The current Fee-For-Service (FFS) reimbursement model is controlled by the insurance payer and is designed to be billing-focused and not patient-centric. This reimbursement model, coupled with the high productivity patient visit goals, sacrifices quality of care and is causing many Primary Care Physicians (PCPs) to leave and fewer medical students to choose primary care.
While there are many reasons for the waning interest in adult primary care careers, it is driven primarily by the unsustainable primary care work life. Studies suggest that the difficult work life may be the most influential factor causing PCPs to retire or sell their practice early and discouraging medical students from primary care careers. Unfortunately, things are only getting worse for doctors who still practice in the traditional FFS model. Just processing the insurance forms cost $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of The University of Maryland Medical Center, who is writing a book about the crisis in primary care.
A recent article (“Why do I only get 10 minutes with my doctor?” by Dr. Schimpff) provides a description of the typical day in the life of a PCP. You call your PCP for an appointment and are told the first available appointment is three weeks out. You arrive on time only to sit in the waiting room for 40 minutes. Finally you get to see your PCP and you begin to explain why you are there. As always, you feel like you have to talk fast because time is of the essence. The doctor asks a few questions, does a brief exam, gives you a prescription and suggests you see the specialist. The total time with your PCP is 8-12 minutes. At the exit desk you are told you owe a $30 co-pay.
The article also noted that on top of seeing at least 25 patients per day, the typical PCP takes 24 phone calls, answers 17 emails, processes 12 prescription refills (above those handled during visits) and reviews 20 laboratory reports, 11 x-ray reports and 14 specialist consult reports. These administrative tasks are all done outside of the visit, take substantial time and are not reimbursed. As their patient load increases, the PCP has less time to determine the causes of your symptoms and cannot properly understand, diagnose and treat the condition. Prescription orders and referrals to specialists increase, which results in substantial frustration for not only you but for your PCP as well. While your PCP truly has your best interests in mind, to remain financially viable they must see an ever-increasing number of patients each day. In order to earn $150,000, a private practice PCP needs to generate $350,000 in gross billings. Given today’s average reimbursement per visit, the doctor has to see at least 25 patients per day. Said a different way, the PCP has to see 15 patients to cover expenses. All income above 15 patients goes to the PCP. So the PCP works for others until about 2pm. No wonder the visit is so short.
As one PCP put it:
I thought I was going to die, literally, if I kept this up. I could not give the type of care and attention that I felt was best for my patients, I could not be compassionate. All the things I treasured doing as a doctor had vanished.
There is an alternative - an alternative that is a fundamental change. Welcome to Direct Primary Care!