The coming changes in health care delivery

There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others.

I interviewed in depth about 150 medical leaders from across the United States to collect information and then distilled it down to a few key observations for my new book “The Future of Health Care Delivery – Why It Must change And How It Will Affect You.”

As a result of those previously discussed drivers of change, here is what we can expect to occur in the coming years.

First, there will be many more patients needing substantial levels of medical care. These won’t be just any patients but two specific groups that are growing rapidly. Americans are aging. “Old parts wear out” and there are certain diseases that become more prevalent with age like Alzheimer’s and osteoarthritis. And of course our society has many adverse lifestyles such as consuming too much of a non-nutritious diet, being sedentary, being chronically stressed and 20% still smoke. These all lead to chronic illnesses like diabetes type II, heart failure, cancer, chronic lung and kidney disease, etc. So there will many more individuals with chronic illnesses. The especially sad thing is that many of these individuals will be moderately young as a result of obesity since one third are overweight and another one third are frankly obese. This increase in chronic diseases and diseases of aging will have huge impacts on care delivery.

With more patients in need of care, there will be a need for more hospital beds, ICUs, ORs, high technology and interventional radiology.  This is different than the mantra of recent decades which proclaimed that we had too many hospitals and too many beds. Now it is the just the reverse. This too is a big change.

But building new hospitals or new wings or renovations cost a lot of money. So does technology such as the electronic medical record, new CT or MRI scanners, and the needed technology for the operating rooms or radiation therapy equipment. To garner the required money, hospitals will need to access the capital markets. But credit is tight and has gotten tighter in recent years. What will smaller hospitals do that have less ability to enter the credit markets? Merge with larger systems to get access to capital. So there will be more and more smaller hospitals merging into larger systems. Indeed there will be few stand alone community hospitals in the coming years. This is quite a disruptive change.

There is already a shortage of primary care physicians and this will undoubted accelerate since few are entering primary care today after medical school and training.  In part to compensate, there will be greater use of NPs and PAs, especially in primary care. No they cannot take the place of the physician as many would assert, but they can be very effective and allow the MD to do what he or she is best at doing. Together they can create an excellent team.

Primary care doctors are caught in a catch 22. They are in a non sustainable business model. Reimbursements from insurers have stayed level for years but office and other expenses have gone up each year. So in order to keep their personal income at least flat, they need to “make it up in volume” by seeing more patients. This means no longer visiting their patients in the hospital and in the ER. Instead they wait for the hospitalist or the ER doctor to call with reports. And they shorten the time with each patient so they can see 24 to 25 patients each day.

But seeing this many patients means they cannot give comprehensive preventive care and cannot adequately coordinate the care of their patients with chronic illnesses – two of the key things a PCP should be doing for optimum quality care.

There are at least two approaches PCPs are taking to counter this dilemma. One is to no longer accept insurance and rather expect patients to pay a reasonable fee at each visit. Pay at the door. It cuts out a lot of haggling with the insurer and means they can spend more time with the patient. Importantly, it recreates a normal, typical professional-client relationship since the patient not the insurer is paying the doctor directly.  But this is certainly a disruptive change to not accept your insurance! It is like going back a few decades.

Another approach gaining rapid popularity is to switch to retainer based practices, sometimes called concierge or boutique practices. The basic concept is to limit one’s practice to 500 patients rather than the typical 1500-2000 or more. This means more time per patient. So in return for a fixed fee of about $1500-2000 per year the PCP agrees to be available by cell phone 24/7 and by email. He or she will see you in the office within 24 hours of a call. You get as much time as needed for the problem at hand. And the PCP will visit you in the hospital, the ER or the nursing home – maybe even do a house call.

The result is better quality. But there is more. Since the doctor now has the time – the patient now gets much more preventive care attention. And if a patient has a chronic illness, the PCP will take the very real time needed to coordinate that care. This will mean much better care from the specialists and will avoid unnecessary tests, scans and procedures. Better care at less expense.  One more very disruptive and I would say transformational changes occurring in medical care delivery.

The coming changes in health care deliveryStephen C. Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and consults for the US Army, medical startups and Fortune 500 companies. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery, published by Potomac Books. 

