ORANGE COUNTY VOICES : COMMENTARY ON HEALTH CARE : The Corporate Physician Has Much More to Offer the Patient : The Marcus Welby professional is a myth. HMOs, other groups allow doctors more time, resources for clients.
One of the most significant changes taking place in the practice of medicine is the rise of the corporate physician--a change some people greet with skepticism. What, no Marcus Welby?
Of course, there is a huge gap between the myth of Marcus Welby and the reality of America’s health care system today. This development of the corporate physician is, however, not something to fear, but rather something to cheer. It is the best answer to our national health care crisis--if you value good health care, careful attention to outcomes and reasonable costs.
More and more, patients are receiving their care from physicians and other health care professionals who are employees of--and often partners in--medical groups or health maintenance organizations (HMOs). Americans are seeing corporate physicians in group settings instead of visiting solo practitioners in private offices. Health care is increasingly paid through prepaid capitation (fixed fee per patient per month) instead of the traditional fee-for-service.
Those of us involved in prepaid group practice see every day how this trend can significantly improve the quality of health care while decreasing costs.
We see, through the success of many of Unified Medical Group Assn.’s members, that this is good for both doctors and patients. We are convinced that prepaid group practice represents the future of health care in America.
Group practice permits the sharing of important data related to medical outcomes, quality of care, utilization of resources, clinical information and medical/legal risk. With this shared data, medical groups can develop comprehensive programs to assure, manage and improve quality. They can examine their systems and practices, and conduct peer review and patient satisfaction studies--all with the goal of improving every aspect of health care delivery.
As electronic clinical information systems and automated patient medical records become more readily available, groups will be able to analyze sophisticated outcomes data and identify “best practices” guidelines for improving quality and reducing costs. Such activities are virtually impossible in an individual practice setting.
In group practice, multiple health care professionals--primary-care physicians, specialists and ancillary providers--can work together, drawing on a bank of information, to assure a continuum of care. The group setting also lends itself to effective ambulatory case management in which case managers help “shepherd” frail and catastrophically ill patients through a complex medical system. All of these factors lead to better outcomes.
In the fee-for-service world, clinicians, hospitals, drug companies and ancillary providers get paid only when they do something. Traditionally, fee-for-service care tends to be reactive rather than proactive. Doctors wait for “sick people” to seek care, hospitals wait for doctors to admit “sick people,” drug companies wait for doctors to prescribe medication to “sick people” . . . and the beat goes on.
Historically, fee-for-service care has not focused on wellness, disease prevention, patient education or early diagnosis and treatment. In fact, traditional indemnity insurance often did not cover such programs. The focus was on episodic ambulatory care and acute hospital care of “sick people.”
Prepaid health care takes the opposite approach. It takes care of people while they are still well and tries to keep them that way.
People don’t want to be patients. They want to be well and stay well. If they are not well, they want to get well quickly and without an economic burden. In a health care system of capitation, physicians, medical groups, hospitals and HMOs, all of whom are “at risk” financially, have identical goals. All are rewarded financially for promoting wellness and preventing illness. To help meet these goals, physicians are encouraged to focus on case management and continuity of care and to provide high-quality ambulatory care that helps prevent acute inpatient care.
Prepaid group practice aligns the goals of the provider, the insurer and the patient. The corporate physician, working within the prepaid group practice, is thus freed from the management burdens placed upon the private practitioner. He or she has the opportunity to focus on what a physician does best--the practice of medicine.
Consumers should be pleased with the advent of the medical group-affiliated “corporate physician.” These physicians learn to focus on prevention first, and then on early intervention and expeditious treatment. They learn to become partners with their patients with the common goal of good patient health.
All these factors favor improved quality and cost-effectiveness. It is a proven system that is already working for millions of Americans. Let us not lament the passing of Marcus Welby.
The corporate physician will do a better job.
