Concierge medicine can complement health care reform in Oregon: Guest opinion

By John R. Braddock | By Guest Columnist | February 09, 2013 | As the state’s primary care doctors prepare to accommodate thousands of new patients as part of health care reform, record numbers of them are choosing to operate outside the system, providing “concierge medical” services directly to consumers on a prepaid, membership-fee basis. It has been about a year since a colleague and I opened a concierge medical practice, and I thought our experience might provide insight.

While the average primary care physician maintains a practice of between 1,500 and 2,300 patients, concierge practices limit capacity to fewer than 1,000 patients per doctor. As a result, each patient is afforded unlimited, 24/7 access to his or her personal physician — by phone, by email or in person. Some concierge practices also provide a suite of executive-style health exams, customized nutrition plans and support from fitness specialists that aims to ensure holistic, preventive care for their members.

My father was a general practitioner when doctors still did house calls, interacted at length with patients and dispensed advice on all relevant health matters. Most primary care physicians would prefer to practice medicine like that today and provide comprehensive services, but they simply don’t have the time or resources to do so.

An estimated 30 million Americans will enter the nation’s health care system in the next 12 months, many of them purchasing insurance for the first time through exchanges. The rapid influx of patients will overrun primary care doctors, who already are in short supply. Meanwhile, only 5 percent of current medical students plan to enter primary care, and one-third of currently practicing primary care doctors say that, over the next five years, they expect to limit their activity or leave medicine altogether. Last year alone, more than 400 primary care practitioners in the U.S. converted to a concierge model.

How can this trend benefit the system?

In the long run, having an active concierge medicine practice network in our country will raise quality of care, improve outcomes and, for many, help detect more cases of potentially serious disease before they develop. Most concierge medicine practices are proactive in treating diseases, not reactive, as our current system so often is. The best medical problem is the one well-avoided.

Patients have told us for some time that the current health care system is simply not accessible. In fact, even people with good health insurance are subjected to increasingly disjointed, episodic care, as opposed to the coordinated, collaborative, holistic version that has proved to work best.

In a perfect world, everyone would receive access to better primary health care. But as we transition to this new system, the reality is that some people will pay extra for access to their primary care doctor. I am hopeful that as the market for concierge services expands, fees will come down. In the meantime, it seems that an Oregon health care system committed to a patient-centered version of primary care would do well to emulate — or at least strive for — the standard being set by concierge medicine.

Physician John R. Braddock is CEO of SendantHealth, a West Linn-based concierge medical practice.


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