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  • andymc12342003

    “There is already a shortage of primary care physicians and this will
    undoubted accelerate since few are entering primary care today after
    medical school and training.  In part to compensate, there will be
    greater use of NPs and PAs, especially in primary care. No they cannot
    take the place of the physician as many would assert, but they can be
    very effective and allow the MD to do what he or she is best at doing.
    Together they can create an excellent team.

    You’re assuming, of course,  that large numbers of NPs and PAs will want to go into primary care (really large numbers will be needed) ..Big assumption. They may instead, like residents, gravitate to specialty clinics (derm, ortho, cardiology) In essence, doing what graduating med students for the past 15 years have been doing-flleeing primary care for specialty practices.

    • NewMexicoRam

      That’s correct.  Our practice has almost as difficult a time hiring primary care extended care providers as we do primary care docs.  Specialists can pay more, and they can see fewer patients.

    • davemills555

      Have you noticed that today, 50 million Americans have absolutely no health insurance? Have you noticed that another estimated 25 million are underinsured? Did you know that those numbers are growing rapidly worse every single day? One quarter of our nation’s population is either uninsured or underinsured! Did you know that? When I see statements like this, I know for sure that health care providers have completely lost touch with reality. In Texas alone, 26 percent of the people there are uninsured. Did you know that? More PCPs? Are you kidding? Who’s going to pay these PCPs? Where will the money come from?

  • chashka

    As a future physician, I would love to learn more about how one would go about opening a “retainer”-structured practice. I did billing for my father’s medical office for many years in middle/highschool, and the thought of dealing with all that bureaucracy, hold-music, and paperwork (not to mention all the sensitive/personal health information I would be providing to some almost-random company) makes me ill. I would love to be able to practice in a format where the only people that get to participate are my patients, myself, and whoever else the patient actively chooses (family, significant other, etc). 

    As a second question, I am interested in how a patient with multiple chronic health problems who is not super-rich might be able to afford this – I imagine that in many major cities there are enough specialists that do cash-only that it might be viable for patients to get high-deductible low-premium (catastrophic) health insurance plans, but how would this pan out in a town or a smaller city? I would love to know how some physicians have made this a viable option for their non-wealthy patients.

    • davemills555

      My advice? Unless your motives are 100 percent altruistic, don’t waste your time or money. The days of Marcus Welby health care delivery are coming to a close. If health care is your chosen profession, find an ACO and submit your employment application. Solo-private practices of the future will serve only those lucky folks in the top 1 percent. The rest of the masses will be taking a ticket and waiting in line to see an RN in the neighborhood clinic. 

    • voitokas

      I think you could serve non-wealthy patients by a retainer model.  If you have five hundred patients (an almost unthinkably low load for a PCP) and they each pay $2000/yr (around the same price as a pack-a-day smoking habit), that’s a million dollars.  As you saw in your dad’s practice, most of the overhead is all that staff to do the insurance company paperwork.  I wonder if you could titrate the number of billing staff you needed if you were only billing for office procedures and things that required very little paperwork.

      • sFord48

        2000/year x 4 members of the family = $8,000
        Catastrophic insurance = $9,000
        Median household income = $50,000

        30% of income going toward healthcare.

        Of course, we would have to add Medicare taxes…

        • voitokas

          And that doesn’t even cover any lab tests that need to be ordered, medication, etc.   It’s not a recipe for saving money in the short run, that’s for sure!  I guess there is no answer for the non-rich in this country right now.

