Declining reimbursements, increasing economic pressure and continued uncertainty around health reform are among the factors forcing many physicians to actively seek alternatives to the way they practice medicine. According to a recent survey of 2,000 primary care doctors, one in five is currently considering a major change in practice model. Nearly half of those considering a change are looking at direct-pay models, including a transition to concierge medicine.
Physicians definitely need to find a more sustainable way to practice medicine. The current assembly line of primary care isn’t healthy for doctors or their patients. But while concierge medicine can certainly solve a practice’s economic woes, it’s actually the wrong move for physicians, patients and the system.
Wrong Move for Physicians
A conversion to concierge medicine requires a radical shift in a physician’s practice, including shrinking his or her patient panel by up to 80 percent. Most physicians did not get into medicine to ration care to a privileged few. They most likely went into medicine to help as many people as possible. Additionally, a concierge practice limits a physician’s options for additional revenue. These types of practices typically wrestle with issues such as incompatibility with third-party payment structures and in many cases they are ineligible to participate in insurance networks or patient centered medical home (PCMH) programs.
Wrong Move for Patients
With annual membership fees of $1,500 to $2,000 or more, concierge practices are simply out of reach financially for many patients. Additionally, most concierge models only cover access to the doctor. They don’t provide additional wellness and prevention guidance or support for health issues such as obesity, smoking and chronic conditions such as hypertension and diabetes. That’s a big check to write just for access to a doctor.
Wrong Move for the System
We are experiencing a severe physician shortage in primary care. Previous estimates projected that we could expect a shortage of 39,600 doctors by 2015. Projections have been updated based on healthcare reform law, and now the Association of American Medical Colleges suggests that number is closer to 63,000.
With the rising shortfall of docs, concierge simply isn’t a scalable solution for our healthcare system. We should be actively pursuing solutions that allow top physicians to support a larger patient roster through the use of technology and additional team resources. Not taking high quality providers off the market almost entirely.
The Right Move
The good news is that alternatives exist. There are ways for practices to augment or diversify their revenue streams and drive more profitability while at the same time remaining patient and payer friendly. Offering additional wellness services and support that are attractive to patients and priced affordably creates a scenario where patients can get more for less, and physicians can practice medicine in a more holistic and proactive manner.
These services can include access to an extended wellness team to augment the physician’s expertise in critical areas such as nutrition, fitness and emotional wellbeing, while also supporting patients between office visits (where they spend 99 percent of their lives). Physicians can provide additional coaching and content for specific health conditions such as smoking, obesity, hypertension and diabetes. And they can also adopt and offer new technologies that create more effective, efficient and convenient healthcare, which is something patients would warmly embrace from their medical providers. (Insert link to 24/7).
This approach results in additional revenue for the practice, better overall care for patients and lower overall healthcare costs for the system thanks to individuals who are more active in managing their health. It also allows practices to invest in technology, care coordination expertise and a proactive health management infrastructure, all of which prepare the practice to capitalize on increased PCMH reimbursements from payers.
In the end, we must think bigger, not boutique, if we’re going to create sustainable improvements in primary care.