Page 25 - Delaware Medical Journal - May/June 2018
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TRANSFORMATION IN HEALTH CARE
system becomes more expensive due to increased specialist visits, emergency department visits, and hospitalizations that could have been avoided had a good primary care doctor been involved along the way.
How are primary care doctors surviving in this climate? Many of our colleagues have been changing their practice model to “concierge,” where the patient pays a membership fee (typically $1,600 a year). These physicians still bill the insurance and collect deductibles and copays. In the last six months, at least three doctors in North Wilmington have switched to this model. This adds job satisfaction
for physicians by increasing their salary and giving them more time with their patients. However, most physicians who change to concierge medicine can only accept a fraction of their original patients to their new practice. This leaves many of their original patients in the common care doctor. Recently, a patient whose physician changed to a concierge practice was taking new patients.
Another way to survive this hostile climate towards primary care would
be to join the hospital system as an employee. This seems like a double- edged sword though, since physicians lose the autonomy private primary care primary care practices drive already high health care costs even higher. Studies have shown that costs are 20
to 30 percent higher for patients of hospital-employed physicians compared to physicians in small private practices.4
One reason is that hospitals can collect a
owned by the hospital are more expensive for the insurance companies too, since the
hospital has increased bargaining power to set reimbursement rates. These hospital- 40 percent higher rates of reimbursement for the same level of care visit that a private practice would offer. Consequently, in
an attempt to save money, the insurance companies essentially penalize private practices by offering lower reimbursement rates, further adding to the struggles
of the private practitioner. Finally, hospital-owned primary care practices preferentially refer to hospital-owned facilities for diagnostics and radiology, so are kept within the hospital system. We, and many experts, feel strongly that independent primary care is the main answer to improving quality and reducing costs.
Most people reading this article will likely depend on a quality primary care provider at some point in their life, whether for themselves or for a loved one. How can you help keep our private primary care doctors from closing shop?
First, you can contact your State Representatives to inform them of the primary care crisis that is occurring in Delaware. Make sure they know how it is affecting not only the health of Delawareans, but also the Delaware economy.
Second, the Medical Society of Delaware (MSD) has helped craft Senate Bill 199, the Improving Access to Primary Care bill, which will improve payment for primary care doctors. Ask your State Senator and Representative to vote for this bill.
Finally, let your patients know that primary care is in crisis in Delaware, and this is threatening their access to care and potentially their health and their wallet. Urge them to contact their legislators to support the MSD’s primary care reform bill.
We, as a community of physicians, need to create momentum around the issues facing primary care so that the legislators take our concerns seriously and enact
a bill soon to help us get fair payment for our work. Primary care doctors
are seeing more and more patients
and earning less and less income. The viability of primary care practices in Delaware is very much in jeopardy. Without urgent and much overdue reform, Delaware will likely see less accessibility to good primary care, with costs continuing to skyrocket. Statewide action is needed to avoid this crisis.
CONTRIBUTING AUTHORS
■ DEBORAH T. ZAREK, MD, FACP is the President of a private internal medicine practice, Progressive Health of Delaware in North Wilmington.
■ JAMES M. GILL, MD, MPH is the President
of a private family practice, Family Medicine at Greenhill, in Wilmington. He is also President
of Delaware Valley Outcomes Research, and an Associate Professor at Jefferson Medical College.
REFERENCES
1. Ginsburg JA, Doherty RB, Ralston JF Jr, Senkeeto N, Cooke M, Cutler C, et al. Achieving a High-Performance Health Care System With Universal Access: What the United States Can Learn From Other Countries. Ann Intern Med. 2008;148(1):55–75.
2. Gill JM, Bagley B. Practice Transformation? Opportunities and Costs for Primary Care Practices. Ann Fam Med. 2013;11(3):202- 205.
3. Odom Walker, K. Health Care Costs and Spending in Delaware. A Review of the Evidence and Proposed Approach to Payment Reform June 2017. Health Care Commission, 06/01/17:3. http://dhss.delaware.gov/dhcc/ files/costswalker.pdf
4. Robinson JC, Miller K. Total Expenditures per Patient in Hospital-Owned and Physician- Owned Physician Organizations in California. JAMA. 2014;312(16):1663-1669.
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