I read carefully the Network for Regional Healthcare Improvement report you cited in your article on medical home implementation (Report urges revamp of doc payment system, Daily Dose, Feb. 19.) I will forward these links to the board of the Society for Innovative Medical Practice Design, or SIMPD, and others and suggest they all read the report, which casts doubts about some of the assumptions made about patient-centered medical homes and National Committee for Quality Assurance guidelines.
There were good ideas in this report, but the difficulty of making it happen through third-party regimented systems was also clearly evident, and in the near term these difficulties may prove insurmountable. The time line for success is short. Within three years 100,000 more primary-care doctors will leave their failing practices according to a recently published Physicians Foundation study, while students will continue to shun primary care, making real medical homes for most Americans a distant dream long before any of these ideas can be put in wide practice.
However, there is a simple way for doctors to design and create true patient-centered, primary-care medical homes. They can arrange them directly with patients bypassing the third-party payment systems that, as the report points out, stifle these relationships and innovation in general.
Up to 5,000 physicians are already doing this for up to 1 million Americans, and this practice design is growing exponentially. The cost to each patient is less than a burger and Coke a day at McDonalds, and is thus affordable to nearly all Americans.
As president of the SIMPD, I want to confirm that the reason healthcare is so fragmented and disrupted today is the lack of excellent primary care that America once had. That fact in large part results from the devaluation of primary care and its extremely low payment status under the third party and Medicare-dominated payment system we now suffer under.
The concept of medical home is a critical one. Every American needs one, a place they can access top-notch primary care immediately. And they need to buy that home directlynot with other peoples money. When they do so, the cost can be very low to the patient and the benefits very high to the patient, primary-care doctor and society.
The only payer willing and able to pay what a medical home will cost is the patient. Interest in concierge medicine is therefore rapidly growing. Starting with the first such practice about 12 years ago in Seattle and growing exponentially, there are now thousands of such practices in the U.S., some are associated with franchises though most are independent. No matter what the government does, that is where the action will be in the future as our numbers grow.
Direct-practice doctors and those who wish to adopt the direct-practice model can join the society and get many benefits including up to 55% discounts on malpractice insurance, practice marketing help, national-care networks and many other services. Our society is rapidly growing its membership. Direct-practice doctors have much more time with their patients, make a better living and virtually never get sued. That is why we get huge malpractice insurance discounts.
Money is actually saved on patient care in such practices because emergency room visits and hospitalizations are drastically reduced because of the personalized, immediate, detailed care we deliver. The cost of concierge care, which averages about $150 per month, can be as low as $40 per month. This is affordable for most Americans, while the fragmented primary care most are now getting through employers or government third-party interference in the doctor-patient relationship is penny-wise and pound-foolish.
The SIMPD believes most Americans can eventually be cared for in such direct medical home practices resulting in far better care. This will result in lower overall cost and a return of interest in primary care by students who now shun the field.
Thomas W. LaGrelius
Society for Innovative
Medical Practice Design