by John Rossheim, Curaspan Health Group
Micropractice: Longer Visits, Lighter Overhead.
Although direct primary care shares with micropractice the goal of improved access to preventive care, the two approaches diverge from there.
The strategy of the micropractice physician? To reduce primary-care practice overhead and increase time with patients by using IT pervasively to replace office staff. Micropractice doctors, usually operating as soloists or in pairs, have no support staff or perhaps one, relying on computer systems to schedule appointments, maintain patient charts and file insurance claims.
“My patients schedule their own appointments, because otherwise that requires an employee,” says Gwen Hanson, MD, a micropractice physician in Bellevue, Wash. “They love the online scheduling, because they can do it at 3 a.m., pick the time they want, and usually get in to see me the next day or sooner.”
When patients don’t have to play phone tag with overwhelmed schedulers, access to care is improved. “One way to help prevent hospital readmissions is to get patients in to see their primary-care doctor as soon as possible after discharge,” says Jeff Cain, MD, president-elect of the American Academy of Family Physicians (AAFP). “Open-access scheduling helps with that.”
With dramatically lower operational expenses, Dr. Hanson can see fewer patients and spend more time with each, a half hour for a routine appointment. She takes copious progress notes and types them into the patient’s electronic chart during the visit, taking care to look at the patient and not the computer as she writes.
“Micropractice physicians are providing very effective patient-centered primary care,” says Dr. Cain.
Micropractices do typically seek reimbursement from insurers. “Patients like that I do the billing, because they don’t get put on hold when they call with a question,” says Dr. Hanson, who does not take Medicare or Washington’s Medicaid program, because “the billing was much more difficult.”
The broader effects of micropractice on the primary-care system are mixed and uncertain. “The down side is that I don’t get to see as many patients,” says Dr. Hanson. “But micropractice could be opened up to nurse practitioners and physician assistants.” Such innovations will be necessary if this practice model is to become more common; today there are fewer than 1,000 micropractices in the United States, according to the AAFP.
READ FULL STORY for a comparison look at direct primary care, concierge medicine, and mircopractices.