Wednesday, October 18, 2006

boutique medicine

Marketwatch reports on Boutique Medicine:

Taylor was seeing as many as 35 patients a day but his business was struggling after a five-doctor practice he was part of disbanded. So he contracted with MDVIP, a company based in Boca Raton, Fla., that helps doctors transition to boutique practices.
"What convinced me to try it was I tried everything else," he said. Now he's winnowed his patient base to 425 from a high of nearly 4,000 and sees "anywhere from eight to 15 at the most on a very busy day."
Such a reduction often translates into longer and same-day appointments, extensive physicals, better coordination with specialists and more follow-up as well as a greater emphasis on preventive care. Taylor's staff of two, for example, is able to keep track of which patients taking cholesterol medications are due for blood work and call them.
"Patients are happier; I'm happier," he said. "I've got more time to devote to each problem a patient has. I feel much more comfortable and confident about what I do."

Physicians want to regain control of their schedules and are frustrated that they still have to spend so much time wrangling with insurance companies after years of pushing for systemic changes, he said.
Retainer practices also cater to some patients' desire to check out every health risk factor and has evolved as an alternative way to navigate the system, Caplan said.
"It's there because the current health-care system is broken and we actually have to pay people to talk to us," Caplan said. "You're buying back personalized medicine, a relationship with somebody, because the current business model has weeded that out."

"It's a tiny drop in a huge ocean," Plested said. "The economic reality and demographic reality is there aren't that many areas that will support this type of practice."
Still, retainer practices point to an uncomfortable truth, Caplan said. "It undermines one of our favorite myths, which is same quality of health care for all. That's never been true, but this rubs our nose in it as a society."

It's hard to practice high quality medicine in a primary setting. PCP's need to see too many patients in too short a time. Fortunately, in my specialty (sleep medicine), I am able to subsidize patient visits with income from sleep studies. The generous reimbursement for sleep studies allows me to spend more time with patients.


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