Comments on: ‘Primary Care Docs Wade Into Payment Reform Debate’ by Amy Whitcomb Slemmer

By: Dr. Cheryl Bryantbruce, M.D.

Dr. Cheryl Bryantbruce, M.D. — Wed, 12 Aug 2009 12:26:24 +0000

Ms.Slemmer,
I find it interesting that at this forum that was supposed to be to a debate on payment reform excluded concierge physicians. It seems to me that one needs to consider all models and the benefits of each if we are to thoroughly explore the possibilities for a most equitable solution. The people best prepared to discuss the benefits and hazards of a model, such as the one utilized by many concierge physicians, are the physicians who are engaged in that particular model. It is my opinion that concierge physicians are on the cutting edge of health reform. When the dust all settles, the remaining health care model is very likely to have a large number of elements in common with what are now called concierge practices. These practices are very similar to what used to work very effectively before physicians ceded the power of governance over to the insurance companies and those who stand to gain financially from keeping the insurance companies empowered. It may not have been a perfect system, but it was a system that provided good care that left patient and physician much more satisfied than the fiasco that has evolved to be the current model.

Cheryl Bryantbruce, M.D.
Elite PErsonal Physician Services, Inc.

By: Martha Bebinger

Martha Bebinger — Wed, 12 Aug 2009 04:29:25 +0000

Sometimes, asking the patient “Would you have back surgery if the MRI shows a severe disc problem? No? Then the MRI won’t help us take better care of you,” can work.

Hi Elizabeth – this section of your comment caught my attention because I’ve heard many docs say they use this strategy to persuade patients some MRIs and CTscans are not useful or necessary. Some docs add that these tests are typically the first step towards surgery.

There is some talk about tiering co-pays for imaging tests. We patients might pay more for an MRI for back pain until after we’ve completed a period of rest, for example. What do you think abou that idea?

By: Elizabeth

Elizabeth — Tue, 11 Aug 2009 18:09:47 +0000

Ms. Slemmer,

I’d love to know how a physician is supposed to handle that MRI request. If we want to make a decent living after paying the overhead costs, we don’t HAVE TIME to spend 15 minutes explaining why an MRI will not help. And one thing that runs through a physician’s head when a patient requests [demands] an MRI is “If anything bad happens to this person & I didn’t order the MRI they wanted, I will get sued.” It’s easier and quicker to order the MRI than to reason with the patient.

Sometimes an MRI can be avoided by ordering another, less expensive imaging test. Ultrasounds, which do not involve ionizing radiation and are relatively low cost, may satisfy the patient’s need for certainty that s/he does not have a serious or dangerous condition. Sometimes, asking the patient “Would you have back surgery if the MRI shows a severe disc problem? No? Then the MRI won’t help us take better care of you,” can work.

But a lot of the time it’s easier and safer to give in to the patient’s request for more tests. Patients are, after all, frightened, and want reassurance that they are not going to die. And tests give them that reassurance.