Dr. Mark Weissman
Pediatric concierge practices will likely be limited mostly to affluent communities where there are enough families to support a concierge practice model. Unfortunately, this model excludes most of the neediest children in our country. What about the many children who really need access to preventive care and management of chronic illness and special health care needs, but are disproportionately clustered in communities that can’t afford or support a concierge model?
As pediatricians, we really need to be thinking differently about growing and enhancing the patient-centered medical home model and the payment mechanisms to support it. Most pediatric practices are working hard to make their practices true medical homes. However, pediatricians often cannot get paid by Medicaid and commercial insurance plans for expanded medical home services, even when a CPT code exists. Telephone management, e-mail communication, health education, care coordination, and care plan development are at the core of a robust medical home.
While concierge practices rely on patient contributions to fund these services, traditional practices are still looking for avenues to support all the time and work needed to provide truly comprehensive care for children. There are now pilot projects underway around the country to fund these enhanced services in pediatric medical homes and they hold great promise and opportunity for the future. That’s where pediatricians must put our efforts.
We must work with CMS, states, insurance plans, and employers to support the payment mechanisms that promote a medical home model, team-based care, and the enhanced practice resources that permit pediatricians to spend more time with patients without suffering financially. At the end of the day, what we really need to do is provide "concierge care" for all children – through appropriately funded and resourced medical homes for all.
Dr. Weissman is the chief of the division of general pediatrics and community health at Children’s National Medical Center in Washington, D.C. He is also the executive director of the Children’s National Health Network and the DC Partnership to Improve Children’s Health Care Quality.