Last night we went to a dinner party, and during a discussion of my travels, I mentioned HR #2350. We had an interesting discussion of the decreasing numbers of primary care physicians. One couple mentioned that they were seeing a friend of mine who is in a 2 man retainer practice. I have previously interviewed that physician.
This couple raved about their relationship with their physician. They love the email access and phone access. They love that this physician spends as much time as necessary with them. They love being able to get an appointment on the day they desire.
This physician provides the ultimate medical home. They feel that the fee has given them great value.
All patients deserve this type of relationship with their physician. We need research to understand the proper number of patients for a medical home. We need to understand the true value of this higher level of physician patient relationship. How much “downstream” revenue would such a model save?
Patients know the value of physician access. We just do not know the “price point.” We need a payment system that will allow and even encourage our best and brightest to care for the total patient.
HR #2350 starts this process. I would hope we would do more, but it is a very good start.
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Most doctors see patients with chronic illnesses, such as T2DM, HTN, Chol, 4 times a year on average with a visit cost for stable patients around $55-$70 to equal $220 to $280 a year for insured and Medicare patients. This is almost a mini retainer model.
Under most of my PPO and HMO contracts require the following: no charge for called in refills, mail order 90 day faxing, preauthorization of meds, 24 hour access to a physician by phone, same day and next day appointments for acute care. Most of these are written in the small print in each contract. In addition, I provide email access to my patients and see my patients on holidays in the hospital without any additional payment. Thankfully most of my patients do not abuse their rights through their insurance plans and do not call me in the middle of the night for refills or trivial illnesses.
Currently most physicians are providing many hours weekly of uncompensated care, despite the AMA having CPT codes for paperwork, e mail, phone calls, after hours care, and holiday care. A simple starter solution would be to require insurance companies to pay for this care. This currently unpaid work still caries liability.
The downside of the retainer model is that only the well off patients can afford a $1,000 to $5,000 a year to retain a physician. Most insured patients expect the same care as retainer medicine for a $25 copay or for free, which is one reason it is difficult to attract physicians to primary care.
Anyone know of concierge or retainer physicians in Washington, DC? MDVIP has only two who are accepting patients.
Concierge or retainer physicians have the advantage of only needing around 800 to 1,200 patients to maintain a practice. Most private doctors need between 4000 – 6000 patients per primary care physician to stay in business. I have not seen any concierge or retainer physicians in smaller towns. Most of them seem to be in suburbs and cater to a well off population.
Note to solo dr: The co-pay that you mention is just that. Something paid on top of what the insurance company pays (which is actually paid by the patient in premiums or reduced income). I understand that retainer medicine is more lucrative but it gets increasingly disappointing to realize that so many go into medicine for the money!
Note to JPB, the range in my area for 15 minute visit fees allowed by insurance companies is $39.95-$70, with an average of $55, including the average $25 copay. A check for $30 comes from the HMO/PPO and $25 is paid by the patient.
Most insurance premiums cost thousands of dollars per person. It is not unheard of for a family of four to pay with 80% of the premium from the employer, a health insurance premium of $5,000-$9,000 annually. The $200-$300 a year total, including the 4 copays per four visits is a very small amount of the premium. I realized that primary care physicians get the short end of the payment, when I had to preauthorize Advair for UHC for a 90 day mail order company. The copay was $121 for each 90 day supply. The real people doing retainer medicine are the insurance companies.
JPB, no creature can survive without profit. If the trout doesn’t get more calories from the fly than he spends catching it, he dies. Profit in Medicine is not wrong, and not the problem. And the profit, for a physician, must be considered in light of the whole investment he makes to become one, not just his operating costs and bottom line. As Eric Sloane said, when a customer objected to the $50 charge for painting a portrait in 30 minutes, “It took me 20 years to do your portrait in 30 minutes.” We deserve to be paid handsomely.