It’s that time of year again – Open enrollment! Everyone is starting to feel the effects of the Affordable Care Act and the impact it has had on the market. Since it’s inception there have been over 31 million people who have entered the marketplace. While it affords an opportunity for people who may have been unable to procure insurance previously, it also poses a challenge for many. Navigating a system of increasing premiums, outrageous deductibles and a smaller selection of plans has forced consumers to get savvy about how they are spending their healthcare dollars.
As a result, Physicians are becoming tasked with more responsibilities from the ever-changing regulations imposed on them, the burden of collections for patient balances and most importantly maintaining patient trust, the reality is it is becoming harder for Physicians to keep their businesses alive. Conversely, many patients may not be able to afford their medical bills when insurers only pay a portion of the charges, leaving patients to pick up the rest. Physicians have been faced with a hard decision as many are retiring, joining large groups and even closing their practices. This puts them and by extension their patients at a crossroad – do they continue to practice medicine this way?
The average visit with a Primary Care Physician has been reduced to only 7 minutes and is anticipated to be even shorter in the years to come, as there are just not enough doctors to serve the demand. As a result we see more mid-level extenders, Physician Assistants and Nurse Practitioners, managing care for this overwhelming influx of people. It’s no wonder that it takes weeks, and often months for a new patient to have an appointment. When you are not feeling well today, an appointment in the a few weeks does not sound like a reasonable solution.
POPULATION TRENDS REVEAL A PHYSICIAN SHORTAGE
The system itself is not only antiquated, it is flawed. How did this happen?
Most Americans have three types of insurance- Home, Automobile and Health. We pay monthly premiums for each of them and for two of them we understand how they are to be used – for catastrophes. We never call our insurer when we need our home painted or gas put in our car. These are regular maintenance activities we perform to keep our homes and our cars in optimal shape. Yet our thinking is so different when it comes to health insurance. We have come to expect it to keep us healthy, but the reality is that it is for catastrophic events.
So how did we get here? Back in the early 1900’s patients used what was called “prepaid physician groups.” Physicians offered inexpensive healthcare by charging monthly fees directly to the patient rather than an insurance company. Undermining the financial burden of unnecessary tests, supplies and lab work they quickly drained their resources. Their focus was coordination of care, as the groups were commonly comprised of various specialty doctors to create a model of comprehensive patient care.
Then came the birth of the insurance company, at a time when these prepaid groups were particularly vulnerable. In the 1930’s and 40’s healthcare reformers and American Medical Association (AMA) took notice and began to combat these prepaid groups. AMA leaders decided that rather than allowing doctors to insure patients, only insurance companies would be permitted to offer medical coverage. Implementing a fee-for-service schedule, prohibiting insurance companies from supervising physician work and not allowing any multi-specialty groups to have access to financing, Physicians amicably agreed to these terms to protect their autonomy and earnings.
This was the foundation of our healthcare system today, a faulty insurance company model that continued to slowly develop and then came the passage of Medicare in 1965. The insurance companies became the program administrators for the government program and they completely dominated U.S. healthcare. In turn, healthcare prices skyrocketed and in order to control prices they implemented cost containment measures. Once forbidden to supervise physician work, insurers now manage doctor’s work by requiring permission to perform medical services and procedures among other tactics.
This changed how medicine was delivered. We moved to a strategy of divide and conquer. Sensible at that time physicians were organized by organ system. These multi-specialty physicians began working in silos as it was thought to be more effective when one doctor treats the ears, another the heart and the kidneys. But along the way we have learned a lot. Science has revealed the interconnectedness of our bodies. We have clearly learned that insulin resistance, atherosclerosis, hypertension, heart attacks, strokes, ED, macular degeneration aren’t discrete phenomena. These diseases flow largely from the same spring of clinical imbalance. The irony is that in one of the most advanced societies with an array of technology at our disposal we still have the highest medical cost per person in the world. The rising cost makes sense considering we treat symptoms with pills, rather than addressing the root cause of an issue.
Today we see many Physicians struggling to find a way to practice medicine in a meaningful way; especially the ones who want to really heal patients not just provide reactive or “sick-care”. On average, a primary care physician sees around 2500 – 3000 patients per year. With short visits and all of the large patient population there is no realistic way a physician can truly diagnose the root cause of a patients problem – until Private Medicine.
Private Medicine, also known as membership based, concierge, or direct primary care, is an innovative way for Physicians to treat a smaller group of patients and bring them to optimal health. By charging a fee for non-covered services on a monthly, quarterly or annual basis, patients become members of a practice the same way they would a health club. Paying the monthly fee provides them with access, advanced testing, longer appointment times, same day or next day visits, access to the Physician through telemedicine and other benefits depending on the Physician’s background and training that are not paid for by insurance. Right now in traditional practices, the cash register rings every time someone walks through the door, yet many encounters can happen remotely via phone, email or videoconference when clinically appropriate which saves travel time and builds a stronger Physician- Patient relationship.
As health care continues to change more and more physicians are exploring the Private Medicine model of care. The ACA, increasing premiums and the political landscape have positioned the revolution of prepaid physician groups. Seaside Medical Practice is one of these innovative practices that saw the need to change the way that medicine was being delivered and by extension consumed. Understanding that our members are unique and must be treated that way has afforded Dr. Yazdani the opportunity to put her attention where it is most deserved – on you, our patients.
With just over 200 patients, Seaside Medical Practice strives to deliver personalized care in a practice that strives to create meaningful medicine and quality relationships. It has been an honor and pleasure working with each of our members.
We thank you for your support and continued confidence.