Back to the Basics of Patient-Centered Care

The United States faces a serious shortage of primary care physicians — and the problem is only getting worse. In fact, according to the Association of American Medical Colleges (AAMC) Center for Workforce Studies, there will be 45,000 fewer primary care physicians 10 years from now than there are today as droves of high-quality physicians leave the practice environment for early retirement and alternative careers in health care.

Current primary care physician landscape
For independent physicians, the landscape is particularly daunting due to consistent reductions in Medicare reimbursements, the aggressive expansion of hospital systems into primary care, Accountable Care Organizations (ACOs), and the price and service-level competition from “big box” retailers such as Walmart and Walgreens.

Meanwhile, against shrinking supply, the demand for primary care physicians has never been greater. The Census Bureau projects a 36% increase in the number of Americans over age 65 requiring primary care. As more of our citizens are insured, their expectations of access to high-quality primary care further swells.

This supply-demand imbalance is particularly troubling given that the central construct of any responsible health care cost containment proposal hinges on high-availability and coordinated primary care. And yet, the payment mechanisms and reimbursement structures in place for primary care are so geared towards volume and episodic care that many physicians are struggling to stay afloat.

How to best address the shortage
In most situations, when supply and demand are seriously out of balance market forces begin to exert influence on the players involved. In health care, with reimbursement policy often dictated by third parties far removed from the actual delivery or receipt of care, realignment is more difficult to achieve.

Primary care doctors have been forced, via shrinking reimbursement on a unit-driven payment model, to serve as high-volume triage referrers to specialists. This model of care is contrary to how primary care physicians are trained to practice medicine.

Alternative models of primary care are emerging that simplify the administrative burden, allow physicians to practice medicine at the top of their license and shift the focus away from navigating increasingly complex insurance to patient-focused care. Seeking to refocus their time and energy on patients, some physicians have begun to practice alternative models of care.

One model for reprioritizing the doctor-patient relationship is a membership-based practice. Membership allows physicians to charge an affordable monthly, quarterly or annual membership fee to enjoy a deeper, more robust relationship with a smaller patient panel. Patients take advantage of extended means of communication outside of the office via simplified technology solutions, such as secure email and text messaging, while also being able to have a more robust, collaborative relationship with their physician. Emphasis is placed on preventative care over the episodic, “sick care” model many physicians are being forced to practice due to the constraints of the reimbursement model.

Physicians who operate a membership-based practice still accept insurance but charge an affordable membership fee structured for individuals, couples and families, and they are less reliant on a broken unit-driven payment model.

Membership gains
Alternative models of care are crucial to reenergizing primary care. The status quo for primary care practices limits the extent to which physicians can fully practice patient-focused care. Medical students looking to get into primary care may be attracted to the work-life balance that alternative models such as membership-based practices offer, given that the level of care is congruent with how physicians were trained to practice medicine.

For physicians driven to the brink of retirement by a shrinking reimbursement structure and a frustrating administrative landscape, alternative models may be the difference between leaving primary care and continuing to practice medicine. For medical students who have the desire to deliver the patient-focused care they were trained in, a membership model makes this possible.

Physicians wanting to maintain their practices will need to be proactive in exploring alternative avenues for success. Some may consider selling to a hospital or health system but many will strongly consider viable, patient-focused models such as membership.

Listen to these two podcasts with Steve on this topic:
Transitioning to a Membership-based Practice: Part One
Transitioning to a Membership-based Practice: Part Two

Steve Wigginton is the CEO and co-founder of Medley Health, a provider of membership-based practice marketing and communications services. Steve can be reached at (925) 452-2800.