Concierge Doctors

[Lone Star]

I saw this article on MSN, and thought that it might make for good reading. I'm opposed to this new direction of health care. To me, all it does is promote elitism, and this ISN'T the direction health care needs to be taking. In this current age of not everybody can afford health care insurance or health care in general, do we REALLY need to be promotint an 'elite class' who get to be healthy, while the poor are just shit out of luck?

Since it's plainly stated in the article that not only do the 'elite' get better access to health care, they're even 'segregated' from the 'commoner' who can't afford the 'preferential treatment'. Not only is this creating an 'elite class' mentality, its REWARDING it by segregation.

I'm especially interested in what the Doctors that frequent this site have to say about this latest trend!

Patients face bitter choice: Pay up or lose care

Premium-pay medical practices grow as doctors seek more control, cash

ANAHEIM, Calif. - When Bob Goodrich’s longtime doctor started providing premium care only to patients who paid a $1,600 annual fee, the 63-year-old felt he had no choice but to write a check.

His wife, Marjorie, 64, was sick with a serious adrenal disorder and nervous about having to switch doctors. And she was drawn to the longer appointments, personal attention and 24/7 access that Dr. Susan Debin promised the new “concierge” arrangement would provide.

But with already-high monthly insurance premiums and constant cash outlays for co-payments and deductibles, the family couldn’t afford two elite medical memberships.

So Goodrich, a retired parks director, gambled that his own high blood pressure wouldn’t get worse. He paid the fee for his wife — but not for himself.

“I’m old school,” he said. “The women and the children go in the lifeboat first.”

The Goodriches’ dilemma is becoming more common as a growing number of doctors enact their own brand of health reform. These physicians are opting out of the system, with some doctors dumping insurance companies altogether and others forcing patients to pay thousands of dollars in cash to keep the care they’re accustomed to.

Doctors often tout this model as “concierge” care — you get more if you pay more. But for some patients, the flip side of this arrangement feels more like pay more or get less.

“It did leave me up the creek,” said Lilly Manning, 74, of Vienna, Va., who left her doctor of 15 years after he began charging patients $1,500 a year to remain in his practice. “I don’t think it’s right. I think a doctor should take anybody.”

5,000 concierge doctors — and growing

As many as 5,000 doctors nationwide have opted for full or partial concierge practices. Surveys suggest that number could quadruple within the next few years.

The result, critics say, is a segregated system that offers extra access for extra cash, even as it escalates a looming health care crisis for everyone else. And there’s nothing in the current health reform bills being considered in Congress to stop it.

“These practices exacerbate a fundamental problem in our health care system, which is this health care chasm between the haves and the have-nots,” said, Laura Weil, director of the health advocacy program at Sarah Lawrence College in Bronxville, N.Y., and an analyst of concierge care.

Here’s how concierge medicine works: Doctors charge anywhere from $1,500 per person per year up to $25,000 or more for a family. This fee acts as a retainer on top of all the insurance-covered services.

In some programs, those who don’t pay are forced to leave the practice. In others, they’re likely to see a nurse practitioner, a physician assistant or a newer, different doctor hired to handle the traditional patients.

The move to smaller, premium practices will worsen an already dire shortage of primary care doctors, creating an elite group of well-compensated physicians who see fewer and fewer upscale patients, dumping the rest on their increasingly harried colleagues, critics contend.

The U.S. is short by between 40,000 and 50,000 primary care doctors now, a figure that’s expected to top 125,000 by 2020, according to the American Academy of Family Physicians. That means people who don’t want or can’t afford concierge plans will have a harder time than ever finding a doctor.

But proponents of direct-pay and concierge care say the new models are the result of frustrated doctors defecting from a broken medical system, one that forces physicians to see too many patients for too little pay and with too much red tape.

Plus, plenty of patients are eager for this kind of personalized care — and are willing to pay for it.

“This is a multi-tiered health system and has been for a number of years,” said Darin Engelhardt, president of MDVIP, a network of some 300 concierge doctors based in Boca Raton, Fla. “What we’re offering is simply a choice along the health care continuum.”

Premium care for the price of a latte

Engelhardt and others reject charges of elitism, saying that paying extra for medical care is no different than affording other amenities of modern life, like a $4 daily latte or a fancy cell phone plan.

“Unless someone is prepared to suggest that a cell phone is an elitist instrument,” he said. “I don’t see it.”

The movement toward concierge care has exploded in recent years. Five years ago, there were 250 concierge doctors in the nation, serving perhaps 100,000 patients. Today, more than 5,000 primary care doctors run retainer practices serving 500,000 patients, according to the Society for Innovative Medical Practice Design, a concierge association.

An additional 7 percent of doctors surveyed in 2008 by the independent Physicians Foundation plan to switch to a concierge practice within three years.

In a parallel trend, more doctors are rejecting insurance and opting for cash-only payments. Nearly 12 percent of doctors had no managed care contracts in 2007, up from nearly 10 percent in 2004, according to the Centers for Disease Control and Prevention.

