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.
