More Physician Disintermediation


On of the changes roiling health care is the disintermediation of primary care physicians. The advent and continued growth of retail clinics and concierge medicine are examples of a new business model chipping away at physician's traditional business. This New York Times story describes a company called Inn-House Doctor.

A new kind of medical practice is flourishing nationwide that offers
to go to where the patients are - whether a home, an office or a hotel - to treat ailments as diverse as a sprained ankle or a bad case of bronchitis. Some services may even wheel in a mobile X-ray machine or an ultrasound machine, depending on the ailment, or perhaps pull out kits to test for strep throat or to draw blood. They may dole out medication on the spot or arrange for pharmacies to deliver prescriptions.

you call, you can speak to a doctor in five minutes, and that doctor
can be there with you within the hour. Where else do you get that kind
of delivery?” said Walter Krause, founder of Inn-House Doctor. The
company says it has 40 physicians on call in Boston, Chicago, Dallas,
Houston, Las Vegas, Phoenix, Philadelphia and Washington; some of the
doctors are in private practice or work in hospitals, and they make house calls during their time off.

This firm charges $250 to $450 per appointment, compared to $80 for a typical office appointment. So what's the problem driving these new services? In some markets where there is a shortage of primary care physicians, patients can wait weeks for an appointment. The office experience itself can be marginal when you get all of 10 minutes with your physician, some times after a lengthy wait to be seen.

Conventional practitioners complain that such interlopers interrupt and fragment the delivery of care to a patient. In reality the office-bound primary care physician with their paper charts and network of specialists they refer to typically don't offer any better coordination of care across a patient's physicians.

The enabler for many of these new services is health care IT. Improving access, convenience, and better coordination of care requires things like open scheduling systems (where patients or referring physicians can book appointments), e-prescribing, EMRs and PHRs. All of this must provide some level of interoperability so that appropriate information can be easily shared with the patient and among providers.

UPDATE: iHealthBeat reports on a radio story about an NYC physician, Jay Parkinson, “who founded a solo practice that treats young, healthy uninsured patients over e-mail, instant message or video chat.” You can check his cool web site here.

If there were more practices like Parkinson's, you could make a case for getting less expensive catastrophic health insurance and paying everything else out of pocket.


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