MDVIP Impact on PA Profession?

[charmstarz]

Has anyone's SP switched to MDVIP?  How did this impact you?

 

How do you see this program impacting other Primary Care PA's and patients in the future? 

 

This article was published last year and goes into more detail --> http://www.newsreview.com/reno/doctor-wont-see-you/content?oid=12135639

 

Thoughts?

[EMEDPA]

that is just one  version of a concierge practice. there are lots of these out there, mostly for folks who can afford a pcp on call 24/7/365.

it's not a model for providing health care to the masses....

I'm guessing any place that does this doesn't use PAs/NPs at all. If you only see 10 pts/day why do you need a PA/NP in the practice?

[charmstarz]

One of the MD's that I know is switching to this method after 25 years of practicing without it.  He had 2 PA's on staff, so I'm assuiming those PA's will have to find other jobs?

Do you think a lot of physicians are going to go this route with ACA more pronounced now?  Will this overtax NP's and PA's in terms of patient load and quality of care if more physicians choose this path?

[EMEDPA]

this model only works in communities with a lot of folks who can afford an extra $1500+/yr for health care. that rules out 90+ % of American households. I make a good income , but couldn't afford to do this if my pcp switched to this model.

this is really a niche market for the wealthy. it will be trendy to have a pcp who does this for lawyers and stock brokers but blue collar folks won't do this and they constitute the vast majority of american households.

[gbrothers98]

I think this model will work in many areas of varying income, with and without PAs or NPs.

What one person considers a financial burden, another may easily embrace.

Some MDs will not have a PA in practice, wont need them or wont want to pay them. Others will use PAs to extend their practice, pay them a median FP or IM PA salary and reap the benefits of charging for their services AND the ability to expand the patient panel and resultant increase in subscription fees.

We have a few local practices with solo MD and solo NP that only take cash for visit, give pt receipt and have them submit to insurance for reimbursement.

What started as a courtesy to patients, billing insurance, instead of asking for cash or other payment has become the standard but it can be reverted back to the old days of pay your bill upon receipt of services. I did a rotation in an urgent care that functioned this way and was plenty busy and very profitable.

For boutique practices or concierge practices, a PA or NP may be a necessity. Much of what these practices tout is prompt access. I have a friend whose local PCP converted several years ago to a boutique practice. Offered a tier of services based upon annual subscription. Never turned away any of their patients but those whom paid got improved access. They did not lay off any employees including PAs in the practice, needed them to keep the access plus with the subscription fees was able to improve pay, give bonuses and improve benefits. It was either that or be bought by the local medical center.

Regards

GB PA-C

[EMEDPA]

don't yyou think folks ponying up extra $$ for a personal pcp will want a "DOCTOR"?

[winterallsummer]

I don't think this will necessarily be bad for PAs. These patients are paying extra to be able to email and call the cell phone of their provider and also have longer office visits, not necessarily because they want to see that specific doctor. In reality a substantial number of patients, especially in FM, tend to think the PA they see is a doctor.

 

Whether or not this is ethical, especially in the face of having to sell a practice or close otherwise, is a separate issue.

[ventana]

this is called care rationing

 

it is something I am not comfortable with unless we have a formal way to ensure everyone has at least basic care - however I can see how PCP practices are moving towards it as the business environment is brutal right now....

 

not for me - I don't ever want the patient to feel that they have control of my practice patterns or that I am their employee or in some way I have to do what they tell me....  I have never liked the idea of them and when developing my own practice had to give good through as to rather I wanted to do integrate this into my practice......  nope

 

 

I think this will only work in a few instances

1- long time established practice where people will pay to not loose their doc

2 - in areas with a disposable income

3 - a provider that stays committed to offering great care - would be easy to get lazy....

4 - harder to sell as a PA/NP but doable..... but uphill struggle

[Febrifuge]

not for me - I don't ever want the patient to feel that they have control of my practice patterns or that I am their employee or in some way I have to do what they tell me...

But doesn't that happen anyway?

[gbrothers98]

don't yyou think folks ponying up extra $$ for a personal pcp will want a "DOCTOR"?

