Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Do we really have a choice in health care?

Cary Fitchmun, MD
Policy
August 18, 2017
Share
Tweet
Share

As every physician practicing today knows, health care is in a constant state of flux. The latest news from Washington creates even more uncertainty. What we do know is that, for the foreseeable future, there will be an emphasis on team care, coordination, technology and, of course, meeting the requirements of the ever-expanding alphabet soup of acronyms, from MACRA to MIPS and beyond.

As I think about all the changes of the past decade, it’s quite remarkable to see where we are, and how far we’ve come. In the 1990s, most physicians were still in independent or small group practices. Today for the first time, the AMA reports that less than half of all physicians are independent.

And so what? Isn’t that just an inevitable sign of progress? Things change. We adapt or die. The message we hear is: prepare for an era when virtually no MDs are independent and where patients are seen by “advanced practitioners” (aka mid-level providers) via telehealth platforms for all but the most serious illnesses.

Is that the only option — to remove choices for physicians and patients? Let’s hope not. I’d like to live and work in a marketplace where there are options for all physicians and patients. Where we don’t force everyone into the same health care delivery system box. I think such a goal is realistic and attainable because that’s how my partners and I have structured our practice.

With a total of six physicians, we are one of the last of the truly independent medical groups in our area — the central coast of California. Our practice is successful and thriving. Our patients are happy, and my fellow physicians and I love the freedom we have to practice medicine the way we know is best.

No, this isn’t a story about direct pay, which in actuality is starting to flounder. It’s the story of a model that puts the decision of whether or not to participate in a concierge medicine program directly in the hands of patients. My colleagues and I offer a hybrid concierge program, where about 20 percent of our patients opt to participate in the concierge program, the rest we see as traditional insured patients.

One of the features that differentiate our practice from others is that we take insurance, even Medicare. We charge a modest fee, about $150/month to cover service not provided by traditional health insurance. When combined, the services we offer well outpace the fee, making it a real value for patients.

This includes a highly personalized annual exam and consultation visit, direct contact information to us for after-hours questions or emergencies, and convenient scheduling with little to no waiting. Adult children up to 26 are covered under the monthly fee. Plus, our appointment times average about 30 minutes for a follow-up, and an hour for a physical, giving us time to talk with our patients — to look at them — and not the EHR screen in the eye. That’s a welcome change considering that the average physician today reports spending a ridiculous two-thirds of their time on paperwork.

What’s most popular with patients and their families is the patient advocacy and advice. When they are sick and frightened, patients aren’t dropped in the middle of a complex and confusing health care system to fend for themselves. We make the appointments with specialists and labs, get the results promptly and share them in a way that is understandable to patients. We don’t abandon hospitalized patients. We remain actively involved in their care, so we can be ready to take over when they are discharged.

How does that work? Easily: we typically schedule one to two hours per day for our concierge patients. We still have to do what all physicians do: we use EHRs, and we also have to meet requirements for MIPS, etc. My colleagues and I still work hard. The difference is, there is no soul-sucking pressure from working in a grind. We have relaxed and enjoyable time during the day to treat patients the way we think is best. If our concierge schedule isn’t booked, we either see other patients or attend to that always-present paperwork during work hours, not at home when we want to relax with family.

We continue to provide the same care to all patients; that’s a point I can’t stress enough. If someone is in crisis, they are seen first. Our biggest source of growth for the concierge program is keeping all patients happy. If we aren’t meeting their needs, they leave, and we don’t succeed. We aren’t getting rich on this model, but our compensation is fair and our practice stable and growing. Most importantly, we are enjoying the practice of medicine again.

I get that there are questions about any concierge program. I surely had them when I was struggling to find a better way to survive and practice medicine. It came down to some fairly simple questions: what’s best for my patients, community, colleagues and practice? For us, the answer was hybrid concierge. Because patient, as well as insurance relationships, are maintained. The model, pioneered by Concierge Choice Physicians, not only works for small practices like ours, it also works very well for large groups and even vertically integrated health systems.

We know health care will continue to evolve and we’re ready for what comes next. We hope that “next” will include practice models that give real choices to physicians and patients.

ADVERTISEMENT

Is that important in an era of physician shortages, increasing demand, rising costs? Yes, because the hybrid concierge can bring a private, non-taxpayer source of revenue to health care delivery. One that can stabilize practices, keep physicians practicing longer and ensure all patients are seen. Are there going to be questions and issues that arise? Of course, but let’s address them, not ban options that physicians and patients want. Health care will continue to be complex and at times confounding. As we search for solutions, let’s make sure that choice remains an option that can benefit everyone.

Cary Fitchmun is a family physician.

Image credit: Shutterstock.com

Prev

Let's change the mediocre status quo of health care

August 18, 2017 Kevin 1
…
Next

A physician doesn't hide his depression

August 18, 2017 Kevin 0
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
Let's change the mediocre status quo of health care
Next Post >
A physician doesn't hide his depression

ADVERTISEMENT

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • To fix health care, ask patients to change their understanding of how a health care system should work

    Richard Young, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • How our health care system traumatizes patients

    Linda Girgis, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD

More in Policy

  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Choosing between care and country: a dual citizen’s Independence Day reflection

    Kathleen Muldoon, PhD
  • How fragmented records and poor tracking degrade patient outcomes

    Michael R. McGuire
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...