Membership Medicine: a Solution for the Independent Physician

By Evan Pankey

The Problem:  Physicians are Professionally Dissatisfied

Is the independent physician on the verge of extinction? According to a recent survey by Merritt Hawkins, “In 2014, just 35 percent of physicians were either practice owners or partners — down from 62 percent in 2008.” Additionally, the same survey reported that 80 percent of physicians feel overextended or at full capacity. 

Well-intentioned government mandates, such as the Affordable Care Act (ACA) and HITECH (Meaningful Use of Electronic Health Records), have had unintended consequences for physicians. The ACA increased patient demand and reduced reimbursements, while HITECH has meant more time spent on clinical documentation and billing and less face-to-face time with patients. 

The result is an epidemic of “high-volume burn out” amongst independent physicians who bill insurance-based Fee for Service.  Essentially, physicians feel they are being asked to do more for less.  Several doctors have compared their current practices to being on a “treadmill.”

The Solution: Emergence of Membership Medicine

Not surprisingly, a growing number of physicians are exploring alternative practice models. Merritt Hawkins reports that six percent of providers are practicing Membership Medicine, encompassing concierge medicine, direct-pay, cash-only, and retainer-based physician clinics. According a recent Accenture report, Membership Medicine is one of the fastest growing sectors of care delivery, with “1 in 3 physicians seeking to transform to subscription-based care.”

Although there are many distinct styles of Membership Medicine practice, they share some common key goals – namely to reclaim the joy of medical practice by restoring the physician-patient relationship, and quality of care through longer visits and increased physician autonomy. These are common elements of Membership Medicine:

  • Monthly patient membership fees ranging from as little as $40 (Direct Primary Care) up to $150 or more (Concierge)
  • Unlimited office visits often without co-pay
  • Visit times of 30 minutes to an hour or more
  • Close to 24/7 access directly to physicians nights and weekends
  • Same or next day appointments
  • Minimal to no wait times for visits
  • Affordable home visits

The Technology: Building the Right EHR for Membership Medicine 

Electronic Health Record (EHR) software can help drive the growth of Membership Medicine, but only if it’s designed to make this new style of practice easy to adopt and allow a small staff (usually one doctor and one nurse) to operate efficiently.  Below are key elements of an EHR that will support Membership Medicine:

Membership Management – Membership Medicine practices charge patients based on an agreed upon monthly or annual fee. Most practices have plans set up by age group, tier, or a combination. A Membership Management tool helps providers manage patient enrollment in plans, payments, and practice revenue.

Patient engagement tools – Membership Medicine practices work best when the patient is involved in their health care. Patients essentially have 24/7 access to their health care provider, so utilizing technology to take control of their health is key. Patient engagement tools such as web portals, secure messaging, video chats, texting, etc., are essential. These tools allow the provider to care for as many patients as possible in the most efficient way.

Intuitive clinical documentation – Clinicians care deeply about the quality of their records, especially the ability to document conditions over time.  However, there is competing need for the documentation process not to be onerous and distract from face-to-face care. An intuitive solution is key for documenting visits in as little time as possible.

There are only a handful of EHR vendors that cater to Membership Medicine. Because of the lack of EHR vendors that meet all of these needs, there is increased demand for a singular user experience from Membership Medicine EHRs. The newest entry into this small cadre of solutions is Pri-Med’s InLight EHR, featuring membership management for managing the revenue stream and a problem-oriented documentation approach that lets physicians be more people-oriented.

According to a 2014 survey conducted by the Physicians Foundation, 20 percent of physicians either practice or are planning to transition to one of these alternative models in the next several years. The combination of unintended policy consequences, physician activism, and emerging software is driving the growth of Membership Medicine.    

Evan Pankey is the Product Manager & Solution Architect  for InLight EHR at Pri-Med.

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