Today’s Managing Health Care Costs Indicator is 2006
The American College of Physicians produced a white paper in 2006 stating that primary care medicine in the United States was facing a ‘grave threat of collapse.’ It’s estimated that there might be 35,000 to 44,000 too few primary care physicians in the US by 2025, and primary care physicians already feel that their workload is overwhelming. Primary care is a foundation for health care reform, but it’s badly broken.
Here are two anecdotes that I’ve heard recently that demonstrate some of what’s wrong with primary care. A colleague complained to me that her primary care physician threatened to “cut off” her supply of an asthma preventive medicine because she had not been in to the office for over 12 months. At almost the same time I heard from a Medicare-age relative that she called her primary care physician for severe abdominal pain on a Friday morning, and was offered an appointment on the following Wednesday afternoon.
The first example –a physician was gumming up her schedule with a value-destroying appointment for a highly motivated patient who was herself controlling her own chronic disease. She was likely doing this because in a fee-for-service world there is no compensation for calling in prescriptions – and no good mechanism to track health care maintenance unless patients physically visit the office. In the second example, a non-clinical worker was performing triage. The patient felt unvalued, her needs were not met, and she is likely to need emergency-setting that could have been avoided.
I’m happy to report that I’ve started a new professional chapter -- I’ve joined One Medical Group (www.onemedical.com) as the Chief Medical Officer as of March 1.
One Medical is the brainchild of Dr. Tom X. Lee, a founder of Epocrates, the mobile medical and pharmaceutical reference tool used extensively by physicians around the world. One Medical offers same day appointments and longer appointments, and is committed to sharing information with patients electronically. The practice has built its own dedicated medical record which better supports the needs of primary care clinicians and patients – and promotes efficiency and higher quality. Patients can book their own appointments – no need to go through triage by a nonclinician.
One Medical has an iPhone app that patients with acute illnesses can use to determine whether they can avoid an office visit. A young woman with symptoms of a urinary tract infection can answer the app’s questions, and if appropriate a virtual medical team nurse practitioner or physician assistant can call an antibiotic in without an office visit. The management team has extensive retail experience, and has focused on how to “delight customers,” not merely meet the minimum requirements to participate in health plans. The practice has an annual membership fee of under $200, and currently has offices in San Francisco, Washington DC and New York, and is growing in its existing geography and coming to new cities in the future.
One Medical was featured in the New York Times last year.
I’m excited about this new role, and the team of clinicians and non-clinicians which I’ve joined. You’ll probably see me focusing on some additional primary care issues, and of course I welcome your comments and thoughts. The blog continues to represent my personal point of view.