There’s a cure for what ails medicine

By Dr. JOHN BRADY

“It can’t be done,” said one consultant.

“You’re crazy,” said another.

Such was the feedback from the management gurus I went to when I was gathering information on how to open The Village Doctor. No one believed it could succeed in today’s toxic medical reimbursement environment.

But after 15 years of management magazines telling me how to fit in the one extra patient a day, I finally read something that made sense. Dr. Gordon Moore, an innovative physician from New York, was using technology to streamline processes and cut overhead, allowing him to see fewer patients per day while generating the same net revenue.

And by seeing fewer patients a day, he spent more time with each one, improving their satisfaction but also improving his professional satisfaction. In other words, by shifting the focus from the doctor-patient encounter to the doctor-patient relationship, everybody won.

In 2003, armed with this theory, I began the experiment of The Village Doctor.

(I bring up my practice to show a way to move forward in primary care and to encourage other doctors to consider a similar approach. This practice design is not for everyone and does not represent the only way to provide great care. But it shows that things can change: Doctors can have the freedom to assess how to deliver the kind of care they long to deliver, and patients can expect to receive the kind of care they long to receive.)

In-house billing

I found and renovated a small home in my neighborhood with the intent of inserting the physician back into the community. I hired a wonderful nurse who does all the office receptionist and nursing duties. I purchased a robust electronic health record system that not only organizes all the information in the office, but also allows me to do my own billing.

Minimizing costs associated with rent and employees reduced my overhead to only a fraction of a traditional office. Although I receive the same insurance reimbursements and co-pays as most medical practices, by breaking free of the other financial shackles, I was able to jump off the treadmill of seeing 30 to 40 patients a day (I average 12 to 15) and spend more time with each patient.

I almost always can see established patients the same day they call, and I rarely have an office wait longer than 10 minutes. My patients can call me, and I can call them back. I am even able to offer home visits to homebound patients in my community. Studies of my patients confirm their satisfaction with a majority of them stating they receive “perfect care.”

But just as important, because I am not constantly overwhelmed, I have the breathing room to analyze the care I deliver and the flexibility to implement changes to improve it. I am able to make a good living, spend more time with my family, and still have the time to go to meetings in the community to try to improve local health, and the time to work in national collaborative studies to try to improve primary care as a whole. I feel in control and happy.

And I am not alone. What started as a fringe idea has now become the Ideal Medical Practices movement. Even as primary care has begun to show signs of constriction, the number of IMPs opening has continued to explode (www.impmap.com).

There is a very active online community where physicians share ideas and information on how to make these practices work. There is a formal curriculum offered where practices can begin to understand how to implement change and improve quality. There is even an annual meeting where we get together and challenge each other to take the next step to continuously improve what we do.

Twighlight years?

Both doctors and patients fear that primary care is entering its twilight years. As expenses continue to soar and reimbursement continues to stagnate, the treadmill of patients the physician has to see will grow to an unsustainable level.

What can be done to save it? The answer is simple. We must refocus on the most important thing — our relationship with our patients.

X Dr. John Brady owns and operates an independent solo practice, The Village Doctor, in the Hilton Village section of Newport News, Va. He is an assistant professor at Eastern Virginia Medical School, a faculty member in the Ideal Medical Practices movement, president of HealthConnector, and was honored as the 2008 Virginia Family Physician of the Year. Distributed by McClatchy-Tribune Information Services.