IN A YEAR WHEN ECONOMIC CONDITIONS made doctors feel they had less control over the way they practiced, and many different plans for healthcare reform were proposed, the consensus in the community care sector is clear: reform is necessary, and soon.
“Similar to what’s on patients’ minds, doctors are wondering how reform will affect them if it goes forward,” said Roland A. Goertz, the new head of the American Academy of Family Physicians. “There is a whole host of financial problems for physicians.”
Doctors want healthcare reform legislation to address the “hassle factor,” said Goertz, a family physician in Waco, Texas. Many physicians spend four or more hours per week dealing with insurance and paper-pushing, he said, and they’d like to spend that time with patients instead.
Some observers suggested early in 2009 that primary care physicians could lead the reform revolution by helping achieve a guaranteed 1.5 percent annual savings in healthcare costs. Such cost savings, it was claimed, would help provide insurance coverage for all Americans.
According to the New England Journal of Medicine, slowing the growth of healthcare costs by 1.5 percentage points annually would allow spending – including total provider income – to rise from $2.6 trillion in 2010 to $4.3 trillion in 2020, while saving the U.S. healthcare system $3.1 trillion of the estimated $40 trillion the nation is projected to spend in that 11-year period.
“A high performing U.S. health system is what physicians and patients need and deserve for the future health and economic security of our nation,” said Karen Davis, president of The Commonwealth Fund.
The patient-centered medical home, or PCMH, model remains popular in many quarters as a way to reform the healthcare delivery system. In a PCMH model of care, primary care physicians partner with patients to understand their needs, manage their healthcare and facilitate care from other professionals. It emphasizes preventing disease, improving care of chronic conditions and behavioral health support education.
According to the “Report on Financing the New Model of Family Medicine,” authored by Stephen J. Spann, MD, of the Department of Family and Community Medicine at the Baylor College of Medicine, if every American had a PCMH, healthcare costs would likely decrease by 5.6 percent, resulting in a national savings of $67 billion per year.
Another healthcare reform concept that would impact physician practices, although many consider it to be an extreme option, is the concierge model of medicine. A small but growing subset of physicians has adopted the concierge practice model, which charges patients a monthly or yearly retainer fee in exchange for quick and easy access to a physician.
The model’s proponents say it keeps physician income high, and “preserves doctors’ sanity.” But total conversion to a concierge practice means a physician must say goodbye to about 75 percent of his or her patients.
“I liked the whole idea that you can see fewer patients with more revenue and do a better job,” said Damon Raskin, MD, a physician in Pacific Palisades, Calif., who considered shifting to a concierge practice. “But I didn’t want to give up a lot of patients.”
Retail clinics, which are small medical clinics staffed by a physician or nurse practitioner, are gaining in popularity with patients and insurance companies. They serve as a complement, or even a replacement, to the traditional physician practice – not to mention the hospital emergency room – although some think they could help improve the entire healthcare delivery system.
These clinics deliver care in non-emergency situations, leaving primary care provider offices free to deal with more serious or chronic conditions and emergency rooms available for, well – emergencies.
Healthcare reform legislation has also prompted many medical practices to consider adopting electronic medical record systems. While EMRs are expected to help streamline both the delivery of care and billing systems, many physicians are worried about the cost of implementation.
An EMR can cost practices up to $20,000-$30,000, although physicians have been offered financial incentives via the American Recovery and Reinvestment Act of 2009, and they face financial penalties from Medicare if EMRs aren’t implemented by 2015. n