High Volume in Primary Care

[arc5005]

One of the concerns I have regarding primary care is the volume and the pressure by employers to see more patients, with less time with the patient, less time in between patients to catch a breathe, and health maintenance. With the incentive to see a higher volume of patients, and higher reimbursement are more primary care physicians having high-volume practices?

If employers are pushing for high-volume, will physicians have a decision in how many patient's they see daily, how long their appointments will be, etc...?

Does anyone have actual salary differences or reimbursement figures for physicians who are low-volume vs. high-volume?

Although high-volume physicians had 30-percent shorter visits (8.8 minutes on average compared to 12.5 minutes for low-volume physicians), they were able to accomplish the same tasks during their visits as their lower-volume colleagues. Based on 20 different behavioral categories, all three groups of physicians spent similar proportions of time on history taking, physical examination, health education, etc.; however, high-volume physicians spent a larger proportion of time planning treatment (defined as prescribing medications, diagnosing problems or developing treatment plans).

This greater productivity of the high-volume physicians did come at some cost, however. Patients seeing high-volume physicians were less likely to be up-to-date on preventive services, including screenings, immunizations and health-habit counseling. Those patients also reported slightly lower levels of satisfaction and scored their doctors slightly lower on several measures of the doctor-patient relationship, such as the doctor's listening skills, explanations of care and efforts to follow up on past problems. Although the magnitude of these differences was small, it shows that high-volume practice does involve trade-offs, especially in areas that are increasingly viewed as markers for quality.

During the time period of the DOPC Study (1994–1995), most physicians in Northeast Ohio were able to determine their style of practice. Thus, differences between high-and low-volume physicians may now be even more profound in environments in which physicians are forced to increase their volume to meet productivity demands. Source: http://www.aafp.org/fpm/2000/0700/p63.html

Perhaps we will see an increase in Direct Primary Care?

Direct primary care has several characteristics that are attractive to doctors, such as having fewer patients and being able to spend more time with them, Lee said.

“In many ways, the promise of it is that there is an opportunity to control flow and pace,” he said.

A typical primary care doctor may have 90-120 patient visits per week and can only spend 10-15 minutes with each patient. In contrast, an E365 doctor will have around 50 visits per week and can spend 20 minutes with a patient, Scherger said.

According to a 2014 survey by the American Academy of Family Physicians, about 2% of members were currently working in direct primary care settings and 7.2% reported they were currently determining if they would transform their practices to that model.

“The direct primary care model is slowly gaining momentum,” said Robert Wergin, the group’s president. He said the model is increasing in popularity because it moves away from the acute, episodic, fragmented care that is common with volume-based medical services, and it allows doctors more time to focus on quality of care rather than paperwork and billing.

http://pnhp.org/blog/2015/08/25/direct-primary-care-and-the-future-of-family-medicine/

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[Shammyguy3]

I know it's apples to oranges, but I work for a private practice of specialists. And between four docs we see over 700 patients during the 5 day week not including surgeries

 

[deleted480308]

Dpc is a vastly superior model for primary care