The Evolution of Primary Care: Part 4

Delivery of primary health care services in the U.S. used to involve a physician and a patient. The physician would see the patient in a clinic, conduct an examination, enter notes in a paper record, prescribe a follow up appointment, and say goodbye until the next scheduled visit. Usually this process occurred within a 15-minute window arranged by the physician’s front office staff. Although this type of health care visit still occurs, it is fast becoming an exception to the new rules of primary care. This column, the fourth in a series on the players changing primary care, focuses on non-physician health care providers.

One of the targets of change in the evolution of primary care is the 15-minute visit. This is because many find visits this short do not allow enough time to provide comprehensive health care. With the population of patients suffering multiple chronic diseases growing, physicians must solve more problems, provide more diagnoses, and prescribe more care. These increasing demands squeezed into a quarter hour or less make many primary care physicians feel like they are “hamsters running on a treadmill.”

To feel less like a hamster, increasing numbers of primary care providers are turning to a new payment model. Rather than accept traditional fee-for-service reimbursement these providers are taking up-front service charges for future health care needs. This payment model is called “retainer,” “concierge,” or “boutique” medicine. A successful example of this retainer-based health care is Qliance Medical Group in Seattle, WA. At Qliance patients pay a monthly cash fee to reserve access to same day visits, routine tests, and most outpatient health care services. Qliance does not bill insurance nor does the retainer cover higher-cost services like ER-visits.

The Qliance model has been widely successful throughout the United States. Retainer-based health care service allows providers to spend more time with patients and abandon the traditional 15-minute rush job. Patients like the model as they receive more attention from their doctor and easier access to the clinic. This has encouraged increasing numbers of physicians to increase their retainer care practices or opt for this model entirely.

While some patients and physicians appreciate the increased access allowed in a retainer model, this type of primary health care also has critics. Next week’s column will examine some of the impacts of retainer care and why some adamantly oppose these practices.

Click here, here, and here for other entries in this series on the evolution of primary care in America.

Photo credit: Biology Big Brother - flickr