Though the debate over the future of the Affordable Care Act almost certainly will rage on whatever the outcome of the 2016 elections, everyone seems to agree that the future growth rate in health care costs, which historically has outpaced general inflation, must somehow be reined in.
Wichita doctor-entrepreneur Josh Umbehr is one of the nation’s pioneers in showing how primary care costs can be controlled, by eliminating the insurance middlemen and enhancing physician productivity, while delivering quality care to his patients.
Umbehr’s company, AtlasMD, provides low-cost “concierge care” to Wichita patients on both the east and west sides, and has provided software for another 150 concierge practices around the country. Atlas has been profiled by such national publications as BloombergBusinessWeek and Time, and Umbehr was one of two entrepreneurs featured at 1 Million Cups Wichita’s launch event Wednesday morning.
Atlas works for its patients even though they pay an out-of-pocket monthly fee ranging from $10 to $100, because it is convenient and affordable: You can get in almost immediately when you need to without an appointment, and Atlas docs even make house calls (I know, as I am one of its patients). The business model also works for Atlas doctors, who don’t carry the expensive overhead of having to deal with multiple insurers for payment and who get to know their patients, both in person and on e-mail or text.
A central question raised about the Atlas concierge model, however, is whether, if it were adopted by all doctors, it would aggravate a nationwide doctor shortage, currently at 60,000 and projected to grow to 130,000 by 2025. The question arises from the fact that the caseload of concierge providers – whose patients often make frequent use of the annual service – is about 600, compared with the caseload of 3,000 patients per doctor in the conventional primary care practice, whose patients tend to show up only for their annual physical, if that.
There are several reasons why this concern may be overstated. For one thing, any transition from the conventional to the concierge model will be gradual. For another, Umbehr argues that if many doctors, including specialists, were to begin taking some primary patients on a concierge basis, that would mitigate any shortage problem. About 22 percent of physicians’ time is now spent dealing with nonclinical paperwork. Releasing that time to deal with patients on a concierge basis would be equivalent to adding 165,000 docs a year.
Another promising idea, developed by Ezekiel Emanuel of the University of Pennsylvania and Victor Fuchs of Stanford University, is to lop off several years of training from the current 14 years typically required of physicians. This is excessive for docs who want to be primary care physicians. More of them might elect primary care if training were shortened and if they could join the kind of concierge practice that Atlas has pioneered in Wichita for a wide range of patients.
Robert Litan of Wichita is an attorney-economist who is an adjunct senior fellow at the Council on Foreign Relations.