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ADVANCE Perspective: Respiratory Views

Some Doctors Opt for Treating Fewer Patients

Published June 28, 2010 9:41 AM by Vern Enge

As a therapist, you find yourself on both sides of a health care coin. Heads, you're a health care provider. Tails, a health care user. And just as your day-to-day job descriptions have changed over the past years, so too might your options in tomorrow's user department.

Doctors especially are trying to make sense of the current health care imbroglio, sometimes changing their practices dramatically in an attempt to create a more stable fiscal environment conducive to personal satisfaction.

Among the growing business models is a trend to set up concierge or boutique medical practices. These are being adopted in response to declining third-party insurance payments, worsening Medicare and Medicaid regulations and reimbursement, and growing hassles in the workplace.

Pros and cons exist in creating such practices, according to Virginia physician and author Jose DeJesus, MD. On the plus side for users are fewer patients competing for care from one individual, fewer hassles with insurance companies, and more personalized face-to-face contact with a doctor.

On the negative side: users pay out-of-pocket fees ranging from $1,000 to $20,000 per year for the advantages of special care.

Advantages can be many including: house calls, preventive care, spa-like amenities, fast access to doctors, and special programs for weight loss, nutrition, and wellness. Boutique physicians limit their patient load to about 600 versus 2,500 in a traditional family practice.

Physicians like Ned Stolzberg of Arizona enjoy the pace of concierge care. He cut his patient load from 30 patients per day to about a dozen.

"Now I can spend a lot more time working on the complicated cases," he told Tony Mecia of the Weekly Standard. "It makes me feel like I'm being a real doctor now, like here's what I was trained to do, and now I can do it." As a plus, he feels free to coordinate the care of a cancer patient with a specialist or spend 45 minutes talking to a diabetic about nutrition and exercise.

Other doctors have opted for a straight fee-for-service model. They don't accept insurance and charge patients a set fee which is paid at the time of service. Prices are listed almost like a restaurant menu: office visit, $49; cancer screen, $30; splint, $41. Like concierge practices, physicians in these services limit the number of patients they will see in a day.

In a nation already experiencing doctor shortages and a sizeable number of veteran physicians reaching retirement age, if general practitioners in large numbers adopt concierge/boutique practices, doctor shortages will become more acute.

To date, the number of concierge practices is relatively small, but they are growing in number. One conglomerate now serves 125,000 patients in 29 states through a network of 365 doctors.

The prospect for potential service changes in your own doctor's office can easily be seen in the types of surveys being distributed today. Numerous patients have been asked to fill out questionnaires assessing perks like house calls, longer face-to-face appointments, 24/7 availability of care, and additions of special health care programs. Surveys themselves are not an indication changes are definitely ahead, but they do provide a signal some thought is being given to changes.

Hospital staff cannot help but be impacted if there are major shifts in the physician provider side. First, it is likely to force more people to ERs for primary care if they have access to only a limited number of physicians. Second, a reduced number of doctors  may cut the number of referrals to hospitals or medical specialists.

Any way you choose to look at it, it's a coin toss for changes in future medical care on both the user and provider side. Let's hope it doesn't turn into a heads I win, tails you lose situation.


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