by – Sheri de Grom
The emerging model of concierge medicine has its roots in both patient and physician frustration.
BASIC CONCIERGE MODEL
- Patients pay a monthly or yearly subscription fee to join a physician practice.
- The physician controls the number of patients in his practice and his income.
- The patients get 24/7 access to their doctor via phone and email, same-day appointments that can last hours, and a relationship in which the doctor’s and the patient’s interests are closely aligned.
- Concierge medicine is a growing premise of provider care. A company, MDVIP is the largest concierge medicine consulting company in the nation with more than 700 physician members and more than 200,000 patients in 42 states.
- MDVIP is a hybrid model that provides a comprehensive wellness screening of all patients. This patient screening becomes the foundation of the doctor-patient relationship. MDVIP accepts insurance, including Medicare, and 94% of patients renew with affiliated physicians.
- A physician with MDVIP sees between 10-12 patients a day. He has a patient panel of about 400 patients, about 10% of his former patient load. He receives about $140 a month per patient and he cares for the children of patients at no charge. MDVIP takes care of all insurance billing and reimbursement.
- Another example includes physicians who charge by age group. Sliding scales often range from a yearly fee of $750 to $4,500. Some doctors screen patients and others don’t.
- A concierge physician has the freedom to include as many services in his practice as he wishes. He controls every aspect of his business. He may or may not have a traditional office.
- At the extreme you might find a doctor with a vehicle equipped with advanced testing equipment and he sees all patients on house calls.
- Another physician might make arrangements for their patients to receive lab and imaging tests for about 10% of the cost that providers bill insurance companies.
Concierge physicians receive guidance as members of the American Academy of Private Physicians (AAPP), a nonprofit group which works with its members to build sustainable concierge medicine practices.
According to the American Medical Association there are approximately 246,000 primary care physicians practicing in the U.S. Approximately 40% are employed by health systems and hospitals. That leaves about 148,000 primary care doctors in private practice.
The editor of Concierge Today reports there are 5,500 doctors practicing concierge medicine and that rate is expected to grow by 15% a year.
The American Academy of Family Physicians kept concierge medicine at arm’s length for years, but is moving quickly to embrace the direct care concept.
A recent study by the Annals of Family Medicine projects there will be a shortage of more than 50,000 primary care doctors by 2025.
John Rother, a policy expert at the American Association of Retired Persons (AARP) wrote, “Those who can afford to pay a monthly fee will get better health care than those who cannot. Medicare patients, who universally have lower incomes, are at a disadvantage under such an evolving two-tiered system.”
After battling our current health care system for Tom’s life over the past 8 months, we would have concierge care, if I could afford additional capital outlay. An internist in a nearby city has joined a concierge team and I hope to interview him in the new two months about taking Tom on as a patient. My frustration is born of not having quick access to Tom’s internist. I’ll be the first to agree that Tom’s body is medically complex but I believe if I could achieve intervention by a physician that cared about his physical health, we could prevent much of what turns into life and death situations. [A perfect example of this is the inability of getting a timely appointment and a virus turning deadly causing last week’s emergency of cardiac arrest].
Or, is the above another example of medicine turning its’ back on the mentally ill patient and physicians continuing beliefs that a patient couldn’t be as ill as reported when requesting an urgent appointment?
My own internist has a highly-qualified Physician’s Assistant on his staff and I have 24/7 access to medical care. I know that when I call my internist’s office, I may not get to see him within 2 days but I will get to see his PA and if my situation is something she needs to consult my doctor about, she does. This has worked for me.
Tom and I used to share this internist and we should have had the same relationship with him but the internist couldn’t get past the idea of Tom’s bipolar diagnosis and thus, was not a good fit for Tom.
I’m all for everyone finding the best medical care for themselves. For the past 8 months with additional medical complexities occurring with Tom, we needed a doctor willing to take calls and guide us through the medical maze that stood in our way. Instead, Tom might have lost both legs and worse, died of an unidentified infection.
It’s hard for some Americans to wrap their heads around the concierge medicine model. Under the law, every American is required to have medical insurance – but direct primary-care patients can seek less expensive policies, because they require coverage only for hospitalizations, surgeries and other specialized care.
Concierge medicine provides a direction to primary care and a less expensive insurance policy than those currently offered by Obamacare. This new approach covers all preventive services and insurance would only be required for hospitalizations, surgeries and other specialized care.
In my opinion, there’s much to be said in favor of concierge medicine. I wish it had come along 20 or 30 years ago.
When people get good primary care, their maladies are diagnosed more quickly and can be managed before they grow into crises. Fewer patients wind up in expensive hospital beds. Emergency rooms treat genuine emergencies, not routine infections and minor injuries. Patients receive timely advice and encouragement from a trusted physician to shed those pounds, change that diet, drink a little less and exercise more. Insurance models discourage this holistic approach. Insurance pays for treating diseases, not addressing questions about preventative care.
It’s no wonder Primary Care Physicians prefer to cut their own path in their own medical practices. The Medicare Formula guiding payments to doctors will cut payments to all physicians by 21% on April 1, unless Congress overrules it. Primary care physicians are also facing a scheduled Medicare cut of 10% on January 1, 2016, unless Congress overrules it, which would be in addition to the cut all doctors will take on April 1, 2015.
Is it any wonder primary care physicians are leaving traditional medicine when in today’s
concierge medicine the average take-home payment is $200,000 to $250,000 per year and they don’t have to worry about Medicare or any other reimbursement policy change. Neither do they have to do mountains of paperwork. These groups of Primary Care Physicians treat their patients, the very reason they went to medical school in the first place.
How about you, have you had experience with concierge medicine and if so, would you like to share?
Would you consider giving concierge medicine a try?
Medical care is changing. Can we afford to allow congress to dictate our healthcare needs? We must have give and take. What risks must we be willing to take?
For Tom and I, perhaps our ideal would include a Concierge Physician for at least Tom and we would continue to maintain the insurance coverage we have. My sole reason for the concierge — immediate access. We have insurance that provides coverage for the specialist in place as well as pharmacy and hospitalizations. I see the Concierge Physician as the doctor that just might be the one that could keep Tom alive!
Today, it’s not just a Medicare issue. Primary Care is everyone’s business.
Thank you for reading with me and as always, I look forward to hearing your thoughts on this all important subject.