Manhattan cardiologist Arthur Weisenseel has enjoyed a long and satisfying medical career; one that encompassed teaching at New York-based Mt. Sinai Hospital, running a successful cardiology practice with another physician, and stewarding his aging patients into a healthy old age. But, somewhere in the last five years to 10 years, his practice became problematic. Weisenseel says that despite working as hard as he could, he wasn't able to consistently pay both practice expenses and himself. He says of that time, "I worked awful hard to get [there]. And to go home without reimbursement was becoming demoralizing."
So, like a growing contingent of like-minded physicians, Weisenseel decided to explore other practice models. Encouraged by his patients and positive conversations with colleagues, he has now successfully converted his practice to a hybrid-concierge model, where patients can choose to pay an extra fee for concierge services or continue to reimburse him through traditional insurance plans like Medicare and third-party payers. Now he couldn't be happier: Relieved of worries about financial and regulatory burdens, he says, "I come to work with joy and confidence."
It's no longer business as usual for physicians and their practices. Tired of the incessant drum beat communicating ever more difficult-to-achieve edicts from payers and government agencies, physicians are looking for a way out of the bureaucratic morass. Many of them feel burned out; many of them tell us that something has to give. And a small but growing number of physicians like Weisenseel are changing their practice models, allowing them to completely side-step payers, institute patient-centric services, or even reduce their patient panels so they can develop genuine relationships with their patients.
This is the fifth year we've been reporting on our groundbreaking Great American Physician Survey, Sponsored by Kareo. In it, we ask physicians how they feel about their profession, their practices, their patients, and home life. We heard from 1,311 physicians across the country. Forty percent say they are employed by a hospital or other institution, and nearly as many are either a partner/co-owner of a private practice or employed in a private practice.
In this year's survey, the numbers tell us that the needle is continuing to move ever so slowly in the direction of new practice models like concierge medicine, direct-pay practice, and Patient-Centered Medical Homes (PCMH). Of the physicians who responded to our survey this year, 35 percent say they would consider or are already working in a concierge-style practice model, 53 percent say they would consider or are already working in a direct-pay practice, and 20 percent are in the process of transitioning or have already achieved PCMH recognition. Historically, that shows slow but steady acceptance of alternate practice models.
Florida-based consultant Christi Hudiburg sees that trend in her own consulting business, Envision Healthcare Consulting. She tells Physicians Practice, "The past 25 years have left many healthcare providers uncertain and unprepared for the future when it comes to reimbursement, technology, and quality programs. This has led them to search for security in alternate areas. With all of the requirements placed on them by CMS and the insurance companies, it is much easier to go into concierge medicine or direct pay, as there is no 'Big Brother' watching over you."
It's no secret that physicians are practicing under growing regulatory and administrative burdens. "Touch-time" with patients continues to evaporate; more time is spent at the keyboard, rather than communicating directly with patients. That loss of personal connection with patients pains many, if not most, physicians. In our survey, 24 percent of physicians indicate "finding more time to spend with patients," was their biggest challenge in 2014. Prior to changing his practice model, Weisenseel says that he didn't want to squeeze in more patient visits just to keep up with overhead. Now he says being a hybrid-concierge physician allows him to give his concierge patients, "a very careful yearly physical and a discussion on everything from diet to economic to psychological to even spiritual needs. It allows you to be the total physician that I'd always hoped I might be able to do for all these years."