Primary care docs are getting ready for consumer-driven healthcare

In a NYT piece titled "Market Forces Pushing Doctors to Be More Available" from June 24th, we learn that many primary care docs -- those who practice family medicine, pediatrics and internal medicine -- are gearing up for a more competitive, consumer-centric world.

It is not just a matter of moving to a small town. Ms. Kissell's doctor, Melissa Gerdes, is one of a rapidly growing number of physicians who have streamlined their schedules and added Internet services, among other steps, to better meet the needs of patients. For physicians like Dr. Gerdes, it is simply good business.

Those doctors know that as walk-in medical offices and retail-store clinics pose new competition, and as shrinking insurance benefits mean patients are paying more of their own bills, family care medicine is more than ever a consumer-service business. And it pays to keep the customer satisfied.

"It's about the patients — making people well and keeping them well," said Dr. Gerdes, 35, who has had her own practice for seven years.

The doctors' professional associations are urging their members to adopt new technologies to increase the ease for patients to see them and to reduce costs.

The academy is spending $8 million on consultants who visit doctors nationwide to suggest improvements in patient care. The advice is meant to "keep them from going to an in-store clinic," Ms. [Amanda Denning, a spokeswoman for the American Academy of Family Physicians] said, while also benefiting doctors by making office procedures more efficient.

Meanwhile, the 119,000-member American College Of Physicians is promoting "patient-centric care," which it made the focus of a policy paper this year, calling for more consumer-friendly scheduling, electronic medical records and electronic prescriptions, among other measures.



Coming back to the featured physician, Dr. Melissa Gerdes of Tyler, Texas, there are some interesting changes afoot in her clinic that depart from conventional care, at least the care I got my whole life, which included waiting days if not a week to see a doctor from when I called (except at the Baylor Clinic, which has same-day appointments), waiting "forever" in the waiting room and again in the patient room, and having to pick up a paper prescription and take it to the local drugstore to get medications.

In Dr. Gerdes's office, the innovations include daily clinics at lunchtime called QuickSick, in which patients who have phoned up that morning can come in for routine problems requiring immediate attention, like an upper respiratory infection, and are guaranteed they will be examined, treated and on their way within a half-hour.

After a nurse checks the patient's temperature and blood pressure and types the symptoms into a computer, the doctor follows up with a brief exam. If medication is warranted, Dr. Gerdes can e-mail a prescription that will be ready when the patient arrives at the pharmacy.

"I can see three patients with acute needs every 15 minutes," she said.

The charge is $52 to $60, which is coverable by insurance and similar to prices at many of the new clinics springing up in places like CVS pharmacies and retail chains like Wal-Mart.

What are the goals of these changes? Lower cost and more convenience, based on the two following quotes. "People will change physicians for differentials of $10 or $15 in a co-pay," said Dr. Anne B. Francis, a pediatrician in Rochester and spokeswoman for the American Academy of Pediatrics... "We try to cut down on the waiting time," [Dr. Larry S. Fields, American Academy of Family Physicians] added. "We need to be more conscious of patients' time."

Are patients catching onto these changes? For some doctors, yes.

Dr. Ellen Blye, an internist with a busy practice on the Upper West Side of Manhattan, said about one in 10 of her patients used the online scheduling system she leased from NexSched, a start-up in Marcellus, N.Y., near Syracuse.

Michael W. Davis, executive vice president of Himss Analytics, a health care technology consulting firm, said that NexSched and a handful of competitors were "just beginning to penetrate the market" and that fewer than 1 percent of physicians offices had installed the technology so far.

"The patients who use it, love it," Dr. Blye said. "They can see what is available and do it any time." Although she does not offer same-day scheduling, her patients "can often come right in, if they see that someone has canceled."

Dr. Blye said that electronic scheduling, together with electronic medical records — a system made by GE Healthcare — enabled her staff of two internists and two nurse practitioners to save on overhead by eliminating one clerical employee.

One change using the simplest of Internet technologies seems promising: e-mail consultations. I have been doing this with my primary care physician, and it's been great. Over email I can get questions answered about when I can come in to see him and what kind of tests they have and how much they'd cost. I've even shared an article or two on medical matters with him via e-mail.

The same computerization that makes online scheduling possible can also open the door to online consultations, which usually involve questions that patients ask about routine matters like diet or possible changes in the strength of a prescription drug. The patient can go online at any convenient time, and the doctor often replies the next morning. But because health plans only rarely pay for these e-visits, such services have been slower to catch on.

I wonder if these changes are purely defensive, which seems to be the case presented in this article, or if some forward-thinking, technology-saavy iconoclastic doctors are driving these changes forward. While the primary care associations have caught on, and seemingly are improving care to improve their patients' healthcare, the big medical association seems to be reacting to a perceived threat to its members' monopoly.

And for all the new openness that many doctors are adopting, some efforts seem mainly defensive moves against the retail clinics, which are typically operated by nurses. At its annual meeting this month, the American Medical Association called on the clinics to accept a list of principles that would limit their scope to simple services and ensure that a physician oversees the operations.

Even Dr. Gerdes seems to be reacting defensively, discussing with her clinic planning group "how we will respond when retail clinics come to Tyler and what we can do to improve access for the patient."

Still, patients quoted in the article express their satisfaction with the changes made by Dr. Gerdes, and so, whether compelled by the desire to remain in business in the more competitive, cutthroat world of medical care thanks to new forces in the marketplace or nobler patient-centric reasons, changes in conventional healthcare are coming without a doubt, and they will be good for patients.