Demand Growing for Corporate Practice of Medicine
- From: "Cowboy" <msbuckaroo@xxxxxxxxxxx>
- Date: 5 Jan 2006 14:41:27 -0800
http://www.heartland.org/Article.cfm?artId=18269
Demand Growing for Corporate Practice of Medicine
Author: Devon Herrick
Published: The Heartland Institute 01/01/2006
Americans often find themselves taking half a day off from work and
waiting an hour in a physician's office, only to see a doctor for 10
minutes. And the primary reason people see a doctor is for access to
prescription drugs.
As a result of time constraints, increased knowledge, and advanced
technology, many patients are beginning to receive some of their
medical services in a setting other than the traditional physician's
office visit. And despite legal obstacles and some objections from the
traditional medical community, the growth of this corporate practice of
medicine is on the rise.
Internet Consultations
One of the primary reasons doctors give for not communicating with
their patients by e-mail is that many insurance companies will not pay
for e-mail consultations. That may be changing. A few insurers are
beginning to see the benefits of e-consultations, as are physicians.
Some health plans will compensate doctors for e-mail exchanges if the
patient has been examined in the physician's office prior to e-mail
contact. Other insurers will pay for e-mail exchanges but at a lower
rate than for in-person visits. The November 10, 2004 issue of the
Journal of the American Medical Association reported physicians find
e-mail exchanges with patients often replace more burdensome telephone
calls.
Phone Consultations
Doctokr (pronounced "doc talker") Family Medicine is a Washington,
DC-area clinic that practices family medicine almost entirely by
telephone and e-mail.
According to the clinic's Web site, http://www.doctokr.com, time is
billed in five-minute increments, and prices range from $15 for phone
consultations with patients who have set up prepaid accounts to $67.50
for in-office visits for patients preferring not to prepay. Although
patients may request an in-person office visit, they are discouraged
from doing so unless absolutely necessary.
Dallas-based TelaDoc Medical Services is a phone-based medical
consultation service, founded in 2002, that works with physicians from
all over the country.
The TelaDoc service is not designed to compete with or replace primary
care physicians. It fills a niche when a patient may urgently need a
consultation but is unable to see his or her primary care physician. To
utilize the service, patients must sign up in advance so their medical
histories can be placed online. When a patient calls requesting a
consultation, several participating physicians practicing near the
patient are paged. The first physician to respond to the call is paid
for the consultation, which costs the patient about $35. Average
call-back time by physicians is just under one hour.
Quick Clinics
A new type of treatment facility, which features limited services but
added convenience, consists of small health care centers located inside
big box retailers and staffed by nurse practitioners. MinuteClinic is
the pioneer and industry leader of retail-based health care in the
United States. Its clinics allow shoppers in Cub Foods, CVS pharmacies,
and Target stores to get routine medical services such as immunizations
and strep tests.
"MinuteClinic is an answer to consumers' overwhelming demand for more
patient-centric health care," said Michael Howe, chief executive
officer for MinuteClinic.
Patients check in at the health care center. If there is a wait, they
can continue their shopping. Within a few minutes, they are paged to
return to MinuteClinic for a consultation. Little time is wasted, since
time ordinarily spent waiting is used to shop. According to its Web
site, http://www.MinuteClinic.com, no appointment is necessary, visits
take about 15 minutes, and the cost of an office visit can be as low as
$28.
Legal Barriers
There are legal obstacles to these consumer-centered models of
practice, however. Physicians are licensed by state medical boards to
practice medicine in a specific state, and many state medical boards
find cyber-medicine (i.e. consultation via the Internet or e-mail)
unethical unless the consultation occurs after an initial face-to-face
examination. State-specific licensure of physicians also makes
practicing medicine online illegal if the patient resides in a state
other than where the physician is licensed.
Finally, many states have laws banning the "corporate practice of
medicine," preventing non-physicians from hiring physicians to practice
on their behalf. About one-third of states appear to have definitive
laws against "corporate medicine," and about the same number have laws
generally allowing some forms (such as hospitals and health plans). In
the remainder of states the laws are either unclear on this matter or
appear to support or restrict the practice to an uncertain degree,
according to a November 2003 report, "State Survey: Corporate Practice
of Medicine," from the Center to Advance Palliative Care.
In some cases, restrictions against corporate medicine could mean a
store such as Wal-Mart cannot open a health kiosk inside the building
and hire practitioners to staff the clinic as Wal-Mart employees.
However, corporations are generally free to staff facilities with
providers who work as independent contractors.
The American Academy of Emergency Medicine (AAEM) warns against the
practice of medicine in a corporate atmosphere. "The obvious conflict
is the interest of the business over the interest of the patient," says
Robert McNamara, M.D., member of the AAEM board of directors and
professor and chairperson of the department of emergency medicine at
Temple University School of Medicine. "A doctor should not be owned by
a corporation that can dictate the standards by which he practices. He
is making decisions about your health and needs free rein to make the
best choices for you."
Standards and Practices
Medical practices are regulated through state medical boards. Those
boards set standards for the licensure of professionals in the practice
of medicine, rather than merely certifying them. An accountant, by
contrast, is certified--the public has the option of picking a
certified accountant over one who is not certified, but both have the
right to practice.
With licensure, the state board holds a monopoly on the practice. If
the (traditional) physicians on the state medical board deem
telemedicine to be unethical, they can censure (i.e. discipline) any
physician performing the service.
A censured physician could lose his or her license to practice in that
state, or might at least become an easy target for lawsuits by
disgruntled patients who could use the censure as evidence of quackery.
A physician treating patients over the Internet across state lines
could be arrested and charged with the unlicensed practice of medicine
in the state where the patient resided.
The setting in which patients receive medical care is largely a
function of how physicians are paid. "Physicians avoid telephone calls
and often refuse to communicate with patients by e-mail because they do
not get paid for these types of consultations," says National Center
for Policy Analysis President John Goodman.
Because insurers pay nearly 90 percent of physicians' bills, they have
little incentive to pay for additional physician services that might
increase their costs. In fact, for many years health economists have
theorized that forcing patients to wait in crowded physicians' offices
is a means of rationing health care using time rather than money.
Consequently, most Americans still access medical care much as they did
four decades ago.
.
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