May 28, 2012

Concierge Medicine Is Not Understood

Concierge medicine is not well understood. As Dr. Centor states, “Policy wonks have ignored this movement for too long. Retainer medicine is a fast growing start-up industry. It grows because it fills an unfilled niche.” Many people and companies are beginning to utilize concierge doctors more frequently and it will continue to grow as our current system continues to languish in its broken state of greed and corruption.

There are some questions that need answering and I will strive to give some answers.  There is an organization named the American Academy of Private Physicians (AAPP), which encompasses the physicians operating in the concierge medical community. The American Academy of Private Physicians and was founded in 2003. Some areas on the site are for membership only but most are viewable by the public.

Within the concierge community, there are a few large groups serving people on a regional scale. What is unique is that when combined with a high-deductible medical insurance policy to cover hospitalization and some other high dollar costs, the model is significantly more cost effective for the patient. At present, there may be some setbacks in coverage, but eventually the medical insurance industry will innovate and cover more of the present holes. I am sure that there is talk between the AAPP and medical insurance to do this.

The one item I have not found that may be a total out of pocket expense for some is prescriptions. High deductible insurance policies will not fill this gap at present. For some with chronic illnesses or diseases requiring expensive medications like diabetes, this could be expensive.

To this point I have been using one term for roughly four types of service. Dr. Centor defines the first three and Dr. Matthew Mintz talks about the fourth. I quote both of them for maintaining clarity.

We need to define terms:
Concierge medicine – paying a large (>$3000/yr) fee to contract with a physician (usually an internist) to provide same day appointments, phone access, email access, comprehensive and continuous care

Retainer medicine – paying any fee to receive the same access as concierge medicine. Generally concierge practices have smaller panels, i.e., the more you pay, the less patients the physician has to follow

Direct primary care – retainer medicine for a lower fee

Boutique medicine - I think the key words in this definition are “specialized” “stylish” and “elite.” The first word is something commonplace in medicine, but the later two words are something usually not associated with medical practice. “Luxury” is also implied in the word “boutique.” Thus, in my opinion, a boutique doctor is one that specializes in unique, often luxurious services, that are not offered by others and which will therefore cost a little extra. Read the full blog here by Dr. Mintz.

I am bothered a little with Dr. Mintz and his concern for ethics and word association. The current medical system is broken and needs overhaul. If I could afford any of the above, I would be there in a heartbeat. I say let the patient decide what level of service he/she desires and can afford. If a doctor establishes excellent doctor patient relationships, he will have a great practice. If a doctor is this concerned about the meaning and connotation of a word, maybe medicine is not where the doctor should be.  Many doctors writing about this topic are stressed about ethics.  I think too many decades of fighting with the insurance industry and government has addled their thinking.  I remember the 1940s and 1950s when this would not have been a concern.  Even before this, we had fee for service, but not the term concierge.  Some doctors were paid with produce and other patients paid with currency.

We as patients cannot always afford the best in care now and are seeing too many cases of government euthanasia because they won't pay for the treatment. See my blog here about the treatment of kidney transplant patients being denied immunosuppressants by Medicare. I predict that if the current system does not have a jolt soon, many patients will not have a place to get care, regardless of the cost.

Our medical insurance industry needs to change and if these types of services can exist without insurance, we may be better off. Hospitals are better able to demand more money from the insurance companies and major medical will become more affordable as some companies are forced out of business for their greed. Insurance executives do not need million dollar plus salaries. As a patient I feel that changes are coming and the patients may do better as a result. Will everyone be happy? This is highly doubtful, and some will suffer as a result of these changes.

Another helpful article on concierge medicine can be read here. This article highlights some of the professional jealousy by doctors and specialists unable to make the change. Insurance companies are angry and have dropped doctors. HHS is also warning doctors. Some states are investigating whether under the insurance laws in their states this is even legal. Read this article with care.

"If Medicare continues to tighten the screws on doctors ... some will react by saying, 'I'm just fed up with the whole thing.'" And if more doctors shift away from traditional practices to concierge medicine, it could exacerbate the physician shortage because there will be fewer doctors to go around. I hate to say this, but this may get action, both good and bad, from the voters when our congressional people refuse to act to get government out of medicine.

Patients have had it too good for too long and will become militant if Congress refuses to act and wait times for appointments become longer and longer.

I must add this Medscape article of May 27.  This is what we need, doctors that are not afraid to speak out and are not intimidated by doctors that are striking out because they think the "system" is the only way.  I found this article very good. 

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