  • James deMaine

    Somehow you seem to think that more glass and steel structures, more specialists, more procedures, and concierge retainer primary care are the future you see.  On the contrary, there’s lots of evidence of waste and duplication in your scenario despite the aging and obesity demographics..   There is evidence that the “home model” in primary care can provide excellent care particularly when the physicians are salaried in a system like Kaiser Permanente.  Specialists who also are salaried have no real incentive to do questionable procedures.  We need to be able to guide patients away from the “Buffet prostate rule” where 81 yo men get PSA’s, biopsies, MRI’s, staging – then even radiation for Stage 1 prostate CA.  See http://www.endoflifeblog.com/2012/04/health-care-costs-leaky-bucket.html

    • davemills555

      Why are we doing “questionable” procedures in the first place? Seems to me, doctors dream up these “questionable” procedures like the Wall Street shysters dreamed up hedge funds and derivatives. The goal? Greed! Any investor in their right mind stays clear of these “questionable” financial tools and the snake-oil salesmen that sell them. Same should be true regarding “questionable” medical procedures and the so-called “doctors” that sell them. Our health care system has way too many witch-doctors with secret potions. Give me a break!  

  • Gilbert Douglas

    Thank you for your interesting post.  As a practicing Internist I see these problems first hand every day.  I agree strongly that the model by which we are currently practicing primary care in not sustainable.  I find it interesting that you bring up the concierge practice model as a solution. Another model of practice I would have loved to hear you add to your article is that on the “Patient Centered Medical Home”.  In this model, the insurer would provide some degree of “retainer” type fee that would assist with covering the added expense of providing the level of service many of the sickest patients we all manage require.  Patient Centered Medical Homes use a team based approach, utilizing physician extenders such as Nurse Practitioners and Physicians Assistants, to focus on quality outcomes as a means to better care for the growing population of chronically ill patients.  For any other readers interested in learning more about Patient Centered Medical Homes, I would recommend checking out the Patient Centered Primary Care Collaborative (www.pcpcc.net).

  • http://twitter.com/#!/CloseCall_MD Close Call

    The difference between a retainer practice set up by a lone practitioner and a PCMH supported by an insurer is the bureaucracy.  With a PCMH financed by a third party, the doctor will still have to jump through the hoops of bureaucracy and paperwork – getting an EMR, tracking the diabetics, achieving A1c goals, submitting data on wait times, etc.  you get the picture.  Basically anything the insurance company wishes to have measured or tallied, the can ask for… because they are the payor.  

    The optimal solution is to create a PCMH model without the insurance company.

    • Gilbert Douglas

      “Close Call” I agree that the third party pay system is fraught with bureaucracy.  I would not say that tracking diabetics or achieving A1c goals is anyway hoops of bureaucracy and paperwork.  This aspect to the management of patients with diabetes is essential and has been studied many times (PMID: 17322483, just to mention one source).

      • http://twitter.com/#!/CloseCall_MD Close Call

        Dr. Douglas,

         I agree that some guidelines and target goals are useful – but even with things like A1c – there is controversy about how strict we should be with the measures and in what age groups.  I bring up the well worn example of more benefit from bringing an A1c down from 12 -> 8, than getting from a 7.5->7.  Guidelines and performance measures are not perfect.  But things like diabetes and a1c goals can be tracked without the “help” of an insurance company.  Having an insurance company involved almost never creates less work for the physician or frees up their time to take care of patients.  A PCMH sans an insurance company is really the best way to go.

    • davemills555

      Bingo! You broke the code! We need to do “all” health care without insurance companies. Private insurers bring absolutely no value to the table. None!

  • civisisus

    “With more patients in need of care, there will be a need for more hospital beds, ICUs, ORs, high technology and interventional radiology.  This is different than the mantra of recent decades which proclaimed that we had too many hospitals and too many beds…”
    Dr. Schimpff, you simply have to back bald assertions like this with something that looks like a credible fact-based model. Otherwise, we’re forced assume you’re just another out-of-touch practitioner who has not been paying attention to the direction of practice patterns over the past 20+ years. In fact, the conventional contours of your “forecast” suggest you’re making some pretty rigid assumptions about the form and rate of practice change into your ill-defined future.

    Please try harder. While you’re at it, start with an assumption like this: “doctors are likely to be less and less central to health care as experienced by the overwhelming majority of people”.

    • http://pulse.yahoo.com/_KL7PN5P3632TBOUFWJQY6HGJKI Maggie

      You’re right. Dr.. Schimpff  doesn’t seem to realize that, under reform, doctors will be paid to keep patients out of hospitals. We don’t need more hospital beds; we need fewer beds.

