For A Price, The Doctor Will See You Anytime

KFF Health News | By Michelle Andrews

Published March 8, 2011 at 11:53 AM CST

If people could get in to see their primary care doctor for urgent problems when they needed to and could work with that doctor to manage their chronic health problems, just about everyone agrees we could save a lot of money on emergency department visits and hospitalizations, among other things.

Now a growing number of primary care physicians have decided that the solution to hamster-wheel care is to bypass the health insurance system entirely. By doing so, the doctors say, they save so much on overhead that they can afford to spend more time with fewer patients.

These practices charge patients a modest monthly sum — generally from $50 to $150 or so — and in exchange provide all-inclusive in-office services, from preventive care to chronic disease management. Clinics are open evenings and weekends, and doctors are available for e-mail and phone chats.

It's similar, but not identical, to higher-end "concierge" practices, which charge a hefty annual fee and in return, patients have unlimited access to their doctor.

One such direct-pay practice, Seattle-based Qliance Medical Management, o pened in 2007, and officials say they have data to show that their clients do in fact visit the ER less often and have fewer hospitalizations, among other things.

In 2010, Qliance patients had 65 percent fewer ER visits, and 35 percent fewer hospitalizations, compared with benchmark data for the region, Qliance says. Meanwhile, the number of patient primary care visits is 92 percent higher than the benchmark numbers for that area. "This model turns around a 50-year trend in ER utilization," says Garrison Bliss, Qliance's chief medical officer.

But it's too soon to break out the champagne, say experts. "Reports of reduced spending have to be taken with some skeptism until done in well-controlled environments," says Robert Berenson, a fellow at the Urban Institute, speaking generally of changes in the use of medical care, not of Qliance specifically. In fact, Qliance's own figures contain this qualifier: The reduction in ER use and other services is "based on best available internal data, (and) may not capture all non-primary care claims."