Blog | Thursday, January 9, 2014

Retainer medicine as a potential primary care solution


A recent article in the New York Times includes a rather sensationalist article about high end concierge medicine, Enhanced Medical Care for an Annual Fee Writing stories about $25,000-per-year concierge medical service provides great sensationalism, but in many ways detracts from an alternative payment model that we should take seriously. I believe that the Affordable Care Act does allow for retainer medicine with catastrophic type insurance.

I believe the concierge, high-cost practices detract from an interesting primary care model. Many experts have written about the problems of our current payment system, which devalues time spent with patients. My personal interviews with some retainer based physicians suggest that their main goal is to deliver the highest quality care to their patients. Obviously, if the patients do not believe that they are getting their money’s worth, they can just leave the practice.

What is the essence of excellent primary care? One could argue, and obviously I will argue, that spending adequate time with patients and using that time to carefully address the patient’s issues and their diseases allows for the best primary care. The best primary care limits unnecessary testing and unnecessary consults through careful history, physical and thinking!

My acquaintances often describe physician excellence through comments like “She really listened,” “He spent time talking with me,” and “She returned my calls promptly”. Retainer medicine, sometimes called direct primary care, places the patient and the physician into a mutual relationship. The physician provides transparent fees and the patient gets access: visits as needed, telephone consultations and usually text or e-mail access.

Patients deserve this brand of high touch, high quality care. If one takes the insurance companies and their induced overhead out of the physician’s office, the costs can be relatively modest. Qliance in Washington State gives such an example.

We ignore the retainer medicine model at our peril. Perhaps this is a much healthier model for both patients and physicians.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.