During that period, the percentage of doctors’ revenue that didn’t come from private insurance, Medicare or Medicaid jumped from more than 9 percent to more than 13 percent, the CDC said.

For docs, a lucrative choice

Doctors who make the switch to concierge practices find it’s a lucrative choice. At MDVIP, which franchises concierge-only arrangements, doctors limit their practices to 600 patients. At $1,500 apiece, that amounts to $900,000 a year. Even with the 33 percent the agency charges for administrative fees, it’s still $600,000 for the docs, in addition to insurance reimbursements.

Bob Goodrich’s physician, Dr. Susan Debin, signed up two years ago with Concierge Choice Physicians to start a “hybrid” model that contracts with 125 concierge patients from a practice of about 5,000.

Debin now tends first to the concierge patients, who bring in $200,000 annually at $1,600 a pop. Another full-time doctor and a staff of four nurse practitioners usually cover the rest of Debin’s patients.

For the Goodriches, the differences are clear. When Marjorie Goodrich goes to the doctor, she doesn't sit in the regular waiting room that her husband uses, with its close-set chairs and drab paint. She enters a different door in back, where plush chairs, fresh coffee and bottled water are available. More important, she sees Debin every time, while her husband typically sees a newer doctor or a nurse practitioner.

That’s OK with Bob Goodrich, who regards the arrangement as a small sacrifice for his wife’s health — and peace of mind.

“I felt that our life would just be affected too much if (she) had to change doctors,” he said.

It's pressure, not pay, that motivates some

Debin, 64, said money wasn’t the reason she switched to a hybrid concierge practice after 25 years of primary care. Instead, it was the grueling pace of insurance-dominated care, where high demand and low reimbursements had her seeing 40 patients a day and reviewing charts until 2 a.m.

Worse, it was barely possible to assess illness, let alone prevent it, which attracted Debin to primary care in the first place.

“I was passionate to do this and to practice a certain kind of medicine.” Now, she says, she can.

For the $1,600 fee, her concierge patients receive a comprehensive physical exam and preventive advice. Those clients are guaranteed premium appointments that begin on time and last 30 minutes, vs. 20 minutes for traditional clients. The extra fee also buys a small USB drive containing the patient’s medical records, and the big lure: 24/7 access, including Debin’s personal cell phone number.

For patients like breast cancer survivor Mary Ann Scherrey, 64, of Whittier, Calif., the extras are worth the price. A patient of Debin’s for 23 years, she didn’t know what to expect when she was invited to a town-hall meeting to hear her doctor’s new plans.

By the end of the night, however, Scherrey and her husband had decided to join. Scherrey, who works at an insurance agency primarily to ensure health coverage, said top-quality medical care should be available to anyone willing to pay for it.

Patient says extras worth the price

“Some people choose to drive a fancy car, some choose to live in a larger home, some choose to go on vacation and spend that,” she said. “To me, the most important thing in the world is our medical care.”

Good medical care is also crucial to Lilly Manning, the Virginia woman whose doctor started a concierge-only practice 18 months ago. But she said she was appalled at the cost of the concierge practice — and the philosophy behind it.

“People are having enough trouble getting insurance, and he wants to have this elite practice?” said Manning, who was recently diagnosed with throat cancer by her new doctor. “I just think it’s really unethical.”

Despite the attention being lavished on health reform, none of the proposals now in play is likely to change the way doctors are paid, which is the key to actual overhaul, according to Weil, the concierge care analyst.

“We’re really not going to create any structural change in the system itself,” Weil said. “We’re going to increase people’s access to insurance.”

Plans likely to grow under health reform

Indeed, backers of concierge and other practices say they regard health reform as a growth opportunity. A greater emphasis on preventive care and personal choice will highlight what they do best — and underscore the benefits of paying extra, said Wayne Lipton, the managing partner of New York-based Concierge Choice Physicians.

“The public is often unrealistic,” Lipton said, “and forgets that, one, someone has to pay the bill, and two, you get what you pay for.”

[JPINFV]

Engelhardt and others reject charges of elitism, saying that paying extra for medical care is no different than affording other amenities of modern life, like a $4 daily latte or a fancy cell phone plan.

“Unless someone is prepared to suggest that a cell phone is an elitist instrument,” he said. “I don’t see it.”

That's actually a very interesting point. How much more could people pay for if they cut some of the true luxuries out of their life? It's a choice, for example, to pay for a cell phone plan that covers unlimited text messaging (of course I'm old and remember a time before everyone had cell phones) and health care. It's a choice to pay for cable or cable with an expanded package instead of health care.

Second, who should set the amount that physicians can earn? I'd argue that if the government going to set physician compensation, then they should also be setting compensation for nurses, paramedics, and the rest of allied health staff. How many here would want the governemnt deciding what they will be paid?

[melclin]

It is an odd and almost uniquely American idea that healthcare is not an essential service and that it should not be provided or at least regulated by the government. You (the collective you) continue to confuse me.

