AAFP

NELSON, MD: “Designing Value into Your Direct Pay Practice, Part I – The Service Proposition”

By Direct Primary Care Physician | Advocate for market-based solutions & Patient-centered reforms | Entrepreneur | Writer | http://encompasshealthdirect.com/

"I believe we should work towards restoring these principles to preserve a really precious thing: the sanctity, privacy and respect of the direct, unencumbered Patient-Doctor Relationship. " Robert W. Nelson, MD -- Tel: 770-881-3906

“I believe we should work towards restoring these principles to preserve a really precious thing: the sanctity, privacy and respect of the direct, unencumbered Patient-Doctor Relationship. ” Robert W. Nelson, MD — http://encompasshealthdirect.com/

OCTOBER 24, 2015 – What do patients really want?  Most surveys, formal and informal, indicate that mostly patients want two things consistently above others: 1) To feel like they’ve been heard and, 2) to have access to their doctor when they need them. 

(we’re assuming here that the doctor is competent & quality is not an issue)

By being “heard”, I mean they desire meaningful & timely communication with explanations, not edicts.  They want to feel involved with their care, as opposed to being given direction.  By “access” I mean, an appointment sooner than a week from Wednesday.  The retail clinics are kicking our behinds in this category; we can do better.

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Certainly there are many skills and resources (and maybe even some apps) to help physicians (and their staff) communicate effectively and pleasingly to their patients; but assuming some of those skills and adjuncts, it is really about active/involved listening with a goal towards meaningful communication and problem solving.

In this article entitled Time and the Patient–Physician Relationship, the authors cite studies that found that time the physician spent in health education and the effects of treatment had an important bearing on patient satisfaction.  

And at the risk of using a citation that gets the “duh” award … in Great Britain, Morrell et al. and Ridsdale et al.  “both found a greater likelihood of patients feeling they had inadequate time with their physician in visits scheduled to last 5 minutes compared with visits scheduled to last 10 and 15 minutes, respectively.”  But it is nice to know there is a limit to how low a visit can go before it starts to impact satisfaction, which is also directly and indirectly tied to clinical outcomes.

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But the sad truth is, in a typical insurance-based practice that takes advantages of economies of scale, meaningful face-to-face time between doctor and patient is somewhere between 5 – 10 minutes.   Interesting, but totally surprisingly, shorter visits tended to result in more prescriptions being written.  From my perspective as a doctor, prescribing is usually a poor surrogate for good counsel and reassurance.

What do you get when you mix low overhead with high technology and wrap it around an excellent physician-patient relationship? You get an ideal medical practice – a practice model designed to enhance doctor-patient relationships, increase face-to-face time between doctors and patients, reduce physician workloads, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system.

The above quote was NOT from a Direct pay doctor or advocate, even though it precisely describes the attributes of DPC.  The quote is from: The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship  (very good article and worth the read time)

The above study was attempting to capture and categorize the Ideal Medical Practice, or IMP, which they referred to as a “micro-practice” model.   This study was published in 2007.  The micro-practice is consistent with the AAFP-led model of care and the patient-centered medical home concept, and is indeed a step in the right direction.

Notice how many of the characteristics of the IMP looks very similar to the characteristics of a typical Direct Primary Care practice.  Unfortunately, the micro-practice, with all its good attributes, was more of a surrender to the effects of third-party domination; as opposed to an alternative to our third-party system and one which facilitated these positive characteristics because they are intrinsic to its financial model, rather than out of necessity for survival.

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The Mark of an IMP (Ideal Medical Practice Model) ~AAFP, Fam Pract Manag. 2007 Sep;14(8):20-24.

The ability to provide exemplary service is a natural element that arises from Direct Primary Care and other direct-pay models, precisely because the recipient of care is also the main consumer of the care.

It is really that simple.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466945/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/#b3

http://www.aafp.org/fpm/2007/0900/p20.html

http://www.slate.com/blogs/future_tense/2013/08/05/study_reveals_doctors_are_spending_even_less_time_with_patients.html

Part II of Designing Value Into Your Direct Pay PracticeCounting the Costs, will be available soon

SOURCE: https://www.linkedin.com/pulse/designing-value-your-direct-pay-practice-part-i-robert-nelson-md?trk=hp-feed-article-title-publish

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