One of the likely effects of the Affordable Care Act will be much higher demand for primary care physicians. Over the next few years, approximately 30 million previously uninsured people will become insured, many of whom have no current physician relationship.
According to a 2013 study by the American Academy of Family Physician’s Graham Policy Center, the average ratio of patients to physicians in the U.S. is 1,485:1. But that ratio doesn’t reflect the disparities in physician coverage. Poor urban areas and rural areas have far fewer physicians than rich urban areas and suburbs. To achieve that same ratio for all communities, we would need nearly 7,000 more rural physicians and nearly 13,500 more inner-city physicians
That kind of an increase isn’t likely to happen any time soon. With many of the newly insured patients living either in rural or inner city areas, already long waits to see a doctor will lengthen further. Nurse practitioners and physician assistants can take up some of the slack, but, even with their help, there will be significant shortages in primary care in the coming years. In fact, even these physician-extenders are themselves increasingly scarce.
The kiosk will see you now
One novel approach to adding more access to care is the medical kiosk, which is a version of the “mini-med” model of retail clinics, like the ones you see at chain pharmacies and large grocery stores. The kiosks will have videoconferencing capability and basic monitoring equipment to measure vital signs. The patient will see the physician (or perhaps a physician assistant or nurse practitioner) by way of videoconferencing. This allows one caregiver to service patients in a variety of geographic areas.
Obviously, there are limitations to this model, but if you live in a place where the nearest physician is an hour away, a kiosk could give you access to immediate medical advice right away. With the right monitoring and testing equipment, the videoconference kiosk can provide an important service by triaging patients to the appropriate level of care – calling 911 if the symptoms indicate a life-threatening condition, sending the patient on for more extensive care if needed or taking care of minor ailments on the spot. For patients reluctant to drive an hour to visit a doctor for what might turn out to be nothing, that triage service is not only convenient, it could be life-saving. When medical care is inconvenient, patients tend to ignore symptoms that could be red flags for critical illnesses.
You’ve got med-mail
In the physician’s office, IT strategies can help physicians manage a larger patient population. Email consults, if supported by payer reimbursement, could provide fast answers to patients who would otherwise schedule a visit. And electronic medical records combined with analytic tools can help identify new patients with chronic conditions who need closer management by non-physicians providers. Recent innovations by Accountable Care Organizations have shown that, under certain conditions, frequent coaching by allied health providers, such as nurses, nutritionists, and health educators, can reduce complications and hospitalizations as well as improve the health of patients with chronic diseases.
This coaching can be enhanced by the use of digital tools to report useful health metrics. This can be as simple as a phone, text or email message from the patient, or a more sophisticated report from a Wi-Fi enabled digital scale, glucose monitor or other device.
That cuts the need for physician visits and also cuts the overall cost of care. Since many of the newly insured will have chronic diseases that have been neglected due to a lack of past coverage, physicians will need to quickly identify these patients and move them into programs that help them manage their conditions. Otherwise, the medical needs of these patients will become a huge burden on the primary care physician’s workload.
Portals improve patient satisfation
Patient portals that allow online registration and scheduling and provide patient access to lab results and other information can reduce the administrative burden for physician’s office staffs. Other industries have used these tools for years, but many physician office staffers still play endless phone tag to schedule patients and enter data from paper forms. It’s a waste of time that adds administrative costs and reduces patient satisfaction. In fact, recent studies have shown that patients rate physicians more favorably if they use digital tools such as electronic medical records that include patient portals. That trend is likely to increase as the insured population includes more young people, who routinely use technology and can’t understand why the medical system takes such an antiquated attitude to digital communications.
While IT tools can’t eliminate the effects of the primary care shortage, they can help ease the burden until we can train and license more physicians, nurse practitioners and physician assistants.