“Physicians are reaching the tipping point on their business models, particularly in primary care,” Tom Blue, executive director of the American Academy of Private Physicians, recently told the San Antonio News-Express in an article about concierge and direct-pay practices. “They just can’t make ends meet. They’re being forced to make decisions about changing their revenue models.”
And while no one knows exactly how fast the retainer trend is growing, a 2005 report from the U.S. Government Accountability Office found there are 146 retainer physicians nationwide, noted USA Today. The article also cited a 2009 report commissioned by the Medicare Payment Advisory Commission that compiled a list of 756 retainer physicians. And according to a 2010 survey of members of the American Academy of Family Physicians, 3 percent of respondents said they ran some form of retainer practice, up from 1.2 percent in 2009. Finally, the San Antonio News reported that the American Academy of Private Physicians estimates 1,100 primary care physicians don’t accept insurance, double the number of five years ago.
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Measuring healthcare in terms of quality is a relatively new concept, one in which even the biggest payer in the country admits is a work in progress.
One initial lesson is that the word “quality” means different things, depending on whom you ask. In a recent survey of 374 new patients with early-stage breast cancer, for example, researchers discovered that the women’s idea of quality varied greatly from the medical definitions of the term used by hospitals, Reuters reported.
For the most part, the patients rated the care they got as of lower quality than their medical records indicated they received. In particular, just 55 percent said the care they received was “excellent,” although 88 percent actually got good-quality care according to medical guidelines, the study indicated. Among those who did rate their care as excellent, most also highly rated their process of getting care, as well as being treated well by medical staff.
Black women, who received the same clinical treatment as both Hispanic and white patients studied, were even less likely to report receiving excellent care (39 percent), the authors found, noting that they were more likely to perceive racism in the process of getting care.
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