Primary Care Alternatives

Physicians and patients alike are growing tired of our healthcare system—the endless wait times, hurried office visits, and financial burdens—which is why primary care alternatives, such as direct primary care, also known as concierge medicine, and "scope of care" bills are gaining attention.

“The direct primary care model is more relevant than ever today for two reasons: It enhances the quality and patient experience of primary care, and it can save the system money by managing medical problems before they become more serious and require expensive hospitalization," Dr. Erika Bliss, President and CEO of Qliance, a Seattle-based network of direct primary care clinics for employers and the general public, tells Healthline.

Direct primary care is when a doctor foregoes a Medicare or other insurance partnership to start an independent practice, and thus sets his or her own rates for patients-—often involving a per-month fee and a per-service fee. Providers say they are abandoning many of the bureaucratic pressures and inefficiencies that come along with the health insurance system.

Bliss cites the Institute of Medicine's finding that one third of all healthcare may be unnecessary and possibly harmful, wasting up to $700 billion a year in federal funding.

"Scope of care" bills, also lauded as a way to save time and money for patients and the system as a whole, would put more power into the hands of nurses, pharmacists, optometrists, and other providers. If these caregivers can do the simpler tasks involved in testing, diagnosis, and prescription writing that usually fall on the shoulders of already-overburdened doctors, patients can have all their needs met in a single, quick visit.

A package of such "scope of care" bills is currently before the state senate in California.

The Drawbacks of Going Rogue

That said, there are also downsides to these new primary care alternatives. First and foremost, if a physician goes into direct primary care, he or she is limited to accepting fewer patients. That means that a well-qualified doctor isn't able to attend to as many patients as before, which challenges the idea that a doctor's services should be available to all.

Of course, direct primary care also means that those patients who do get seen receive more focused, quality time with the doctor—up to two hours if necessary.

Likewise with "scope of care" bills, if patients can be seen sooner by nurses or pharmacists than by doctors, many of their ailments will be addressed faster and more cheaply. But if doctors are taken out of the picture, there is a risk that the quality of care will decrease and that ailments will go undiagnosed.

Finding a Happy Medium

Bliss says that Qliance offers patients more attention and greater access to lower-cost primary care, with longer office visits, extended weekend hours, 24-hour access to physicians via email or phone, and coordination with nearby specialists and hospitals. 

So perhaps there is a middle ground—if "scope of care" bills and direct primary care gain popularity and are subject to regulation, requirements such as a minimum number of patients and minimum educational credentials could help ensure that all patients are seen across direct primary care practices and that nurses tending to patients have advanced credentials in particular areas.

"At a time when millions more are gaining entry to a health system already beset by physician shortages, direct primary care ensures patients have easy access to a high-quality physician relationship and better care. Direct primary care makes the concierge model of care, which was previously available only to the rich, accessible and affordable for the general public," says Bliss.

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