Concierge Medicine and efficiency
Updated: Jun 13, 2020
Efficiency is defined as solving problems using the least number of steps, in the least amount of time.
The fee-for service model is how most doctors are reimbursed in the United States. If you have a medical problem, this model can be very inefficient. It incentivizes the doctor to draw you into their office for a face-to-face visit; an office visit is the only way to bill insurance. Yet, once you are in the office, the Fee-for-service model disincentivizes the doctor to diagnose and treat your problem. He gets his small office fee whether he solves it or not. He is not rewarded for spending extra time, nor does he want to take on the medical-legal risk of diagnosis and treatment.
The Fee-for-service model incentives doctors to draw you into the office, but not to diagnose and treat your problems.
This is quite unfortunate, as the majority of medical problems are common problems. They make up a short list that includes: headache, backache, fatigue, cough, nausea, diabetes, and high blood pressure. These problems may take more than a ten minute visit to properly address, but they are well within the scope and training of a primary care doctor.
The majority of medical problems are common problems.
Instead of handling these common problems, the fee-for-service primary care doctor offloads the work and the risk by referring you to a specialist. This delays diagnosis and treatment by exposing you to additional time-consuming visits and testing, and to the bias of the specialist. Specialty care is extremely important in medicine; however, specialists are professionally, legally, and financially incentivized to aggressively diagnose and treat you. For common problems, this can be inefficient and even potentially dangerous.
Referral to specialists delays diagnosis and treatment, leads to additional time-consuming visits and testing, and exposes you to the bias of the specialist.
Concierge Medicine model
The Concierge Medicine model, based on an annual fee, rewards me for solving your problems - and solving them efficiently - not for the number of face-to-face office visits I rack up. I want to make the best use of your time.
We can skip the office visit if it's only purpose is to bill your insurance. For instance, you don't have to come in to review blood tests when this can be conducted over the phone. If you have a rash, send me a picture. To review your blood pressures, text me your latest Bluetooth blood pressure cuff results. I try to employ technology and telemedicine whenever and wherever possible.
We can skip the office visit if it's only purpose is to bill your insurance.
I do not punt common problems to specialists. I take them on directly. We have a lot of time to spend together to thoroughly investigate them; more time than specialists. Consequently, diagnosis and treatment are accurate and come without delay. Unnecessary visits to specialists, with unnecessary testing and unnecessary treatments, can be avoided.
Common problems are diagnosed and treated without delay.