As physicians face the growing challenge of chronic disease management and the need to help older patients maintain their functional status, the traditional brief office visit and physical exam are proving to be necessary but insufficient for providing effective care. My own practice would benefit from a “wrap account” approach, which would entail a flat fee and encourage patients to rely more on e-mail and phone calls for ongoing medical guidance, rather than office visits.
The spectrum of new payment models can be quite wide—ranging from the medical home to concierge care—but clearly, the fee-for-service model for face-to-face visits fails to offer incentives to develop more effective patient-physician interactions.
Our efforts to shore up the declining base of office-based physicians who know their patients well and efficiently assist them with their health needs will succeed only when payment models address the value of clinical activities that go beyond the traditional acute-care visit.
William E. Golden, M.D., is professor of medicine and public health at the University of Arkansas, Little Rock. He reported no relevant conflicts of interest.