Solutionist medicine: How the concierge model can reinvent primary care

Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions.  In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting other’s needs before our own are the key components that help to define us as physicians.

As a young(ish) physician, I enjoy speaking with other doctors from around the country and world, who impart advice on me not just about business, but about “the shape of things.” I especially love speaking with other concierge physicians to learn about their model, their infrastructure, and how they provide the best care for their patients. In speaking with some colleagues, their words of wisdom all too often seem to revolve around how to keep your head above water in a high cost, low reimbursement rate industry.

Yet, all of our personal statements for medical school and residency in some form gave endless prose to how we wanted to care for the sick and change the world for the better through improving health. Somewhere along the never ending road of learning, student loans, managed care, and shrinking insurance reimbursements, some doctors are still searching for the solution of balance between business and altruism.

How can concierge medicine reinvent primary care?

Let’s look to other types of insurance that many people also have, such as car insurance and renter’s/homeowner’s insurance. We all purchase car insurance, yet, for routine maintenance (oil changes, tire rotation, even new tires), you probably do not submit a claim with your car insurance company. Rather, we pay “out of pocket” for routine care which keeps the cost of our annual car insurance premium low.  Similarly, when it comes time to change the air filter in your home or patch a nail hole, you either do it yourself or hire a handyman. You do not submit a claim to homeowner’s/renter’s  insurance company. If we started asking for reimbursement for these routine maintenance type services, aka: primary care for our cars and homes, the costs for insurance would become astronomical and the system would not remain sustainable.

Using a concierge model for primary care, where physicians are paid for the relationship they have with their patients, doctors are incentivized to do things for their patients, rather than to them, and time spent counseling is not only paid for, but also rewarded (with improved patient health and fewer middle of the night phone calls). Insurance coverage would remain an essential part of a patient’s care, using coverage for prescriptions, labs, radiology, hospitalizations, surgery, or consults. Concierge medicine can reduce reliance on insurance reimbursement not only by reducing overhead, but also helping to improve the health care crisis and lower costs.

But what is true concierge medicine? Is it house calls? Telemedicine? Allowing patients to have access to your cell phone or email? Is it having a smaller patient base, enabling a doctor to spend more time with their patients? Or is it removing the insurance reimbursements to physicians for primary care visits to let doctors make a statement and take back control of their own industry?

Clearly, concierge medicine is not the only way for patients to receive the best care. And certainly there are millions of patients who are unable to afford any additional costs to their already costly health care. There cannot be one “all-encompassing” solution, but rather multiple options and solutions that best serve each individual and family.

How can we all be on the same page within concierge medicine?

Concierge medicine involves all of the above questions referenced above, but also can help to provide a solution to the bigger picture, the primary care health crisis. Ultimately lowering insurance coverage costs to the patient, while keeping and most often times improving physician salary, the tomorrow of primary care can begin to improve today. Concierge medicine can reinvent primary care by allowing doctors to reinvigorate who they are at the core, solutionists.

Chad Rudnick is a concierge pediatrician and practices at Boca VIPediatrics, Boca Raton, FL.

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