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Healthcare providers nationwide are as frustrated as you are by crowded waiting rooms and rushed appointments that have to be scheduled weeks or even months ahead. Many are reinventing their practices to offer more patient-friendly care. Here, innovations that may be coming to your town.Doctor on Call
In 2006 Robin Merlino, a primary-care doctor in Fairfax, Virginia, left a four-physician practice with a patient load of 2,000 to form a new concierge, or boutique, practice with just 600 patients. For $1,500 a year, her patients are guaranteed same- or next-day appointments that begin on time, an annual 2-1/2-hour physical, a secure personal Web site through which they can review their medical records, and 24-hour phone access to the doctor, who schedules appointments with specialists when necessary. Such concierge practices have sprung up across the nation. At her old office, with ever-larger numbers of patients to see each day, "I wasn't able to treat people the way I was trained to," she says.
One of Dr. Merlino's patients, Kimberly Arnold, a 44-year-old Christian missionary, says the care she gets is worth the extra fee, which costs less than her annual cable bill. Dr. Merlino isn't just efficient, notes Arnold, she's also attentive, making follow-up calls to check on patients' progress. That enhanced relationship is a major draw of boutique care. "Patients want someone who cares," says Edward E. Goldman, MD, chief executive officer and founding partner of MDVIP, the for-profit company that advised Dr. Merlino.
Boutique medicine promises a closer relationship with the doctor and a focus on prevention. But the hefty fee -- typically $1,500 to $2,000 yearly per person, though it can go as high as $15,000, according to the Government Accountability Office -- doesn't cover prescription drugs or most therapies, lab tests, and other treatments beyond the annual physical. So patients must have additional health insurance that will pick up the tab or be able to foot the bills on their own.
Though Dr. Goldman cites unpublished data from MDVIP's 19,739 member patients showing this model of care reduces hospitalizations, no one has proved whether it actually helps patients' health. Some experts also note that luxury care makes healthcare less accessible to less affluent patients.
House calls were once routine but disappeared as increasing costs meant physicians needed to fit more patients into every hour, notes Walter Krause, president and founder of Inn-House Doctor, a doctor-on-demand service that started in Boston. His firm, now in eight cities, is one of many that have sprung up in recent years to offer urgent care around the clock for travelers, families, and others whose problems don't mandate an ER trip. The physicians may work full-time for the service or have other jobs.
Within minutes of your call you speak to a physician, and within an hour one shows up ready to do basic tests and treat such routine ills as earache or food poisoning. "We take care of 85 percent of what you used to go to the emergency room for," says Jordan Shlain, MD, medical director of the San Francisco On Call Medical Group. Services generally provide a report for your own doctor. Depending on your plan, insurers may reimburse some of the $200 to $800 per-visit cost. For the insurance company, house calls are a savings over ER fees.
Difficulty scheduling visits is a widespread problem. One solution is as simple as it sounds: same-day scheduling, also called advanced or open access. You call or e-mail your doctor in the morning and get an appointment that day, because the practice has left a large percentage of its slots open for this purpose.
Mark Murray, MD, developed the idea in the early 1990s while managing a busy Kaiser Permanente primary-care department near Sacramento and cut the average wait time for appointments from 55 days to just one. A form of the system is now available to all 8.7 million customers of the giant California-headquartered healthcare system, and other practices have begun similar programs.
Reportedly, some 160 million U.S. adults have gone online for health information. But the Web is more than a research tool. Many people and their doctors are using Web-based services to communicate and to electronically store medical records accessible to patients and doctors and easily transmittable between physicians.
"You request an appointment, pay your bill, and update your insurance online," says Pamela Pure, president of McKesson Technology Solutions, which owns RelayHealth, one such service for just under 12,000 doctors and their patients. Another option: Medem Inc.'s iHealth system, with more than 70,000 physicians.
These networks let your doctor write your prescriptions electronically. Lab results arrive via e-mail to you and the doctor. Patients feeling under the weather can schedule e-visits: Their online answers to questions about symptoms are reviewed by the doctor, who decides if they need to come in. Fees may or may not be reimbursed by health insurance.
Last year 23 percent of the nation's primary-care physicians kept electronic medical records for their patients, according to a Commonwealth Fund study.
Originally published in Ladies' Home Journal, December 2007.