Why the solution to the challenges of healthcare can be found in the exam room of a primary care physician
The woman in the examining room was suffering from several chronic conditions that she and her primary care doctor had difficultly managing. The doctor thought these illnesses should be under control and wanted to get to the core of the problem. So during a follow-up visit, they just talked. Over the next 30 minutes-a visit duration unheard of in most medical practices-the patient opened up.
“I’m going to tell you something I’ve never told anyone, even my husband,” the woman confided. She recounted a violent sexual assault on her when she was a child in Europe during World War II. She had repressed the memory for almost 70 years. Yet, it apparently lurked in the background, becoming the source of ongoing struggles. With this door opened, the woman and her doctor together were able to start on the path to recovery. Today, her difficulties are behind her.
Their shared tale serves as an example of how improved doctor-patient engagement can lead to the best possible outcomes. As practitioners, politicians, executives and consumers seek ways to improve healthcare outcomes and the patient experience, the model for many doctors is found in the place where it all begins: The doctor’s office.
Practicing medicine today, though, is not the same as when most of us left medical school. We graduated with dreams of preventing disease, helping people and making a difference in their lives. We know the key to improving health and wellness is creating an engaging experience that invites open dialogue between patient and practitioner. This encourages improved patient compliance and delivers more positive results at a lower long-term cost to the individual and the nation’s healthcare delivery system.
This way of practicing medicine is no longer possible for most physicians. With the daily demands and overhead of primary care, we must see more patients just to keep our doors open. Health executives call this increasing mean throughput; physicians call it burnout. Over 77% of physicians are pessimistic about the future of the medical profession and 58% would not recommend medicine as a career.
It’s no secret patients are increasingly frustrated. They talk about the “rule of threes- three months to get an appointment, three hours in the waiting room and three minutes with the doctor. This is only slightly exaggerated. The average office visit is only about eight minutes. You can’t delve into chronic conditions and prevention in eight minutes, much less explain cardiac inflammation, fat grams or carbs. Disease prevention is a whimsical fancy.
It’s no secret either that medical outcomes are worsening. Most of our healthcare costs come from preventable, chronic disease. But who has the time to coach patients and work with them to focus on healthy eating and exercise?
We have all the latest tools, but can’t deliver the most basic care. As some have said, “We’re in the Golden Age of technology, but the Dark Ages of delivery.” We have all these resources, but no time to utilize them to their highest and best use. Many physicians have the desire to deliver improved care, but don’t know how to manage the conflicting demands of delivering patient-centered care in what’s become a time-starved schedule.
Next: Personalized medicine is the solution
The solution for many is personalized medicine. In this model, doctors partner with patients to keep them healthy. We spend time discussing prevention and wellness, not just putting Band-Aids on chronic conditions or referring out to specialists.
By creating a practice model built on the physician-patient relationship and greater in-office coordination and collaboration across the healthcare continuum, practice innovators have witnessed increased patient engagement and compliance and reduced costs to patients, insurers and government providers alike.
For an annual fee that ranges from $1,500 to $2,200, depending on the provider, patients receive a set of non-covered services, screenings and interventions designed to identify risk, prevent events, encourage change of detrimental lifestyle habits and improve quality of life.
To be able to practice in this fashion, the patient roster is limited to a maximum of 600 patients. Each patient enjoys a 90- to 120-minute annual wellness visit similar to an executive style physical. This includes an exam, review and coaching for every patient. Follow up visits last 30 minutes. Under this calculation, doctors see eight to 12 patients a day.
Physicians benefit on multiple fronts. We enjoy financial stability in this uncertain time. We regain the freedom to practice the way we were trained. Our time, tools and technology improve our abilities and make us even more valuable to our patients than we were before. Partnering with a consultant or an organization who provides the resources to transition successfully to this model is critical particularly to ensure that your practice is compliant with all federal and state laws.
The model even improves national outcomes. Hospitalizations are down – by 79% in Medicare patients in one year and 72% in commercial patients. Readmission rates for common problems (Acute MI, CHF and pneumonia) are all under 2%, as compared to the national averages that range from 15% to 21%. Control of chronic conditions is better against all benchmarks and together, these saved the healthcare system over $300 million a year.
The patient benefits of a smaller size practice include same-day appointments, 24-hour availability, no waiting and a higher level of coordination of care. As a result, patient satisfaction tops 94%, with nine in 10 patients renewing annually. Moreover, physician satisfaction is over 95%.
With the right tools and model, we get to practice medicine the way we had been trained. We find the time to talk. We tease out buried details, identify issues, and become the hands-on healers we once were.
For their part, patients become more accountable and see real results.
Today’s patient-centered medicine and personal care models were developed to let us deliver care that’s not one size fits all. We’re able to focus on prevention and wellness so we can work with our patients to live healthier lives. Many physicians in this model were ready to leave medicine. Personalized medicine has reignited that fire they once held for medicine and has encouraged many of us to remain in practice.
Yes, healthcare is changing. So, too, is healthcare delivery. Doctors must be the change they seek.