The Current Mess
If you practice medicine in the US, you are probably worried. We are stuck on the tracks, and Healthcare Reform train – by that name or any other name – is bearing down on us. Like right now!
Both physicians and patients alike are dissatisfied with the current medical care system. The care itself isn’t so bad, it’s mostly the business part of it.
The business part of medicine is ruining it for most of us. For both patients and physicians. There was a time when medicine was a joy and privilege to practice, as a profession. Then it became corporate. That has ruined it for most of us.
Reimbursements for both primary care and specialty services are rapidly declining. We have reached a tipping point where practices are not economically viable unless they increase the number of patients seen per unit time. Shorter visits means little or no time for complex medical problems, counseling about preventive strategies, or careful, personalized examination, diagnosis, and treatment planning.
We’re Getting Older, Our Healthcare Needs are More Complex
In the context of our aging population, these financial pressures are completely at odds with the increasing complexity of our healthcare needs.
Just at a time when we need more primary care physicians to care for us as we are aging, fewer medical school graduates are choosing primary care as their practice: the number of physicians selecting either internal medicine or family medicine careers dropped 27% between 2002 and 2007 alone! And the projected growth of the U.S. population aged 65+ through 2025 will be 4-5 times the growth in number of total physicians (not just primary care docs) during this same period!!
So, as a physician, what are your options?
Many physician practices are being “bought up” by their local hospitals. Consolidation – by acquiring practices, and by merging or acquiring hospitals – is rampant in medicine.
Being employed is often perceived by physicians as a secure paycheck. Maybe. Maybe not. As hospitals are being squeezed, and their reimbursement is ratcheted down, how “secure” do you think those paychecks will be?
And, along with those “secure” paychecks comes constant pressure to perform. To see more patients; to not refer patients to providers who you think might provide indicated medical care, but to providers who are “within the system;” to cover more ER call time or other call, etc.
So, what can you do if you just aren’t a “corporate medicine” type of doc? Perhaps you are dedicated to spending the necessary time with every patient. Perhaps the doc-in-a-box, churn-‘em system is not for you? What are your options if you want to maintain your independence?
There are some options. Let’s review one sort of “cash practice” that is called “concierge medicine.”
Here’s the Concierge Medicine model:
- Patients pay a monthly or annual “retainer fee” in exchange for focused, individualized medical care
- Patients pay a small, cash co-pay for every visit – usually something like $10
- Patients are responsible (in most concierge programs) for paying for lab tests or procedures
- + for patients: they can visit as often as they like
- + for patients: they don’t feel rushed for time with the doc
- + for patients: they usually have a direct phone number and email for their docs
- + for patients: the program can even include house-calls
Now let’s review the positives for the physicians:
- Need to see fewer patients per unit time. Typically, a concierge doc will see 8-12 patients per day instead of 30+
- Ability to opt-OUT of insurance programs if you like
- Increased revenue. The average primary care physician in the U.S. is reimbursed $160,000 / year; Those who practice concierge medicine make more than that. Some make multiples of that, depending on their concierge subscription model and the demographic of their patient community.
- If you opt-out of taking insurance, you relieve yourself of the hassle of all the personnel required for billing and coding (and pre-authorization, and re-submission of rejected claims).
In sum, physicians who practice concierge medicine report reduced stress, reduced overhead, more time with their patients, and greater satisfaction with the profession of medicine.
Critics of concierge medicine suggest that this model will result in providing care only to the wealthy.
Let’s take a look at the financial reality.
Whereas there are a few elite concierge “subscriptions” of $25,000 per year, there are also concierge medicine subscriptions that cost the patient no more than their monthly cell phone or cable-tv bill. Do you think that your health is worth the cost of a daily Starbuck’s mocha? Do your patients? Take a look at this article, Concierge Medicine Myths and Realities for some perspective.
What about the un-insured? The fact is, a patient without insurance will be billed full charges for any care at most practices or hospitals. That is, they won’t even be billed at the reduced, contract levels that are provided to insurance plans: they will be charged more! And if they are unable to pay, the hospitals turn them over to collection agencies, as standard practice.
Under concierge medicine plans, un-insured patients pay the same as everyone else. For arguments for and against concierge model, take a look at these articles in Medical Economics, “How to Run a Cash-Only Practice and Thrive,” and Bloomberg Businessweek, “Is Concierge Medicine the Future of Health Care?”
To get a sense of charges from one of the successful concierge medical programs, take a look at Atlas MD fees. Also have a look at the SimpleCare model for concierge medicine. There are others. [For transparency: we have no financial or other relationship with either Atlas MD or SimpleCare].
If You DO move to the Concierge Medicine Practice Model
If you do consider this model for your medial practice, consider that your brand will matter more than ever. That is, if you are not employed by a healthcare system, with their built-in Patient-Centered Medical Home or other referral program, your brand will determine whether you get patients.
And how do patients find physicians these days? In this digital world?
Well, Google tells us that patients find us through search. Google tells us that your brand – your reputation – matters more in a patient’s choice than any other consideration. More even than whether their insurance program is accepted! (And Google might know a thing or two about search).
We would suggest (very modestly, of course) that your brand in the digital world is profoundly important to your practice of medicine, regardless of your financial practice model. Take a look at some of the free resources here at Anicca Media to learn how you can improve your brand in this digital world.
Have you considered a concierge practice model for your practice? Do you already use this model for all or some of your practice? Do you think this is the solution for our current healthcare mess, or just another wrong turn? Let us know in comments.
Free Anicca Media Resources
To learn about the huge return-on-investment (ROI) from a healthcare social media program, take a look at this FREE instructional video series, The Benefits of Leveraging Social Media in Healthcare.
To learn about how you can get the maximum kick for the minimal investment in your Healthcare Social Media Content Program, download our FREE ebook, Social Media First Aid.
For help deciding which social media “platforms” to participate in, see our recent free Infographic, Healthcare Social Media: Choose the Best Tools for the Job.