Sunday, December 3, 2017

Total Transparency - Our Practice, Delaware, and Primary Care

We at Progressive Health remain committed to our patients and their long term welfare.  Our mission will always be to "add years to your life and life to your years".

But for economic reasons, some big changes are coming to our practice.

You might be aware that numerous primary care practices in our market have gone concierge or closed.  Concierge means that patients must pay as much as $1600 per year to continue to be patients of the practice.  Each time another practice does this, thousands of folks are left without a doctor, and must scramble to find one.  For years now we have seen a seemingly endless stream of new patients seeking to join our practice.  That is wonderful because we enjoy meeting the many great people.

But the increasing load has taken its toll.

We face big personnel changes in our practice.  In the first quarter of 2018, we will lose 2 or more of our physician assistants.  I see this as part of the national crisis in provider satisfaction that plagues our health care system.  Throughout the country, doctors and providers face burnout, depression, and growing rates of suicide.

We are actively seeking Nurse Practitioners, Physician Assistants, and primary care docs to join us.  But it is not easy to find providers.  Zero of the 16 graduating internal medicine residents from Christiana Care will go into primary care, for example.

In almost every market outside our own, private insurers pay doctors at or above what Medicare pays.  Nationally, struggling primary care offices look at Medicare and Medicaid as the cheapskates, and will sometimes eschew such patients for the more lucrative privately insured.  In Delaware the commercial payers are even worse.

In our market, private insurers have played hardball with private primary care practices, and give themselves a big discount.  Private insurers in Delaware reimburse at 69% - 86% of Medicare.  Less than what Medicare pays!  This is almost unheard of in our country!
They pay the big hospitals above Medicare rates.  So there is far from a level playing field.

Imagine taking a small business with tight operating margins and cutting 20-40% off the top.

It is hard to fathom why private insurers would do this.  A large body of research shows that spending on primary care reduces overall health costs, whereas spending on most other things (specialty care, hospitals, testing facilities) increases cost.  Most places in the US spend on primary care less than half of what is recommended for a good health care system.  In Delaware it is much lower than that.

Compared with the large hospital systems, we believe that our practice offers a fresh perspective.  We are the only lifestyle medicine practice, and we spend considerable time and effort on helping people reverse their chronic conditions through an improvement in diet and exercise.  We offer some innovative services, the likes of which are not offered by anyone else in our region.  For example, since 2016 we have run the Cure Diabetes Program.  This is a 6-week program designed to fix the underlying cause of type 2 diabetes, and rid folks of their need to take medicines.  This program has had huge success.

So our practice, I believe is a shining example of private enterprise at its best.  Innovations like these have never come to fruition through our region's large health systems.  But it is hard for us to offer these programs, much less expand them, if we are constantly in a state of financial trouble because of low reimbursement rates.

What can you do?  There's a lot actually

  • Refer to us any PAs, NPs, RNs, certified health coaches, or physicians that you know who want to work in our friendly and lifestyle-focused practice
  • Contact your Delaware state representative AND state senator.  Tell them that we need legislation to require commercial insurers to reimburse primary care doctors at least what Medicare does, and preferably the higher amounts that are recommended by health care experts.
  • Understand that Progressive Health of Delaware will change.  We will have new personnel.  It might be harder (at least in early 2018) to get a super timely appointment.  We will try new practice models designed to involve others besides us docs in the care of patients.  Often these nurses and health coaches bring something new to the table, so there is a likely win-win here.
  • If we ever do go concierge (we are trying not to!), then please know we did it as a last resort, to stay in business.



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