Can 'concierge medicine' improve primary care?
the Clinical Advisor take:
Too many patients, too few providers, and too much paperwork have fractured primary care in the United States, according to an article published in Medical Economics. Shifting traditional primary-care practices to direct primary care models may solve the ‘primary-care crisis’.
“The crisis means that there are not enough primary-care [providers] today, and it will only get worse because students in medical school see the impact of the crisis and choose not to enter primary care as a result,” explained author Stephen C. Schimpff, MD, former CEO of the University of Maryland Medical Center.
While insurers held reimbursement rates low, practice costs kept rising, and to keep the lights on, offices took on more patients per day. Schimpff estimates, with a practitioner that sees 25 patients per day, direct contact with the patient is around 8-12 minutes. “This is long enough for a simple problem but much too short for someone with a complex issue, or someone with multiple chronic diseases and taking multiple prescription medications,” explained the author.
Direct primary care (DPC) is used in many forms and is sometimes called membership, retainer, or concierge medicine. “But in essence it means charging a flat rate by the month or year for all primary-care services,” wrote Schimpff.
Despite being classified as health care for the wealthy, DPC can be affordable for working families. “When DPC is combined with a much less expensive high deductible health insurance policy, the savings for patients are substantial and the total costs of all care decline quite dramatically.”
Movement from traditional practice to direct primary care has been slow and steady, according to Schimpff. To speed up the transition, the public needs to advocate for better primary care and demand political leaders, health-care providers, and insurers develop policies that support the growth of direct primary care.
“When the PCP has more time, care gets better, frustrations come down, satisfaction goes up and total costs come way down and, as an added bonus, many more students will select to become primary care [providers] thus resolving the PCP shortage,” concluded Schimpff.
Direct primary care, or concierge care, increases time spent with individual patients and frees health-care providers from increasing practice costs.
There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you.
The crisis means that Americans do not get the level or quality of healthcare that they deserve and need. This crisis is the major reason that healt care in total is so expensive and why costs keep rising. This crisis needs to be fixed and fixed as quickly as possible. The solution is not too difficult.
What is this crisis? The fundamental problem is a flawed and non-sustainable business model that forces primary care doctors (PCPs) to care for too many patients and as a result not have the time they need to provide high level care. They need time to listen, time to think, time to give quality preventive care and time to coordinate care for those with complex chronic illnesses.
In other words, they need time to practice at the top of their profession, something they currently are unable to do fully.