Retail pressure forcing doctors to reconsider care model
When we at Bankless Times address the topic of gargantuan organizations watering down the quality of customer service, we usually mean the big banks, but it is of course happening in other sectors too.
One of those is health care. Since the 1980s, medicine has moved toward a retail model which forces doctors to see as many patients as possible throughout the day. In-depth consultations are a rarity, and house calls have been virtually eliminated.
Pressure from insurance companies and government is the reason. As they expect more for less, doctors are forced to make tough choices about how they administer care on a daily basis, Wayne Lipton says.
In concierge medicine, patients pay an annual fee, which guarantees an enhanced care level from a physician. That fee may serve as a retainer from which withdrawals are made with each visit, or it may cover all procedures normally completed under different levels of care. In some models fees are charged for each procedure but those fees are often a fraction of rates charged to insurance plans.
Roughly 5,000 of the more than one million medical practices in the United States employ a concierge model, Mr. Lipton said.
The additional revenue stream allows the doctor to see fewer patients for a portion of the week. Fewer patients means more time spent with each one.
Concierge Choice Physicians offers a number of different programs reflective of the wide variety of average patient incomes, practice types and sizes doctors work within. They study the practice, develop a pricing structure and marketing plan while also helping the practice transition to the new model.
I am writing from Canada, where any suggestion of two-tiered medicine (even though if you pay attention it happens all the time) is treated as an attack on a sacred institution.
This is not that, Mr. Lipton said, and for many reasons.
Every practice Mr. Lipton works with devotes a portion of their week, often a half-day to one whole day, to their concierge members. For the large majority of the week it is business as usual.
“A full model concierge practice would disenfranchise people,” Mr. Lipton said. A hybrid model benefits both concierge members and the rest of a practice’s patients, he added.
The guaranteed revenue from the concierge memberships lessens the anxiety of uncertain revenues and allows the entire care team to focus more on patients. More time and less stress produce a better consumer experience, one which naturally spreads to the remainder of the week Mr. Lipton explained.
“It’s hard to turn that (renewed focus) on and off.”
Market forces also help the rest of a practice’s patients, Mr. Lipton suggests.
People paying money, especially for enhanced service, expect that service to be the highest quality. Over time that money will flow to the top practitioners, who will then be able to provide better care to the rest of their practice.
There is also a better chance all patients in concierge practices will get to see the actual doctor, Mr. Lipton said.
The stressful environment fostered by the large retail models means more and more patient care is being delegated to nurse practitioners and other practice members. While some aspects of care can be properly administered by other professionals, patients, especially those old enough to remember when better care was the norm, gain comfort from seeing the doctor.
While concierge practices attract people of all ages, older people have their own unique reasons for choosing the option. They average more trips to doctors and are more likely to move to other practices to follow their favorite doctors.
Utilization rates for many procedures actually drop in concierge environments, Mr. Lipton said.
Concierge models do not work for every medical specialty, Mr. Lipton explained. Children past the toddler stage do not often get sick, so paying to reserve regular care does not make sense. Oncology, ear, nose and throat and orthopedics are others where the model may not work. Non invasive cardiology, hematology, rheumatology, endocrinology and gastroenterology have potential
“If a reasonable percentage of people are likely to visit on an ongoing basis then it is possible,” Mr. Lipton said.