Friday, March 28, 2014

March 27, 2014

Six New Relationships Essential to Primary Care’s Continuing Existence

All essential knowledge relates to existence, or only such knowledge as has an essential relationship to existence is essential knowledge.

Soren Kierkegaard (1813-1855),  Concluding Unscientific Postscript (1846)

Independent primary care physicians feel like an endangered species.Their numbers are shrinking, they are unhappy,  they are advising their children not to enter medicine,   many are retiring, medical students are choosing specialties rather than primary care,  nurse practitioners are practicing medicine,  they are being replaced by teams of caregivers,  hospitals are gobbling up their practices. 

Primary care doctors are creating new ways to survive, even thrive with six  new sets of relationships with other stakeholders in the new health care reform environment.  These relationships are not always perfect.   They are sometimes messy.  They are complex.   But they are evolving rapidly because everybody knows primary care is an essential gateway to other realms of medicine.

Six New Relationships

One, with patients.   There is a return to more personal relationships with patients. “Patient engagement” has become the mantra. This engagement is most visible in concierge practices, in which doctors  spend more time with patients,  schedule a visit on  day ta patient calls, and aeconstantly available by cell phone.  Prices for services are transparent and known in advance.

Two, with third parties.  “No” relationship would be more accurate than “new” relationships.  Primary care physicians are touting “direct care.” No insurance is needed to see physicians.  You pay for their services directly when you need those services,  or you pay a monthly or annual retainer to be seen when needed.  Retainer costs average $80 to $100 a month for patients.

Three, with employers.   Primary physicians or their business agents  are approaching employers to lower employer costs. There are several ways to do this: set up primary clinics within large businesses,  encourage expansion of health savings accounts,   offer primary retainer contracts for all primary care services, encourage shopping for primary care services acrpss a primary care network.

Four, with specialists and other providers.  Some concierge physicians contracting directing with labs, physical therapists, imaging centers, and specialists for discounted direct cash arrangements.    It’s a win-win-win for patients who receive deep discounts,  primary care doctors who facilitate convenient access to specialists for their patients,  and for specialists,  some of whom welcome cash only discounts at an alternative and supplement to 3rd party payments..

Five,  with health plans.   Because of increased costs associated with ObamaCare,  health plans are always looking for ways decrease their costs.  Primary care services account for 10% to 20% of these costs, and if primary care physicians can persuade health plans to “unbundle” primary care costs, i.e., remove these costs from their insurance offerings, it is an effective way for plans to lower premiums while maintaining profit.

Six, with social services.   Connecting patients with community  services --social workers,  employment and housing and transportation services, and visiting nurses,  has always been a problem for physicians.    But now through an organization called Health Leads,  which maintains help desks,  in many clinics, hospitals, and other practice settings,  doctors can “prescribe” access to these services, through volunteers, usually students interested in health care careers, who will connect patients to these services.

Tweet:   Primary care physicians are pursuing new ways to make their services less costly to patients, less dependent on 3rd parties,  and more essential to employers and health plans.

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