Erickson Tribune

Ann's Choice

UPDATED: Friday, December 15, 2006

What happened to quality health care?

Posted on Wednesday, December 27, 2006
 

For middle-class America, it’s disappearing

By Wendy Meyeroff
THE ERICKSON TRIBUNE

For more than a decade now, Americans have witnessed a distressing trend: the loss of quality health care for the average citizen. Estimates say the average primary care doctor now sees anywhere from 2,000 to 4,000 patients each year. It’s a number that makes it nearly impossible for doctors to provide personalized care.

It’s a problem that’s likely to get worse for two reasons. First, the U.S. is losing doctors—physicians are quitting or never training for reasons ranging from exhaustion to fear of malpractice suits to frustration. The American Medical Association has finally admitted that the next generation might not have enough doctors. Second, the U.S. has an aging population, with nearly five million citizens 85 and older. That number is expected to increase 33% in less than five years.

John Marcelis, M.D., one of three practicing full-time physicians and the senior medical director for Ann’s Choice. He remembers the challenges of caring for an aging population when he worked for one of Pennsylvania’s major medical centers. “In my previous practice, I generally had 15-minute appointments and I didn’t really get an actual 15 minutes for the exam. Some of that time was getting the patient into an exam room, obtaining information from them, paperwork, interruptions from phone calls. It was busy and frustrating,” says Marcelis. Older people need more personal time; lack of exam time can be dangerous.

“Older people often have five or six chronic conditions— high blood pressure, heart problems, lung disease, arthritis, diabetes—and you may also be treating something temporary, like a cold. That makes it easier for symptoms to go unnoticed, or be masked, unless you do a careful, thorough exam,” he says.


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Enter ‘concierge’ medicine
To ensure patients have the kind of quality they need and deserve, physicians nationwide are turning to a new system, called “concierge” or “boutique” medicine. “The concept is the patient has special privileges and receives special attention, usually from their primary care physician,” says Julie Silver, M.D., assistant professor at Harvard Medical School’s Department of Physical Medicine and Rehabilitation.

What kind of special services? It varies, but the most common guarantees are shorter waiting times, more time with your physician, same- or next-day appointments, and emergency access to your physician.

To guarantee these privileges and attention, patients pay the doctor a retainer over and above their office visits. That fee varies by geography, type of practice, and other details. Fees can be paid monthly or annually—there are different arrangements. In recent years, the annual retainers were ranging between $900 and $13,000; now some estimates put them as high as $25,000.

Because older patients tend to have multiple medical problems, they generally pay higher fees. One Miami practice was charging $1,500 annually to patients under the age of 45, while charging up to $3,000 for older people.

Erickson HealthSM asks: Why pay extra?
“There is a lot of incentives for older people, who are obviously at highest risk for serious health problems, to invest in their health,” says Silver. Still, some physicians or patients are not comfortable with the idea of patients having to guarantee their doctor’s care with a special fee.

Marcelis is happy he didn’t have to make such a choice. Instead he’s been able to provide quality care by working at Ann’s Choice. “What they’re talking about in concierge medicine is what we already do in communities built and managed by Erickson. It’s called Erickson HealthSM, a unique, all-encompassing system for promoting the health, wellness, and fitness of people living in Erickson communities, like Ann’s Choice.”

“In my previous job, we saw 20-25 patients—or more—a day. In Erickson HealthSM, we have more time with our patients because we only schedule two patients an hour. We almost always get people in the same day,” he says.

Centricity—the extra benefit
Everyone who lives at Ann’s Choice has access to a doctor in case of an emergency. “One of us is on call 24 hours a day, so there’s always a doctor available. Through our Centricity electronic medical records system, that doctor has access to everyone’s medical records. That means even if I’m not a certain person’s physician, I’ll know everything I need to help them when they or emergency personnel call me,” Marcelis explains.

The Centricity system lets doctors in the Erickson HealthSM system provide a service even most concierge services can’t yet. “At the end of the appointment, we give people a printout to take with them. Among other things, it lists their current medications and their instructions.”

“They keep that where they can see it easily and they can also take it with them, so if they’re at a specialist’s office, or simply traveling—to the mall or on vacation.

They have those records to give to another health provider if needed,” says Marcelis.

Not everyone, of course, is lucky enough to live in a community that offers the kind of quality services Marcelis describes. If you do, take advantage of it. If you don’t, find ways to work with your current physician to ensure you get the care you deserve. It starts with simply saying things like, “I don’t just want a prescription, I want you to explain to me what this is and why I’m taking it.”



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