Patients open to care options that don’t involve physicians

A report by the consultancy Deloitte paints a picture of health care consumers who like physicians but in many cases are ready to seek care elsewhere — if at all — if they don’t believe the care is too inconvenient or expensive.

Since 2008, Deloitte has conducted an online survey of 4,000 nationally representative adults asking slightly different questions to get at consumers’ attitudes about health care. For its latest report, released June 12, Deloitte asked questions that focused on what it sees as a trend to which physicians and everyone else in the health system must respond: the conversion of patients, who passively accepted care, insurance plans and anything else the health system had to offer, into consumers who question the care they receive and shop around for the best value in treatment and insurance.

For example, of the 78% of adults who said they had a “primary care provider,” 76% said they were satisfied, a much higher rate than for hospitals and insurance. However, while the survey didn’t break down who that “provider” was, there is a chance it was not a physician. The Deloitte survey found that 50% of respondents believed that care delivered by nurse practitioners and physician assistants is “comparable” to what a primary care physician can deliver.

Meanwhile, 50% of patients born between 1965 and 1981 and 52% of those born between 1946 and 1964 said they would see an NP or PA if a doctor wasn’t available right away. Those age groups, at 26% and 27%, respectively, had the highest rate of saying they would use a retail clinic — generally staffed by an NP or PA — if a doctor wasn’t available. As for actually using a retail clinic for care for themselves or their family members, 19% of a younger age group, those born between 1982 and 1994, were the highest percentage that reported doing so.

Some patients not choosy

Doug Smith, MD, a family physician who practices near Minneapolis, co-founded the company that became the retail clinic chain MinuteClinic, acquired by CVS Corp. in 2006, and is chief medical officer of Consult A Doctor, a telemedicine company based in Miami Beach, Fla. He has found that his young adult patients are very attached to him, driving home from college to see him, for example. But baby boomers are more pragmatic, he said.

“As much as we believe our patients think we’re the best, and all doctors believe they’re the best doctor, what [patients are] really going in for is a solution to a problem,” Dr. Smith said. “If they think somebody else can solve the problem, and it’s easier for them, they’re willing to do that.”

The Deloitte survey also reflected the level of patients’ cost-consciousness. It found 57% of patients were confident in their ability to handle the cost of care, up from 36% in 2009, the last official year of the 2007-09 recession. However, Deloitte said the confidence was a reflection of their overall confidence in health system overall — one in three rated U.S. health care an A or B in 2012, up from one in five in 2009 —and not a reflection of actual ability to pay.

Though wellness visits went up (65% in 2012, from 61% in 2008), prescription use went down (51%, from 60%), physician visits for illness and injury fell (39%, from 53% in 2009), and over-the counter medicine use dropped (31%, from 38% in 2008). Emergency visits went up (19%, from 13% in 2008), a trend experts in other reports have said is caused by patients with no insurance, expensive insurance, or who delay care until they no longer can ignore their symptoms.

The Deloitte survey noted that 40% of patients used home remedies and over-the-counter medications because it was cheaper than going to the doctor. Thirteen percent of patients decided not to see a doctor when sick or injured because of cost, making up half the population that did so for any reason. The survey said 7% delayed follow-up visits or did not follow recommended treatment because of cost, more than half of the 12% who did that for any reason. Deloitte said 13% asked about price before agreeing to treatment.

Deloitte did not give specific recommendations regarding how physicians should react to these trends. Their message was mostly: Be aware that patients are acting more like consumers.

“I think if you’re a practitioner in primary care, you’ve got to read the writing on the wall — this is the market responding,” said Paul Keckley, PhD, executive director of Deloitte’s Center for Health Solutions.