[HERBIE1]

There always has been, and always will be 2 sets of rules- one for John Q Public and one for the rich/elite/powerful. It applies in the case of the law as well as health care, and I agree that with the proposed health care reform, this "concierge" medicine will likely increase for those who can afford to pay for it.

Fair? No, but it's also reality. Think about all the tax breaks someone who is wealthy can get vs the average citizen. Regular folks save receipts for charity donations to justify any write offs we want to take. The rich have a team of CPA's who find loopholes and tax dodges that allow them to skirt what we would think of as "paying their fair share".

In a sense, many people have this concierge system now. You accept and construct an insurance plan that balances your out of pocket expenses like copays for treatment and medication vs the monthly premium you can afford to pay. On the high end, you pay top shelf premiums for an all inclusive plan that allows you freedom of choice for any doctor, at any hospital, and any treatment or medication your doctor decides. On the other hand, you can choose an HMO that limits your out of pocket expenses, but the plan dictates when and where you can seek care, who will provide that care, which hospitals you can be admitted to, and how long you can stay.

Without derailing the thread, I agree we need to change the system, I just think that the proposed changes will not bring about the desired effect. There will always be a disparity between rich and poor. Think about the utopian type socialist countries and how the average citizen lives vs the powerful. I think human nature is such that despite good intentions, there will always be the "haves" and the "have not's".

\\relinquishes soap box..

[46Young]

Not that it's right, but if I were to go to school for all those years, do a residency, fellowship and whatever else required, not making any real money until I'm 30 or older (loan repayments), insurance against tort, and investing in a private practice, along with lousy reimbursement rates I'd look for ways to make my educational investment actually be profitable as well.

[HERBIE1]

Not that it's right, but if I were to go to school for all those years, do a residency, fellowship and whatever else required, not making any real money until I'm 30 or older (loan repayments), insurance against tort, and investing in a private practice, along with lousy reimbursement rates I'd look for ways to make my educational investment actually be profitable as well.

NO argument with you at all.

What's wrong with making a good living? Most docs are hundreds of thousands in debt by the time they finish their residency. Simple economics dictate that they need to earn a certain income in order to make investing all that time, effort, and money into a career worthwhile. The struggles they have with reimbursement, as you noted, are a very real problem. Does that make them any less dedicated to their profession if they enjoy a higher standard of living than most?

I have a friend who busted his arse for years, sacrificed, and put himself in about 300K in debt to become a doctor. He now has become partner in a surgical firm and is living the good life. He has several cars, a Harley. a huge house, is building a dream house by a lake, and even has a small plane. I don't begrudge him one bit- he earned everything he has. He is also one of the brightest and most dedicated doctors I have ever met.

[Lone Star]

Nothing against PA's and NP's, (please don't take this as a 'bash', I'm not hating on anyone here), but why can't the 'common poor people' see a 'real doctor' just because the doctor is getting greedy and wants to cater to those that are 'well heeled'?

What happened to the whole concept of 'treat regardless of their ability to pay'?

Do poor people/working class poor not deserve the same medical access as those that were born with a silver spoon stuffed in their face?

The disparity between socio-economic 'classes', just like racism will never be eliminated if we continue to rub the noses of the 'have nots' in what the 'haves' can afford!

[HERBIE1]

Nothing against PA's and NP's, (please don't take this as a 'bash', I'm not hating on anyone here), but why can't the 'common poor people' see a 'real doctor' just because the doctor is getting greedy and wants to cater to those that are 'well heeled'?

What happened to the whole concept of 'treat regardless of their ability to pay'?

Do poor people/working class poor not deserve the same medical access as those that were born with a silver spoon stuffed in their face?

The disparity between socio-economic 'classes', just like racism will never be eliminated if we continue to rub the noses of the 'have nots' in what the 'haves' can afford!

These elitist doctors are not the vast majority, Lone Star- even now.

I submit that you will get your wish if we get heath care reform in the manner the far left wants.

I also submit that in the coming years, we will also see the results of that reform when the best and brightest minds turn to professions other than medicine because altruism is nice, but it also does not pay the mortgage and the medical school debt.

[crotchitymedic1986]

There is nothing elitist about this, it is just the free market working, and it has been around for years. Following you guy's logic, there would be no need for any vehicle with more standards than a Ford Focus. If you can and are willing to pay for a BMW, Lexus, or Mercedes does that make you elitist because some people can't ? If you do not eat Ramen noodles at least twice per week, are you elitist ? If you can afford a good steak restaurant instead of Krystals are you elitist ? How many times have you been really sick, and called your Doctor to find out that they were booked solid ? How many of your Doctors will call you in a script without seeing you, or doing a bunch of expensive labs you dont need ? And this is great for the Doctors because they dont have to see 40 patients a day just to keep the lights on (because insurance reimbursement sucks).

[JPINFV]

What happened to the whole concept of 'treat regardless of their ability to pay'?

Just checking. When you transport a patient who lacks the ability to pay for the transport, do you give up your pay for the time on that transport?