Getting What You Pay For: Primary Care

January 25, 2010 in Health Care "Reform" by RangelMD

Dr. Laura Heiby used to have a patient panel of 1,700 insured patients and like many primary care physicians these days she couldn’t afford to spend enough time with patients to actually practice . . medical care. So she switched to a prepaid cash only practice model which is what the media sobbingly refer to as “concierge” or “boutique” medicine. Her patients pay $1,500 out of pocket per year and her patient panel has shrunk to 400. Instead of being hand-tied by declining reimbursements and excess bureaucratic overhead and paperwork, and with far fewer patients to juggle and while maintaining the same income level, Dr. Heiby is able to spend more time and attention per patient.

Now she sees her patients for every visit and has more time to go over their health problems. She coaches them on exercise and nutrition and suggests extra testing to head off disease that might be years down the road.

This is actually confusing to many because they think, “this is what physicians are supposed to do!” Right, practice medicine, attend to the patient’s medical needs including preventative medicine and counseling on healthy living and education about disease processes . The problem is that 40+ years of insurance domination of the economics of medical practice has perverted how we think of medical care so much so that the harried 10-15 minute rushed doctor visit (often after several hours wait) is considered to be the acceptable norm and everything beyond that is extra, or excessive, or gravy or boutique or for the rich. Just consider the headline from the story about Dr. Heiby by the Virgina-Pilot News.

More personal care? It’ll cost you.

Really? How about some alternative titles that more properly reflect reality and not a skewed perception: “Solo doctor attempts to correct 40 years of decline in medical care with new practice model.” Or what about, “Medicare and Private Insurance have ruined primary care and this doctor is trying to fix it.” Or, “Medicare and Private Insurances effectively no longer pay for proper primary medical care but with this doc, you actually get what you pay for.

And is $1,500 a year excessive? Consider this.  The average American cable TV subscriber pays $900-1200 A YEAR for crap like MTV’s Jersey Shore and there are over 175 million subscribers. In contrast, Medicare usually pays $57-86 per patient visit for those with multiple complex medical problems (Diabetes, hypertension, arthritis, heart disease, stoke, etc).  The average patient 45 years or older (those likely to have the most medical problems) visits the doctor 4.7 times per year. This amounts to about $300-$400 total per patient per year (slightly more for those with private insurance).

For the average primary care doc who does not commonly perform much higher paying procedures, this $400 per year is not enough to cover overhead and make a living that justifies their high level of education and training. This is why they commonly have patient panels of 1,700 or more and see 25-40 patients per day. And this is why patients wait for hours and then get only a 16 minute visit on average.

Yet two illogical ideas still pervade the medical economics land scape: 1. Medical care is something that is paid for by someone else (i.e. insurance or the government). 2. Medical care is a “right” or is critical in the very least and so patients should not have to pay too much for it. But the only reality is that you get what you pay for.

Please share.