Concierge Medicine: Patient-Centered, Personalized Care
By Dr. James Palermo // December 10, 2013
PHYSICIANS WORK DIRECTLY WITH AND ONLY FOR PATIENTS
One of the basic premises of the Affordable Care Act (ACA, aka Obamacare) is to focus on more individualized health care that best meets the needs of our population.
One of the critical elements of this concept is the patient-centered medical home, a team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The theory is that medical homes allow better access to health care, increase satisfaction with care, and improved health.
Unfortunately, Obamacare is fundamentally a health insurance reform law and, although there are some incentives for provider practice restructuring, attempting to make insurance available to uninsured Americans does not ensure a better patient-provider relationship, increased patient satisfaction or improved health outcomes.
In fact, it is widely predicted that with implementation of the ACA there will be an acute demand for more primary care services and associated resources to meet the healthcare needs of the millions of new insured Americans.
Physicians will be faced with seeing more patients in practices where their time with and for their existing patients is already limited by increasing administrative and regulatory demands.
PHYSICIAN-PATIENT RELATIONSHIP UNDER ATTACK
It is my opinion that the bane of our medical culture over the past fifteen years has been the depersonalization of the physician-patient relationship. Try calling to make an appointment with your doctor for an office visit or ask a question about your care or condition.
One of the first things the recorded message will say is: “If this is a medical emergency, you should hang up and dial 911.” This may be followed by recorded information related to what seasonal vaccine is now available and/or the opening of the new orthopedic clinic in the medical group. Once past the unassisted, unilateral decision option to call 911 and the marketing announcements, entry into the phone tree offers up to 9 selections, which depend on the reason for the call, and chances are the caller will be asked to leave a message on voicemail for the doctor’s nurse or assistant to respond to later.
A layperson may not have the same perspective on a medical ”emergency” as a medical professional or a member of that professional’s staff. One has to wonder how many 911 calls have been made that could have easily been avoided by a warm body and concerned voice on the other end of those calls.
DR. PINSKY PROVIDES PATIENT-CENTERED, PERSONALIZED CARE
All of the above having been said, I do understand the challenges that medical offices face in providing clear, concise, and current patient information, and how second and third person processes that often end up in voice mail can save time for providers and their staffs in their volume overloaded circumstances. However, I am strictly “old school” when it comes to the absolute necessity for a patient-centered and personalized approach to patient communication and care.
A study published in the December 2012 American Journal of Managed Care, showed that a direct primary care model, also called concierge medicine, cut hospitalizations in that patient population by 79%, readmissions after hospitalization by 94%, and specialty care needs by 50%. These findings reinforce the decision of many primary care physicians, one of which is local primary care physician Dr. Mark Pinsky (featured in Space Coast Medicine and Active Living magazine and SpaceCoastDaily.com), who have transitioned to a practice model in which physicians are “working directly with and only for patients” and avoiding any conflict of interest that might prevent what is best for each individual patient.
Dr. Pinsky has embarked on a new model of practice, the foundation of which is customized, pro-active, readily accessible and affordable care. He is part of a new and growing generation of concierge doctors who, in this era of health reform, see more opportunity in a smaller practice, allowing more time with each patient, a more comprehensive focus on prevention and wellness, higher levels of satisfaction for both patient and physician, and no phone trees. This model of care closely resembles the patient-centered medical home, but is not dependent on a third party “middle-man” payer, and not encumbered by imperious governmental bureaucracy.
The excerpted article below from MedpageToday.com talks about the burgeoning interest among both physicians and patients across the country in the direct primary care model, and how this new model empowers the physician-patient relationship.
Concierge Medicine Gains Ground
By David Pittman, Washington Correspondent, MedPage Today
SAN DIEGO — Concierge doctors are spreading the word that it’s possible to operate a direct primary care practice, make a living, and avoid one of the biggest headaches for family medicine physicians — dealing with health insurance companies.
Multiple sessions at the American Academy of Family Physicians (AAFP) scientific assembly informed attendees about the growing world of direct primary care, sometimes called concierge, boutique, or retainer-based medicine. These practices charge patients a monthly or annual membership fee for unlimited office access, and bill patients for the tests and supplies they use.
When Doug Nunamaker, MD, and Josh Umbehr, MD, ended their 45-minute AAFP talk about their direct primary practice in Wichita, Kan., the two had barely walked off stage when they were besieged by a couple dozen doctors wanting more information.
Nunamaker and Umbehr opened Atlas MD, a direct primary care practice, in 2009 shortly after Umbehr left residency. They charge $50 a month in membership fees for adults ages 20 to 44, with fees ranging from $10 to $100 a month for pediatric and older patients.
They describe their payment structure on the Atlas MD website as a “direct fee-for-services arrangement [that] frees us from the typical contractual agreements that prevent physicians from offering wholesale prices on laboratory tests, imaging, and medications.”
The practice quickly grew to about 600 patients in the first couple of years, with a monthly revenue of $30,000 in membership fees. The only marketing has been word of mouth.
They said patients loved the open access to their physicians. Patients are encouraged to email, call, or text their doctors with questions. The office has no office staff, and the physicians answer the phones, which they said “freaks out” patients at times.
Nunamaker and Umbehr said they loved not having to deal with insurance payers for such issues as prior authorizations or rejected claims.
CLICK HERE to read the complete story on MedPageToday.com.