Wither the Traditional Physician Office Visit

It’s not your imagination or the self-serving forecast of a healthcare consultant angling for your business. Fewer people are seeing their doctors in person in a physical office. It’s a foundational change in the way care is delivered in the U.S.

Last week, the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, released its latest annual report on office-based physician visits. Based on the agency’s 2016 National Ambulatory Medical Care Survey, the NCHS said there were 278 office-based physician visits per 100 people in 2016.

The NCHS’ Data Brief didn’t offer comparative rates from previous years. I looked them up, and you can, too. By comparison, there were:

• 313 office-based physician visits per 100 people in 2015, or an 11.2 percent drop in the visit rate over the previous year
• 322 office-based physician visits per 100 people in 2011, or an 13.7 percent drop in the visit rate over the previous five years

As we’ve noted in previous blog posts, when patients decide that they need ambulatory medical care, they increasingly are getting it from other sources and settings. They include urgent-care centers, retail health clinics, telemedicine providers, retail pharmacies and advanced-practice providers like physician assistants and nurse practitioners. It’s more convenient. It’s on-demand. In many cases it’s cheaper. And in most cases, health plans incentivize it because they want to lower their medical costs by paying out less in professional fees to doctors.

Here are some of those other blog posts, if you’re interested:

• “New Primary Care Provider, Same or Better Outcomes.”
• “New Primary Care Provider, Same Old Price.”
• “An Urgent Message for Those Who Want Care On Demand.”

So who still goes to their doctor and why?

The answer to the first question is the elderly. Adults age 65 and older saw their doctors at a rate of 498 office visits per 100 people in 2016. That’s almost double the rate of 278 for all patients and more than two-and-a-half times the rate of patients age 18 to 44. The rate for that age bracket was 190 office visits per 100 people.

Yet, even seniors are seeing their doctors less. In 2015, the rate for adults age 65 and older was 658 office visits per 100. That’s a drop in the rate of more than 24 percent in just one year.

The answer to the second question is a chronic medical condition. Thirty-seven percent of the office visits in 2016 were for treating a chronic condition. It was the No. 1 reason, followed by a new medical problem (27 percent), preventive care (23 percent), an injury (7 percent) and pre- or post-surgical care (6 percent). Those reasons and their prevalence haven’t changed much over the previous five years.

I’m not an economist, and I don’t have my MBA. But if I ran a medical practice, a hospital or a health system, I’d be thinking about those numbers as I reposition my healthcare business for the future. What things should I start doing, e.g., on-demand urgent care, telemedicine? What things should I stop doing, e.g., acquiring legacy physician practices in the hopes of securing and building my patient referral base.

It shouldn’t be too complicated. Know what your patients want. Restructure your organization to give patients what they want. And you should stay in business.

But, as this story in the Naples Daily News reminds health system executives everywhere, you could lose your job.

According to the Florida newspaper, Allen Weiss, M.D., resigned last week as president and CEO of the NCH Healthcare System in Naples following a no-confidence vote in his leadership by the physicians at the system. The story said the physicians were angered by a pilot program to use more hospitalists to coordinate the care of patients admitted to the system’s hospitals.

In 2017, Dr. Weiss, now a member of the American Hospital Association’s Board of Trustees, told AHA News: “The hospital of the future will be an emergency department, an intensive care unit and an operating room. And one of its biggest functions will be in prevention.”

Unless the current healthcare system becomes completely responsive to what patients want and need, forward-looking healthcare executives may become as rare as the traditional physician office visit.

Author

David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here