Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
====
"I hear and I forget. I see and I remember. I do and I understand." - Confucius
====
"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
====
" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
====
"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
====
"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
====
"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
====
"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
====
"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
====
"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
====
"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
====
"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
====
"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
====
"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
====
"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
====
"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
====
"There are no facts, only interpretations." - Nietzsche
====
"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
====
"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
I disagree with @DrVal – retainer medicine is the answer
17 Dec2009
Dr Val wrote this post this week – Why Concierge Medicine Is Not The Solution To Primary Care Woes
I think the concierge model doesn’t accomplish what we need in health reform – expanding the primary care base. It actually just decreases the common person’s access to physicians.
My practice uses a “pay-as-you-go” model with time-based billing. That means that I charge for my time only – I can do house calls, office visits, small procedures, webcam visits, email, phone calls, texting… Whatever is both appropriate and convenient for the patient.
The big question that we must pose is how do we make the job desirable. Why would someone refocus their career to primary care?
Now skeptics will say that we must produce more primary care physicians. Production will not work. We are losing primary care physicians to other generalist options. Thousands of former primary care physicians are now hospitalists. Hospital medicine has become a desirable, enjoyable option for many internists and a growing number of family physicians.
Cash only practices are a reasonable option, but I believe that a well run retainer system would bring physicians back to primary care.
What is wrong with primary care?
- Lower pay
- More paper work
- Unreasonable documentation expectations
- Unnecessarily complex billing structures
- Not enough time to spend with each patient
Primary care should attract students and residents. In primary care physicians develop long term relationships with patients. These relationships are very rewarding.
Retainer medicine can fix all the problems. While we may not yet have the best definition of retainer medicine, the Qliance model is a worthy staring point. Direct primary care – an interview
Direct primary care improves primary care physician pay. It greatly decreases paper work because it avoids billing based on documentation. It encourages spending more time with each patient and communicating through email and telephone.
The Qliance model has costs in the $60-$70 per month range. Many readers gladly pay that much for internet access, and more than that for gas.
While we might not yet know the optimal retainer model, I believe that such practices empower physicians to practice medicine in a better way – focusing on the patient rather than the billing.
Cash only practices have their advantages, but I believe that the retainer model may be superior.
Related posts:
- In which I continue my debate with Dr Val
- Retainer medicine – from 7 years ago
- Shortened visits – more on the suits
- Direct primary care – an interview
- Are retainer practices the model for PCMH?
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
5 Responses to I disagree with @DrVal – retainer medicine is the answer
Dr. Val
December 17th, 2009 at 10:03 am
The problem with retainer medicine is that it incentivizes smaller patient loads. I understand that this is desirable for doctors, it's not good for the healthcare system as a whole. My point is that direct-pay IS a great option for many people, but I question whether the exclusivity of VIP concierge practices is good for the common person. My model rewards volume while decreasing admin paperwork and decreasing costs. This can be scaled, while concierge practices cannot.
Jenny
December 17th, 2009 at 4:06 pm
According to Concierge Medicine Today recent 'recession' poll, when we asked currently practicing 'concierge physicians'…'Financially, how is your practice doing compared to one year ago?'
100% of physicians surveyed said Better or No Change
75% responded saying their concierge medicine practice was actually doing better than this time last year
less than 25% indicated 'no change'
Rocky Balboa, Jr, MD
December 17th, 2009 at 8:44 pm
How do you differentiate "cash only" from "retainer"?
In my opinion both are cash only.
HelloHealth allows an individual to customize the payment model.
Could charge $35/month plus $200/hr. Or $20/month plus $250/hr. Or waive monthly fee plus $300/hour. Or whatever floats one's boat.
Prices will always be transparent.
The payment model will adjust to the local market.
#1 Dinosaur
December 19th, 2009 at 8:46 am
What Val said.
Retainer medicine is better for doctors, but limits access to patients with more limited financial means. "Many patients" may be willing to pay $60-70 monthly (which adds up if you have a couple of kids and are paying that per person) but it still quickly exceeds the reach of others. Where are they supposed to go?
If you're talking about "job desirability", I propose more than lip service to fixing the culture of medicine where primary care is considered intellectually second-rate. Improve compensation, yes; reduce the day to day regulatory and paperwork hassles, sure; but you'd be surprised how much financial altruism there is out there that withers in the face of intense scorn from med school on.
solo dr
December 19th, 2009 at 5:43 pm
It is difficult to say what will fix the system. Currently doctors who take insurance and Medicare are expected to do for free drug prior authorizations, MRI/CT prior authorizations, and phone calls during regular and after hours. We get the same pay for working holidays/weekends and are told by the insurance companies to have extended hours on weekdays for the same $55 average office visit.
No other profession would exist under the current conditions with HMOs and the Government whittling away any independence of physicians. Dentists, Accountants, and other professionals charge for their paperwork and phone calls. We are told we cannot charge the CPT codes by the insurance companies and Medicare, yet we are liable for the care.
The current system is about to break. For 2010 premiums, copays, and deductibles are increasing, meaning patients will be paying more for the same or less care. Once copays hit $40-$50, it might make sense to drop insurance completely and let the patient pay for each office visit/phone call etc. Let the patient spend 15 minutes on the phone prior authorizing an MRI or telling the Medco/Caremark company why they need Wellbutrin for depression and not simply for smoking cessation.