot afford concierge care.
In addition, another concierge service, Qliance Medical Management, offers a monthly retainer fee as low as $44. Qliance is targeting the working poor, the uninsured and small business owners looking for affordable and quality health care.
When critics label such practices as elitist, one needs only to look at the numbers. Some practices work out to roughly $4 to $5 a day—about the same amount people spend on cigarettes or a coffee at Starbucks. If health care is a priority, then concierge medicine can become mainstream and affordable, not unjust.
The concierge model is showing early signs of success. Data from MDVIP show decreases in preventable hospital use, resulting in $119.4 million in savings in 2010 alone. Almost all of those savings ($109.2 million) came from Medicare patients. According to the American Journal of Managed Care, these patients experienced 56 percent fewer non-elective admissions, 49 percent fewer avoidable admissions, and 63 percent fewer non-avoidable admissions than patients of traditional practices. Additionally, members “were readmitted 97 percent, 95 percent, and 91 percent less frequently for acute myocardial infarction, congestive heart failure, and pneumonia, respectively.”
A large-scale study funded by the Robert Wood Johnson Foundation found that 55 percent of patients died in hospitals even though they had expressed their preferences to die at home. For most patients who died in the hospital, care was rarely aligned with their reported preferences, even though extensive efforts were made by trained nurses to align their care with their wishes. These findings underscore the importance of innovative approaches such as concierge medicine that demonstrate dramatic decreases in hospitalizations.
The concierge model gives physicians a chance to be physicians again and patients the chance to be patients. The system can emerge healthier as satisfaction is achieved, both mentally and financially. As Josh Umbehr, co-founder of AtlasMD, states, “there is an idea that it is wrong to go down to 600 patients, but it’s wrong to have 3,000 patients. Cost and quality suffer.” Social justice does not demand the unsustainable. It demands solutions, one step at a time.