This Is What Your Doctor’s Office

If you want a glimpse of the future of healthcare, just take a walk through downtown Las Vegas a few blocks from its famed strip.

In a nondescript office building on Bridger Avenue, you’ll find the Turntable Health medical clinic.

The facility has been open for a year and a half. It gives customers the option to pay a flat fee of $80 per adult per month to visit as many times as they need.

Inside, there are doctors, but there are also health coaches, a yoga studio, and a kitchen that features cooking classes. All part of the monthly charge.

“We’re an innovative primary care ecosystem,” says Dr. Zubin Damania, the founder and CEO.

doctors

You can also step into the future, as well as the past, by going to a website that proudly proclaims “The House Call Is Back.”

Heal offers an iPhone app that lets you request a doctor to come to your home.

Within an hour, a physician and a medical assistant will arrive to examine you or your sick child, perform blood work or other tests if needed, and authorize a prescription if it’s warranted. All for $99.

The service now operates in Los Angeles and San Francisco, with plans to expand.

“We’re bringing medicine to people’s homes,” says Dr. Renee Dua, the company’s founder and chief medical officer.

Turntable and Heal are just two examples of the rapidly changing healthcare industry in the United States. In the next five years, where and how Americans get care will look a lot different than it does today.

Doctors’ offices will still be around, but they are going to change dramatically.
Kurt Mosley, Merritt Hawkins consulting firm

Driven by high healthcare costs, new technology, and an impending doctor shortage, the country’s medical industry may see its biggest changes since Medicare and Medicaid were approved in 1965.

“Doctors’ offices will still be around, but they are going to change dramatically,” said Kurt Mosley, vice president of strategic alliances for the Merritt Hawkins physician search and consulting firm.

Ron Vance, a managing director in the healthcare division of the Navigant consulting firm, also sees change coming, though he thinks it will arrive a little more slowly than predicted.

He said the Affordable Care Act is pushing some of these changes, but they also started before Obamacare was signed into law.

“We’re going to see an increasingly different landscape in the healthcare field,” Vance said. “It’s the continuation of a trend.”

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Where You’ll Go for Treatment

In 2020, chances are you won’t go to a traditional doctor’s office if you have the flu.

Your visit to your family physician may be at an urgent care center when your doctor has time between other duties.

Or it might be at a hospital-owned medical facility where a group of doctors work.

Or at the local Walgreens or CVS pharmacy.

Mosley predicts that in five years the number one location where people will get medical attention will be at pharmacies and other retail centers.

He notes that in 2007 there were 1.4 million patient visits to retail centers in the United States that offered healthcare services. In 2010, there were 4.1 million patient visits. And the number keeps growing.

At these centers, a nurse practitioner deals with issues for which people now go to their doctor or perhaps even the emergency room. The ailments range from a hacking cough to strep throat to a swollen wrist or an ear infection.

doctors

Mosley adds that these places are also dealing more and more with people who have chronic conditions, such as asthma or diabetes.

Mosley points out that 50 percent of the $3 trillion the United States spends each year on healthcare is spent on 5 percent of the population. Much of that $1.5 trillion is spent on chronic care patients.

Mosley believes the retail centers will significantly reduce that cost because they will provide the care for less money out of pocket, so patients will visit before their ailments become expensive crises.

“We have to do something to keep from coming back to the hospital,” he said.

Vance agrees. He says clinics at retail centers and other places will force the industry to become more efficient and cost-effective.

“They’ll have to do more with less,” he said.

Those who don’t go to Walgreens may see their doctor in an urgent care center or the wing of a large hospital or medical group facility.

The Physicians Foundation released a survey it did of its members in fall 2014. More than 20,000 doctors across the United States responded. This wasn’t a scientific study, but the organization said it did reveal some trends.

About 35 percent of the respondents said they own their own independent practice. That was down from 49 percent in the foundation’s 2012 survey and 62 percent in its 2008 survey.

About 53 percent of the doctors described themselves as hospital or medical group employees. That was up from 44 percent in 2012 and 38 percent in 2008.

Things are going to change a lot. We’re going to have fewer and fewer small practices.
Dr. Ripley Hollister, Physicians Foundation

“Things are going to change a lot,” said Dr. Ripley Hollister, a Physicians Foundation board member and a family medicine doctor in Colorado. “We’ll have fewer and fewer small practices.”

Hollister said that trend is already apparent in more urban areas. He expects it to spread to less populated areas in the next few years.

Hollister says there are a number of factors pushing this change, including the Affordable Care Act’s mandates for insurance coverage and the recent changes in Medicare payments.

Dr. Alice Chen, the executive director of Doctors for America, sees three other factors driving physicians from solo practices.

