By Terry Bauer, CEO, Specialdocs Consultants
Twenty years may seem like an eternity in an industry as rapidly evolving as healthcare, where today’s brightest innovations can quickly become yesterday’s failed experiments. So, as concierge medicine begins its third decade, it’s certainly worth considering the remarkable upward trajectory of the practice model.
While the healthcare landscape continued down the path to dysfunction, concierge medicine has moved from a niche concept to a mainstream movement due its core value propositions:
- Physicians have the time and availability to build meaningful relationships with their patients
- Physicians can focus more on preventative care and patient wellness
- Physicians experience more autonomy, a better work-life balance and avoid burnout
The model’s value is verifiable, supported by a growing body of data that clearly points to the success of the concierge medicine approach on every level, from every perspective.
In just the past year, several pivotal reports illuminated why the concierge model enables physicians to practice medicine at its highest level while benefiting patients, insurers and the healthcare system itself. I’d like to share some highlights with you.
Time: medicine’s most precious commodity
“We must stop equating testing with caring and thoroughness, and instead, emphasize respectful listening, examination, follow-up and collaboration with the patient to ‘coproduce’ diagnoses.” – Annals of Internal Medicine, October 2018
A diverse group of clinicians, educators and health policy experts created 2018’s well-documented “Ten Principles for More Conservative, Care-Full Diagnosis,” pinpointing time as medicine’s most precious commodity.
According to the study published in the Annals of Internal Medicine, accurate diagnoses and optimal care depend on time to listen, observe, explore symptoms in detail, discuss and reflect – a philosophy that fully reflects the foundations of concierge medicine.
Individual time with patients, in ever-shrinking increments at traditional medical practices, is identified as the decisive factor that separates good diagnosis from under diagnosis and over diagnosis.
The authors maintain that both direct and downstream harm can be caused by excessive diagnostic testing, which include adverse reactions and complications to unnecessary treatment of false-positive test results and asymptomatic risk factors, and labeling patients with conditions that may never cause suffering.
In a time when so many people are striving to age gracefully or cope with multiple chronic conditions, this thoughtful and conservative approach to diagnosis is essential and physicians are increasingly aware that a concierge practice provides one of the best opportunities to care for patients in this way.
The real key to better care
“The fact that the doctor is hearing what you are saying and cares about you and understands what you are going through makes coping with the illness and the implications of the illness that much easier.” – Dr. Don Barr, Stanford Medical School professor, on the impact of letting his patients speak without interruption
Time was also of the essence in an August 2018 New York Times article which asked the provocative question “Should You Choose a Female Doctor?”, citing studies and interviews showing that female doctors tend to listen more and their patients fare better as a result.
A closer look, however, revealed the difference was not as much about gender as in taking the time to really listen to patients, fully discuss their concerns and form the deep and meaningful relationships that are the gold standard of a concierge practice and nearly impossible to achieve in a traditional fee-for-service model.
The hidden healthcare system
“I don’t conform to what the hospital wants, I do what’s best for the patient.” – Orthopedic surgeon Kevin Koth, MD, commenting to the Wall Street Journal on being named in an anti-trust lawsuit for referring patients to a rival hospital
One of the reasons for the soaring costs of our country’s healthcare system was laid bare in a recent Wall Street Journal article, which revealed the challenges experienced by employed physicians who are frequently mandated to keep in-house lucrative referrals for specialists, surgeries and MRIs – even if an outside referral might benefit the patient.
The referral mandate can mean a smaller pool of potential doctors, lack of choice and higher out-of-pocket costs for patients. According to the Journal and the Health Care Cost Institute study, the same procedure often costs twice as much or more when delivered in a hospital setting, compared with a doctor’s office.
In contrast, concierge physicians who remain independent are not obligated to follow hospital directives, giving them the freedom to make referrals based solely in the best interests of the patient.
Rise of the wellness economy
“Addressing wellness is foundational to the health of our society, the success of our companies and the stability of our households. It’s not an afterthought or miscellaneous expense; it’s a strategic imperative.” – Paul Keckley, healthcare policy analyst and editor of the widely-read Keckley Report
In his insightful end-of-year report, healthcare analyst Paul Keckley posts that consumers have created the current “wellness economy,” a $200 billion market that’s growing at a rapid clip, spurred by rising awareness of the benefits of a healthy lifestyle. Ranging from diet programs, fitness facilities, wearables, vitamins and supplements to alternative care, genetic testing and self-care smart phone apps, the quest for wellness requires attentiveness to the whole person – defined by the National Wellness Institute as emotional, occupational, physical, social, intellectual and spiritual health, says Keckley.
Integrating wellness with primary care through proactive prevention and expert management of chronic diseases – a hallmark of concierge medical care – is increasingly recognized by payers for its value in preventing hospital admissions and avoidable complications. For concierge medicine patients, it’s a very real affirmation of the investment they’ve made in their long-term health by becoming members of a practice distinctly focused not just on treating illness but restoring and maintaining wellness throughout their lives.
It’s worth noting the considerable progress made in just 10 years, when Harvard professor and thought leader Clayton Christensen noted in his influential 2008 book The Innovator’s Prescription: A Disruptive Solution for Health Care: “There are more than 9,000 billing codes for individual procedures and units of care, but there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”
What will the next 20 years bring in terms of change inspired by technology, advanced testing and clinical breakthroughs? We may well be talking about the expansion of robotic surgeries, diagnoses made through artificial intelligence (AI) and precision medicine that lives up to the promise of its name.
Regardless, I am confident that we will continue to put increasing value on what concierge medicine offers: physicians who take the time to fiercely advocate for their patients, listen to their stories and use that knowledge to keep them in the best of health. It has been the driving force behind every one of our Specialdocs transitions in the last two decades. That will never change.
Terry Bauer is the CEO of Specialdocs Consultants. Terry’s vision of concierge medicine as an innovative and sustainable model for healthcare’s future began in 1999 when he first learned of the business from industry pioneers, and his interest in the sector continued to grow over the years. Learn more about Terry.