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March 27, 2014
Six New Relationships Essential to Primary Care’s Continuing
All essential knowledge relates to existence,
or only such knowledge as has an essential relationship to existence is
Soren Kierkegaard (1813-1855), Concluding
Unscientific Postscript (1846)
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
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
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.
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.
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
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