      Even patients who are dying will be going into hospices, or going home where they can receive
      palliative care or hospice care.

    • buzzkillersmith

      Dr. S is engaged in futurebabble, presenting a possible future scenario and then making the unwarranted assumption that this scenario will come to pass.  We hear this nonsense from “experts” all the time.  Listen to the news: financial, international affairs, sports–confident predictions of a future that does not come to pass, but by then the expert is on to the next prediction. Dow 36,000 anyone?
       Don’t believe this stuff.  Quite simply, like the hedgehog and in contrast to the fox, Dr. S has a big idea and he neglects the denominator, all the possible other outcomes. He doesn’t know what the future will bring in medicine; no one does. As an aside, UC Berkeley’s Tetlock has written extensively on the failure of expert predictions.

  • southerndoc1

    The Patient Centered Primary Care is dominated by large insurers who are often paying primary care docs at 60-70% of Medicare rates. They see the PCMH as a way to get docs to do even more work that they won’t get paid for (i.e., they’re now offering “retainer” type fees of up to $0.50 per member per month!) Don’t fall for it.

    • Gilbert Douglas

      “southerndoc1″, can you give some examples of these type of PCMH organizations?

      • southerndoc1

        I was referring specifically to the large, for-profit insurers – the Aetnas, Uniteds, etc. – who sit on the executive committee of the PCPCC. In large areas of the country, they have created what are called “distressed practice environments,” where, through market dominance, they can get away with paying primary care docs at 50-60% of Medicare (I know eastern Pennsylvania/New Jersey are experiencing this).

        When these same insurers do decide, in some situations, to pay for PCMH services, it can be from $1 on down for level III certification. And the rates are dropping.

        The PCMH financial model – hire the staff, invest in the infrastructure, do the work, and give it away for free until one of these kind insurers decides to throw a bone in your direction – is so ridiculous as to verge on delusional.

        Read the proceedings of the PCPCC: it’s all above lower payouts (i.e., higher profits) by the insurers. They never mention paying the docs fairly for the work they do. And they’re very enthusiastic about PCMHs with no doc in the house at all (even bigger savings).

        For a dose of reality, read the  recent WSJ about a Colorado practice that is doing everything “right,” and is subsequently on the ropes financially.

        That the leadership of the primary care societies decided to push this model of practice management on their members BEFORE addressing the financial aspects is so irresponsible as to verge on malfeasance.

        • MarylandMD

          I have to agree with you, southerndoc1.  A few years ago, I looked over all I could find out about PCMH, and I, too, concluded that the efforts by the specialties focussed on primary care (AAFP, AAP, etc.) to heavily promote the PCMH model without ANY concrete plans for reimbursement was irresponsible to say the least.  “If you build it, they will come” may work when you are mowing a cornfield in a movie, but it isn’t a viable option for physicians in the real world.

          While currently some insurance companies are offering money to practices that get certified for PCMH, the money generally isn’t all that much.  Further, there are no guarantees for long-term funding, so many physicians could be buying into a very elaborate bait-and-switch scheme–one that was conceived by brilliant minds in their own specialty society!  Finally, all the “extra time” you get with the extra money they give will be largely taken up by meeting all the certification and reporting requirements, so you really may not be all that much more available to the patients than you were before.

    • davemills555

      May I suggest that you contact the AFI-CIO?

  • http://twitter.com/PathcareNow Pathcare Now

    Interesting and thoughtful post on a number of uniquely American problems – obesity for one and pre-occupation with technology for another.
    The experience in other countries such as Norway is that with better care by family / primary care physicians – the number of hospital beds can be reduced by half. Surely – the Norwegians didn’t need high-tech  to make this happen.

    Having said that – it is notable that modern digital technologies for private and secure networking are far more effective than a phone and email for maintaining a two-way connection with a patient – where the doctor provides the guidance and the patient provides his personal experience, status and key vital signs. This is of particular importance in chronic disorders such as diabetes and Parkinsons.

