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Danger in the High-Volume Medical Practice Trend: How to Avoid the Ghost

Michael Kagen, MD, leads the membership-based concierge medical practice, Kagen MD, in Park City, Utah.

Imagine getting an MRI for an injury or suspicious pain and being incorrectly told you either do or do not have a serious medical situation. Either way, this can be a life-threatening, not to mention mentally anguishing, occurrence. Recently, a disturbing news story has come out regarding allegations of fraud against one of the nation’s largest MRI-reading companies, ProScan. The company is accused of letting physician assistants, who are not radiologists and are unqualified to read MRI imaging, “ghost read” MRIs. “Ghost reading,” in this case, is using a radiologist’s signature without the radiologist interpreting the radiographic studies, an act of fraud that may have caused injury to patients whose reports were incorrectly read.

While the alleged fraud is shameful, the underlying story is that the modern health care industry has a perverse incentive structure, in which insurance reimbursements drive the need to maximize the number of billable events, like office visits and procedures. This, in turn, encourages health groups to prioritize quantity over quality, and for clinicians to become proceduralists. In 2018, ProScan advertised that they had 35 board-certified radiologists on staff to read 350,000 studies per year, a physically impossible feat, according to the lawsuit.

Large health care centers have become people-processing centers, but a new movement has been underway. Concierge medicine, also known as direct primary care or boutique medicine, turns away from the mass-production variety of medicine. It removes the insurance-fueled financial benefits to large health care centers’ laser-focused efficient patient processing. It refocuses the physician’s efforts on maximizing the health of patients. This healthcare model relies on a membership-based structure in which patients pay a monthly or annual membership fee that covers visits with their physician. There is no insurance paperwork processing, no co pays and no influence on recommended care outside of the doctor. The number of visits, amount of time spent in consultation with the doctor and the recommended medical courses of action remain unaffected by a large healthcare machine or insurance company.

As evidenced by the ProScan debacle, maximizing efficiency to the point of impossibility results in errors. Patient advocates are needed now. What’s also needed is time: time for patients to spend with their doctors and time for physicians to speak with other physicians. Doctors who have chosen to practice direct primary care have embraced the opportunity to think differently about how to deliver old-fashioned relationship-based medicine while still embracing modern technology. Concierge medicine physicians understand the desire for patients to be heard, to be prioritized and to be treated like a person, not a number. And concierge medicine practitioners know that a diagnostic test is meaningless without a physician’s interpretation of its clinical significance.

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This philosophy is often practiced with open communication between doctor and patient in a way that is most comfortable and convenient for the patient, rather than being determined by processes in place to maximize the number of patients seen each day. Video calls with concierge doctors are not uncommon, as are home visits or meeting in a place that is most accessible for the patient. Appointments are as long as necessary for the doctor and patient to form a relationship that ultimately builds trust. This also allows the time needed for a doctor to analyze test results, interpret their significance, determine what further course of action is needed (or next steps), and communicate all of this to the patient. It also affords both doctor and patient the ability to digest results and plot a course of action that is most beneficial to the patient and takes other factors into consideration, including their health goals and other health conditions. Concierge Medicine doctors also typically have relationships with highly qualified specialists, enabling the patient to be connected to specialized care if testing reveals conditions in which specialized care would be beneficial.

One can only hope that dangerous practices like the ones that allegedly took place at ProScan will be swiftly caught and stopped. Unfortunately, it is likely that as long as insurance-driven financial incentives to maximize revenue exist, stories like these will not end. In the meantime, find yourself a concierge medicine doctor and start to enjoy a doctor-patient relationship that’s focused on you, not just the bottom line.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2019 Michael Kagen MD


Jennifer Hatfield from Cincinnati on June 01, 2020:

Very interesting and informational. After 15 years in healthcare as a LPTA, I understand that some discrepancies do exist in the field of Physical Therapy and other medical disciplines. Although the thought of this never occurred to me. This is why I have left the profession. I want to help people using a blog and writing instead.

The thought of using concierge medical services is appealing to my family, but we have not done any research in our area. Good food for thought. Thanks for the article.

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