Thursday, April 17, 2014

Concierge Practice, Maximum Direct Pay and MedAccess USA

Concierge and direct payment models are becoming more common for practices.

Now that the ACA seems to have started, without any reassurance that it will be solvent for long, the rest of us can remain creative.

Some PCPs are not waiting for the government or insurers to catch up to the reality of how their daily practices are run.  Dr. Tom X. Lee is meeting patients demand for a  high-tech,  high touch doctor visit designed for  'One Medical Group" The group was formed in 2005 near San Francisco and rapidly expanded to it's present size of 27 sites, the most recent one in Los Angeles, CA.  The group has been described as concierge medicine without the concierge price tag.  Lee describes it as a completely re-engineered doctor's office.  Lee says concierge is really designed for affluent people, our system is designed for everyone.  It's a primary care system focused on delivering higher-qualitycare and service at lower cost. We manage that through overhead reduction and support systems.
The support systems are proprietary technologies Dr Lee helped develop. Patients pay an annual $199 membership fee to support noncovefred services that are coverfed by technology.  They utilize a patient portal to make appointments, or using  the One Medical app.Patients may email their physician, look up lab results, request Rx Refills, all from a smartphone.

Traditionally the way a  medical practice evolves is the office starts off simple, and then grows through administrative and clinical complexity, they hire staff and layered process on top of process, continuing to use legacy systems, such as fax and paper which are less efficient in today's world of technology.  

Using technology is no longer an option, those who do not are going the way of the dinosaur. Lee states that incorporating the system reduces physician support from 4  employees to 2.

Current business models only allow for ten minute patient visits, much too short to diagnose and/or treat a patient. In the office time is the missing ingredient. The new system allows a patient volume of about 15-16 patients/day. This eliminates the FFS necessity for volume and replaces it with the new paradigm of value based care, prominently proposed for the affordable care act.

In 2006 Jay Parkinson, M.D. was a pioneer for the use of electronic health records and HIT in starting a new general practice in Williamsburg, N.Y (Brooklyn).Beginning fresh after residency training he was able to use the technology without any legacy records, or organization with multiple layers of administration.  He essentially runs a one man general practice to make house calls. He forged new ground working from home and a very small office using an online app and portal plus message. His goal was to deliver home care.  Today the HIT apps have become pervasive and have leveraged his time and scaled the method.

Forbes named Lee as one of the 12 most disruptive business names in business in 2013.  He is known for his development of Epocrates while earning an MBA from Stanford University. The success of Epocrates attracted $77 million to invest in One Medical.

The One Medical paradigm is also applicable to other specialties, such as oncology, and hematology. For a multiple doctor group it is essential to communicate and decide on a uniform treatment protocol, especially in a specialty such as oncology, where chemotherapy drugs are expensive and many protocols for multiple agents exist.

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