    We’re looking for partners in our Pathcare project – a private and personal social network for a physician and patients and caregivers.  Visit http://www.pathcare.co to sign up for free

    Danny Lieberman
    Pathcare – connecting doctors and patients

  • Dorothygreen

    We need serious health reform but perhaps we don’t need more health care providers. Rather, we need  fewer sick people.  We are leaders in sick people.  80% of the SAD (standard american diet is unhealthy diet (processed sugar, fats and lots of sodium).  Decrease the consumption of this (start with a RISK tax upfront like in the tobacco model) and our health care costs for chronic preventable diseases would be no worse than say, Switzerland.  Obesity rate of 9% ,40% overweight total.

    People are aging all over the world but the US has the lowest percent of aged.  More and more illnesses are being linked to diet and other lifestyle factors – sedendary, stess etc.  THESE ARE REVERSIBLE and yet we spend most of our health care dollars on them.  

    It’s a public health crisis.  Don’t fix our eating culture we will never fix our health system. 

    • davemills555

      Don’t you hate when health care consumers get sick? How dare they let that happen! If these losers would simply mail in their premium checks and never file a claim, our health care system would be in much better shape. Can you imagine if nobody filed a claim but everyone paid their premiums? We’d have the greatest health care system in the world, right? Those darn patients need to stop being such pests! It’s all their fault!

      • Dorothygreen

        What? I was talking about preventable chronic diseases.  Real prevention.  Unfortunately, there will still be many many sick people with unpredictable diseasee even when we fix our eating culture.  We can share risk  for basic services through non-profit insurance or taxes but we need universal coverage.  If you are proposing “free market” everyone pay their own – we will be the worst country on earth.  Fixing our eating culture will make health care costs manageable.  

        • davemills555

          I hate it when people make wild assumptions without any legitimate data and facts to back up their statements. Are eating habits and smoking the cause of our health care system going broke? That’s a huge stretch! More like doctors and hospitals double and triple billing for their services? More like health care providers prescribing a brand name drug instead of a perfectly good generic? More like ordering two or three MRIs or CT scans when a conventional x-ray would do just fine? So, the consumer is the blame? Yeah, right! Give me a break!

    • Linda Pedigo

      There seems to be a part to the obesity problem that is rarely discussed but is a reality to every working poor, food stamp eligible and most single parent households in this country.  Nutritious food costs WAY MORE than junk food.  Grocery prices have increased to the point where even a family with a breadwinner is running out of food before payday.  I witness this phenomenon monthly as part of the food bank for my church.  We can’t keep the shelves stocked even with desperate pleas going out to our poor, but very generous, congregation on a regular basis.  Kroger is a national chain.  A simple exercise would be to scan the type of items on their usual 10 for $10 promotions.  There are few whole grain choices, no lean protein, little fresh produce, etc.  Then check the prices on the nutritious foods less likely to cause obesity.  They are out of reach of the average working poor and starting to be out of reach for many middle class families.  Let’s move on to the other determinant of obesity.  The neighborhood where our church started is one of the poorest in our community.  There is no city bus service.  Before our church became involved, bought the topless bar in the center of the main street and turned it into a Christian coffee and meeting house, there was a time when no pizza company would allow deliveries there.  There was a park, and one of the most joyous points of the year for our congregation was our free Labor Day picnic given for the residents of the neighborhood, members of our church or any other or not.  There were children’s games, live music, basketball and baseball tournaments for the older youth, and of course, all the food a veteran group of pot luck providers could show off on this, our day of no strings attached friendship and fun which went a long way to melt the distrust of people who had been stigmatized and pre-judged for decades.  Well, guess what happened?  Our city leaders, in their creativity and wisdom, turned the ONLY source of free outdoor recreation for the kids in this neighborhood–the park was expansive, with much open grass space, basketball courts, a skateboard area, playground equipment for the younger set and a baseball diamond–into a DOG PARK.  Yes, now the counties dog owners, for an annual fee, have what used to be a park for the most disenfranchised children in the city, as a place for FIDO to get their exercise.  After all, obesity in dogs is a problem now too, isn’t it?  Our church leaders begged for this project to be squashed, after all, there are many alternative dog park sites, but no alternative inner city youth sites.  And organized sports?  Even school sponsored, for the most gifted of the athletes, is way beyond the budgets of these kid’s parents; $55 for a used pair of football cleats, similar uniform fee, entrance fees, etc. for ONE sport for ONE child.  And what about practices?  Remember there is no city bus service to get the kids home once the regular school bus has run its route.  And these parents usually have no car, especially a reliable car, and often work 2-3 odd hour jobs to make ends NOT meet.  Our community is fairly affluent, yet this happens without a blink of an eye, so I’m sure it’s repeated all over the nation, with some cities hit even harder than ours.  But let’s blame them for their obesity….the dads who stick it out (our state doesn’t allow aid to married couples, causing many dads to leave just for their families to get help), the moms trying to make their meager food budgets fill up hungry toddlers, grade school kids, and ravenous, fast-growing teenagers, and of course the kids themselves.  They want to be too fat to enjoy their lives fully and are so, so eager for another strike against them when it comes to competition for jobs, suitable mates, and health care.