No, I think patients whom are paying the extra $$ will want someone that fulfills their promise, which is basically access. The example I related, if a family paid the top tier, they got a same day appt for complaints (dedicated call in #), they got a call back within one hour after business hours from whomever was on call or text/email depending upon their preferences. This was also presented to patients as the only way the practice could stay open and be independent of the multiple local health systems.

GB PA-C

[gbrothers98]

I don't think this will necessarily be bad for PAs. These patients are paying extra to be able to email and call the cell phone of their provider and also have longer office visits, not necessarily because they want to see that specific doctor. In reality a substantial number of patients, especially in FM, tend to think the PA they see is a doctor.

 

Whether or not this is ethical, especially in the face of having to sell a practice or close otherwise, is a separate issue.

I work with several PAs and NPs whom see pts in the clinic. Their patients always describe them as their 'doctor'. By that they intuitize that this is the professional responsible for their health and wellbeing and does so competently. They also understand that their 'doctor' is not a doctor but can do for them what is required and many times above and beyond that.

 

As for the ethics of a practice such as this, I dont think one can hold a small IM or FP practice to a standard that the rest of medicine is not held to. Its ok for the ortho, rad, gi or optho group to run a practice that delivers significant salaries and other perks to the owners but the IM and FP folks are left to struggle? I hope no one on this forum is naive enough to not realize that they are part of a trillion dollar business that contributes a large percentage of economic clout to the engine that drives this country. As many pharmaceutical and medical equipment companies have shown, ethics is a slippery slope and there are other more worthy targets of ethical judgement besides the small practice that is just trying to be financially successful.

 

GB PA-C

[gbrothers98]

But doesn't that happen anyway?

You likely will have some patients that will expect something other than access for the money they pay.

 

There may be some that will drop you after they realize their subscription fee still does not get them 90 Percocet for their back pain or a Zpack for their 1 day URI. But you struggled with those patients prior to this change. The driving force should still be that you are a professional healthcare provider, the patient has come to you for evaluation and treatment. Just cause the TV said the Biaxin would cure their sinus infection or their aunts lumbago is better with vicoprofen does not mean that you will ignore your training and experience to instead deliver this to them. This groundwork can be laid during the transition by reinforcing existing policies of the practice as regards good prescriptive practices and patients should be made aware of them.

 

I would also hazard to say that since the subscription fees provide a financial buffer for the practice, the loss of a handful of patients whom think you have opened the medical equivalent of burger king in combination with still billing insurances, should open the door for new patients that may actually desire someone that will provide them with thoughtful care rather than an eye on the clock and a workflow to maximize volume.

 

GB PA-C

[Febrifuge]

Yep, exactly, GB.

 

I had read somewhere - I'll have to dig around a little and see if I can find it - about the subscription medicine service being used really well, and not just for the executive treatment, the concierge VIP deal. What I'm thinking of was more of an old-fashioned co-op sort of a thing, where families bought in for an amount that was paid 4x a year, and was a little less than what their crazy-high insurance premiums had been. In exchange, everybody got one yearly physical with a panel of routine tests, people who needed it got twice-yearly A1Cs or cholesterol or what-have-you, and everyone got x number of walk-in or same-day appointments per year.

 

If I'm remembering right, it was a smallish practice with a panel of 100 to 500 patients, and while a few people needed to bump up to the next level or pay a little extra per appointment because they needed so many, the vast majority were seen 1 to 3 times a year, they paid less than they had been paying their insurers, and they were crazy happy about the lack of stress and red tape involved.

 

Now, this was a few years ago, before the ACA, but it struck me how this model can be made to work for "regular Joes" and not just the 1%. I think it's a mistake to equate it with only the high-end wealthy types.

 

And then there are jobs like the one I'm interviewing for, where the provider and clinic are dropped right into the corporate campus and take on some of the primary care burden for a couple thousand people in a specific locale. Some of those bill insurance, some just have the hosting company absorb the cost as a benefit they can offer employees. Either way, it's all about access, and finding new ways to get patients into the clinic with a minimum of fuss.