One is that medicine is a more complex business than it used to be. Second is medical schools don’t train students to own a business. And third, the technological challenges, such as electronic record keeping, which can be overwhelming for a single practitioner.

“Medicine is like a lot of other industries where larger institutions are gobbling up smaller ones,” said Chen, who is a practicing internal medicine hospitalist at the UCLA Medical Center.

From Reactive to Preventative Care

Once a patient arrives at their destination, the type of care they get will be different from what they might receive today. Experts say the healthcare industry is swiftly moving toward providing better preventative care.

Part of the movement is driven by the Affordable Care Act, which stresses prevention. The other is that preventative medicine is less expensive and saves time in the long run.

Facilities like Turntable Health in Las Vegas have already adopted this model.

Damania says treatment at his facility is a team-based approach, with a health coach at the helm. Doctors and other medical professionals will not only treat a patient’s problem, they’ll assess how best to keep it from happening again.

Does the patient need a different diet? Do they need more exercise? What stress can they avoid?

The idea is to keep you healthy and that takes a team.
Dr. Zubin Damania, Turntable Health clinic

“We have aligned the financial incentives. We get paid a flat fee to keep you healthy,” said Damania. “The idea is to keep you healthy and that takes a team.”

The idea is also part of Heal’s medical app. Dua said their house calls put medical professionals in a person’s home where they can see their entire environment.

Is the air circulation adequate in the house? Are there fast food bags on the dining table? Is there a lot of dust on the floor?

Dua said her doctors like this model because it gives them more time with their patients. Basically, quality of care over quantity.

“The big thing for them is not having to rush,” said Dua. “And they are able to see what their patient’s home life looks like.”

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Technology Pushes the Envelope

Technology like the Heal app is also pushing a lot of changes in the industry.

Mosley points to some of the new gadgets that are already making a difference. One is the polymerase chain reaction (PCR) machine that was used in Dallas on an Ebola patient who eventually died.

Mosley said these types of machines can diagnose pathogens from a DNA swab, eliminating the need to draw blood, as well as saving time.

“Treatment will be decided before you leave the exam room,” he said.

Telemedicine is also altering the playing field. More and more, patients will be able to video chat with doctors or take photos of their rash or bruise on their mobile devices and send those to the clinic. Kaiser Permanente already has a humorous television commercial promoting this service.

[Patients] won’t be coming in at all unless there is something that needs to be checked.
Ron Vance, Navigant consulting services

There are also hand-held devices that can detect viruses. Automakers are developing cars that take your blood pressure and heart rate by placing your hands on the steering wheel. And of course, there’s the Apple Watch.

“A lot of people won’t even be going into the doctor’s office,” said Mosley.

Vance said the telemedicine trend is already under way. He said the biggest change will probably be tasks such as blood work that patients will be able to do from home and then send to their doctor via their mobile device before they arrive at the office.

“People will be able to do health checks themselves,” said Vance. “They won’t be coming in at all unless there is something that needs to be checked.”

‘Now Is a Perfect Storm’

There are still a number of serious obstacles doctors will have to hurdle as the industry transitions. One of the biggest is the projected shortage of providers.

The Physicians Foundation survey predicts there will be a shortfall of 65,000 primary care doctors in the United States by 2025. An equal number of specialists may also be needed.

The system will also have to deal with the ever-rising number of Medicare and Medicaid patients. Every day, 11,000 baby boomers turn 65 and become eligible for Medicare.

In addition, more than 5 million people have signed up for Medicaid since the Affordable Care Act went into effect. That number may be reduced if the U.S. Supreme Court strikes down government subsidies for Obamacare in a ruling expected in June.

Already, many doctors are restricting how many of these patients they treat.

In the Physicians Foundation survey, 25 percent of the doctors said they don’t see or limit their number of Medicare patients. That figure was 8 percent in 2012. Another 38 percent limit or don’t see Medicaid patients. That’s up from 26 percent in 2012.

Vance said there is also a “generational crossroads,” in which doctors who’ve been in the business for awhile are reluctant to change while younger ones new to the field are more willing to do things differently.

Now is a perfect storm. Now is the perfect time for something like this.
Dr. Zubin Damania, Turntable Health clinic

“The question will be how are we going to break this culture and cross that bridge?” he said. 

Those on the cutting edge of healthcare changes say the industry needs to change with them. 

“This is an uphill battle, but it’s a battle we have to fight,” said Damania of Turntable Health. 

He said there’s a move toward an entirely new standard, where quality of care is highlighted, visits to the doctor are more flexible, and payment systems are more reasonable.

“Now is a perfect storm,” said Damania. “Now is the perfect time for something like this.”

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