      • Dorothygreen

        Linda,

        I don’t believe your story is so much about obesity as it is about the struggle in a poor community to eat nutritious food with limited choice.  An apple should not cost more than a bag of chips anywhere.  Nutritious food is only about 20% of what this country eats – rich, poor or middle.   Our entire eating culture needs to be changed.  If anything your diet would produce malnutrition if the stamps weren’t enough but people can also use food stamsp for soda and sweets and tasty processed stuff that shouldn’t even be called food.   The exercise you gave from a chain stor (all those goodies 10 for $10)m  is marketing at its worse.  And there is no reason for it except to keep people addicted to the bad stuff which the poor will buy because it is “comforting” and cheap. 

        It is a story about a limited life. No bus, no park – taken away for a stupid reason to make a bit of money because your governemnt needs to pay some bad debt created by someone probably betting on derivatives.  

         There is a food revolution going on in this country but it is voluntary.  It is hard to get the message out about Big Ag, GMOs, Big Food.  If something is done about obesity like it was done with smoking – the poor would be helped first through a change in what food stamps could buy. Why?  Because the conditions caused by an unhealthy diet are very expensive and taxpayers like me don’t want to pay for health care that can be avoided.. If health care reform is repealed it is going to be a dog eat dog world in health care and our country will go backwards.   And even worse if we don’t fix our eating culture. 

        And Linda, forget about lean meat.  Forget about cow meat.  You can get good protein from beans, legumes, eggs, some fish – we all eat tooo much meat and it is bad food to begin with  full of antibiotics, hormones and fed corn that they can’t digest.  It is disgusting.  It is a lot of what is making Americans sick.  A cow has to be killed to get any kind of meat – lean or fatty. 

        Good luck to you and your community.  Any vacant lots you could use for a garden?  It is happening in many poor neighborhoods. 

        You should send your story to Michelle Obama -     

  • http://www.facebook.com/people/John-G-Self/1354275188 John G. Self

    The conventional wisdom of industry consolidation driven by tight credit has been around for a long time.  There is ample evidence that is an established trend.  But much of the consolidation we have seen since the dawn of investor-owned hospitals — a key instigator of consolidation —  has been driven by a cost-based system. However, there are several changes that WILL occur that could well upset this conventional wisdom:  1. investor-owned growth has been fueled by stock price which is driven by “sick care” admissions and growth in revenue.  Growth in revenue is now in question and that will impact the stock price of many companies.   2. Medicare as we know it today is not sustainable.  The growth is this program — numbers of beneficiaries( a new person enters the Medicare program every 4 seconds) and the costs of care — is outstripping our ability to pay the tab.  The math simply does not work.  3. Corporations are increasingly concerned with the cost of healthcare in the U.S. and its impact on their global competitive position. In essence, today insurance companies buy care that is more costly than ever and corporations pay for it through employee benefit programs. They would prefer to dump this costs onto their employees through a combination of lower payments to employees and tax incentives.   We will all see lower rates of reimbursement for everything we do. 

