Defragmentation of Care- PCP and Specialist Combined Visit ( A Medical Students Take)
When was the last time your PCP accompanied you to a specialist visit? Never? Same here. That’s actually not entirely surprising in today’s healthcare environment, given the demands placed on healthcare providers and primary care physicians in particular. But last week, I had the opportunity to be a part of such a visit.
I’m a medical student on my family medicine clerkship with Dr. Gold, and on his schedule this day was a cardiology visit for one of our 78 year-old patients. In the afternoon, we drove to meet her at the cardiologist’s office. She had recently had an episode of atrial fibrillation picked up by her pacemaker, and at this appointment, we would discuss the possibility of starting her on blood thinners. The cardiologist thoroughly explained the algorithms that guide decision-making for the treatment of new a-fib, along with the risks and benefits of blood thinners. He concluded by saying that, while he slightly favored starting the medication, he would leave the decision to our patient. As she took a moment to take in this information, her eyes began to well up. Amidst her tears, she explained that having to add yet another medication to her regimen or the thought of a stroke or going into a-fib again or bleeding from a fall was all too overwhelming to process.
The situation was complicated further by our patient’s chronic pain, which she experiences as a burning sensation across her lower chest. It has been treated with varying success for many years, and she was soon visiting a pain clinic for further assessment. So how was she to decide given these circumstances? The cardiologist offered expertise focused on giving her the best possible care for her cardiovascular health and went on to reassure her that the pain was not cardiac in origin. The presence of her primary care physician in addition, however, proved essential in helping her feel comfortable with her options. Primary care physicians are charged with taking care of the whole patient, a-fib, pain, tears and all. So when it became Dr. Gold’s turn to offer his input, he took a step back and considered her quality of life and her priorities. He helped her to sort through the risk calculators, EKG results and medication side effects to reveal what was really causing her the most distress each day and keeping her up at night. It was not her cardiac issues. It was her pain. Perhaps, he advised, we should address this issue first and then reconsider starting blood thinners in the future.
I would argue that any primary care physician would want this opportunity, the chance to sit down with his or her patient and another member of the healthcare team for one hour and determine what is really best for the patient at a given point in time. The problem is finding that hour amidst the multitude of patient visits, phone calls, notes, prior authorizations and EMR notifications. This time is what Dr. Gold offers his patients, and I believe that this single visit demonstrates how essential that time can be.
Tufts 3rd Year Medical Student
Employers and Direct Primary Care: A No-Brainer!
Not surprisingly, recent studies have shown a broad value proposition that links workplace health and well-being to favorable business performance. So why don’t more employers invest in programs that promote healthy employees? Expense is one glaring reason! Employers, both large and small, are being crushed by the rising cost of providing insurance benefits to their employees. Most employers address this growing cost by shifting it to their employees in the way of increased premiums, higher deductibles or higher co-pays. There is a cost effective solution and this solution is Direct Primary Care.
With Direct Primary Care, employers pay a fixed amount for all primary care services. This removes the guessing game on how much money will be spent on claims filed by employees. Direct Primary Care can be inserted into the overall health insurance plan offered to employees and ultimately control downstream costs. DPC, combined with an appropriate supplemental catastrophic plan, can save employers up to 40% on healthcare costs! This is all in accordance with the Affordable Care Act, so employers won’t get fined for non-compliance.
If saving money wasn’t enough to convince you, other perks for the employer include: decreased absenteeism, decreased workman’s comp claims, utilization of telemedicine to evaluate employees so they don’t leave early for doctors’ appointments or miss work altogether. Employees benefit too, as they receive same day appointments, a personal relationship with their physician, telemedicine/virtual visits, decreased out-of-pocket expenses, no more visits to urgent care centers.
Direct Primary Care physicians can be an employer’s most valuable ally as they search for ways to control healthcare costs, while simultaneously offering their employees the highest quality of care. Check out this article http://www.directdoctors.org/blog/direct-primary-care-a-solution-for-small-businesses to learn more.
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