The Swinging Pendulum of the Primary Care Practice

Nat Findlay - Hello Health's CEO

Hello Health’s CEO, Nathanial Findlay, talks with Gibson Consultants about the Primary Care Practice.

We’ve all read the reports – and, good grief, there are certainly enough of them. If you believe the headlines, primary care physicians are abandoning ship at a reckless rate, knocking each other out of the way to line up at the hospital employment office. Just last month, the New York Times itself groaned “Where have all the primary care doctors gone?

"In the United States, we are now short approximately 9,000 primary care doctors. These are the general internists, family doctors, geriatricians and general pediatricians, the doctors responsible for diagnosing new illnesses, managing chronic ones, advocating preventive care and protecting wellness."

It’s a sobering reality. This is a frustrating time for physicians, and that must be acknowledged. Mounting regulatory pressures and increases in the cost of doing business are influencing trigger-pulling decisions, and docs feel pushed to shutter the practices they’ve worked so hard to build. According to a new report from Accenture:

"Increasingly, private practice doctors have sacrificed their independence to seek employment as independent physicians have dropped from 57 percent in 2000 to 39 percent in 2012. By the end of 2013 [it is estimated that] the market will comprise of only 36 percent of independent physicians."

Sounds bad. But, is it really cause for panic? I don’t think so. Why? For one thing: there are plenty of physicians out there ready to embrace the necessary changes to not only stay in business, but increase their profitability while retaining the autonomy they sought in private practice at the start of their careers. Also? Being an employed physician is no panacea for the doctor or, as it turns out, the employer. A recent survey by Accenture shows that 47 percent of employed physicians are likely to seek or regain independence over the next 12-18 months. And, every month, more and more independent physicians are looking at new business models to maintain their independence. Look at the rest of that report from Accenture:

"As the physician employment trend continues to accelerate, those who remain independent are beginning to test alternative business models. Of those who remain in independent practice, Accenture estimates one in three independent physicians will aim for higher yields by adopting subscription-based care models, and this trend will increase 100 percent annually for three years."

Doctors who convert to subscription-based models that shift the focus away from service volume will not only access greater financial rewards, but will also gain the flexibility to get back to the basics of patient care. Patients could also reap the rewards by gaining enhanced access to care at a service level they can afford.

Did you catch that last part? It’s significant — patients want to receive the care to which they’ve become accustomed, and at an affordable rate. The doctors with whom they’ve had relationships for dozens of years are suddenly moving to large complexes, billing them differently and treating them like cogs in a wheel. And while we can’t escape the continual reminders that “the days of Marcus Welby, MD are over,” many patients don’t like what is being touted as an “inevitable” change in how things work. A recent series in Cleveland’s The Plain Dealer examined patient reactions to receiving hospital bills for what they thought were the standard office exams they had been used to receiving from their GP.

These days, more and more doctor’s visits are at one of a growing number of off-campus health centers, which bill patients for outpatient hospital visits, a designation that brings higher payments from Medicare and private insurers for the same services performed in a doctors’ office visit. These visits can be expensive for younger people with high-deductible private insurance plans because there are usually two separate charges — one for the doctor often charged at a higher hospital rate and another for the space used to treat a patient, known as a facility fee. This dual bill for a single treatment can result in charges that are two, three, or four times more costly for patients — all for basically the same care.

“How about publishing a list of solo practitioners, so we can avoid these excessive charges?” one reader asked in the article’s comments. We cannot discount how frustrated patients will drive the market to return to the days of the “trusted family physician.” And when that happens, those physicians will be ready.

Pairing the right technology with the right business model for their practices will be the key to success. Is Dr. Welby really ancient history? Maybe not. Physician services technology is catching up to the needs of private practice to the point that doctors can now find new revenue in places they’ve never earned before. On top of the myriad options now emerging for subscription-based models – concierge services, direct-pay models, mixed-models, etc. — physicians will be able to make money on the dozens of time-consuming tasks that have traditionally eaten away at their profits. Things like records requests, specialist referrals, and enhanced patient communications – the latest EHR and practice management technology makes the billing and processing for these tasks automatic.

So, while everyone else is looking ahead to this new era of hospital-based care … maybe we should be looking through it. Instead of panicking about the physician exodus to hospital HR rosters, we should be shoring up the ones who remain independent, and preparing the way for the ones who will likely return.

About the Author

Hello Health helps practices be more efficient and increase patient engagement through a comprehensive and affordable EHR, Practice Management system and Patient Portal.

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