    There will be a transformation in healthcare, but I doubt that it will be driven by the Patient Protection and Affordable Care Act — meaning Washington.  No, I think the federal deficit crisis will force a fundamental change in our business model — one in which  employees will be providing their own insurance coverage — aided by tax incentives and changes in corporate benefit plans.  In this new world, price and performance will be everything.  Inefficient and ineffective providers will not survive   The days of the big box hospitals, which are less efficient than smaller community hospitals, are numbered. That does not mean that there will not be consolidation, but I argue that forming mega systems is not the golden bullet that will enhance quality and improve efficiency. We are already seeing that highly centralized health systems with an underlying command-and-control philosophy does not mean better, safer more efficient healthcare.  Perhaps the future means smaller. I am not sure.  But in light of the host of disruptions that will occur I believe there is some truth to the old saying that conventional wisdom is rarely right.

    • davemills555

      Although this is just another opinion, one of the thousands out there, I agree with it in part. Unlike the past where the goose seemed to have an unlimited supply of golden eggs, belt tightening will be our future. EVERY BELT MUST TIGHTEN! We need to face facts. The cow has run out of milk! The goose is on life support and the consumer is sick and tired of being cheated and bilked by and industry where thrift has never even been so much as a passing thought. For better or worse, big-box health care will be the name of the game going forward and the small operations will either join the movement or they will be kicked to the curb.

  • davemills555

    Don’t you just love those folks who put the blame for the outrageous cost of health care on patient lifestyles? They keep telling you that if health care consumers, especially seniors, watched their diet, got some exercise, stopped smoking, stopped excessive drinking and stopped drug use, all of our cost problems would be solved overnight. Yeah, right! They keep preaching this nonsense while Medicare fraud is costing taxpayers in excess of $60 Billion per year. Don’t believe it? Do a web search for…

    “Medicare Fraud: A $60 Billion Crime”
    Blaming the rising cost of health care on patient lifestyles? 

    What a joke!

    We ain’t drinking that kool-aid!

  • MarylandMD

    So, Dr Schimpff’s solution for the primary care shortage is make primary care sustainable by having everyone pay $1500-2000 **per year per family member** to their PCP.  So, now we have Americans paying even more for health care to physicians who are seeing 1/3 to 1/4 as many patients in a time of significant shortage of primary care physicians!

    This sounds like yet another “fix” for the 99% offered by a member of the 1%.  Makes sense to him!  All his family is in a concierge care practice and it works great!  If it works for us, it’ll work for everyone!  If others can’t afford concierge care, the let them eat cake!  Where is a family of four just above the poverty line going to get the $8000 per year to keep their PCP who can now email them even though they can’t afford a computer or broadband access?

    Dr Schimpff seems like yet another health care policy talking head who can’t even do basic math.

    • davemills555

      Where did you see “per year per family”? The way I’m reading this plan, it sounds like it’ll cost $1500-$2000 per patient per year. Obamacare, by contrast, has a minimum individual penalty of $95 in 2014, $325 in 2015, and rising up to 2.5 percent of income (or $2,085 maximum) per family in 2016. That means the first-year spread between the penalty and the cost of coverage for an individual may be 20 to 1 or 30 to 1. Uh, given the choice? I’ll take Obamacare!

      • MarylandMD

        I am not sure what you are talking about.  Generally signing up with a concierge practice costs you $1500-2000/yr per patient (each family member counts as one patient).  I quoted a per family cost as $8000/yr for a family of four.

        Keep in mind, signing up with a concierge practice is NOT the same thing as buying insurance.  The $1500-2000/yr per patient cost is simply a fee that you have to pay to your primary care doctor in return for that doctor promising to be on call 24/7, see you in the hospital, communicate via email, etc.–i.e., it only covers those “extras”.  You still have to buy health insurance!  That fee won’t cover your bills for medications, specialist visits, labs, hospital fees, surgical fees, anesthesiology costs, etc.  In many concierge practices, you still also pay fees for your visit with the physician–the visits are not included in the $1500-2000/yr cost.

        Dr Schimpff says concierge medicine gives us “Better care at less expense.”  Less expense for the patient?  How does he figure that?

        • davemills555

          Thanks. I stand corrected.