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August 19, 2010
Who's Choosing The Concierge Doc? It’s Sure
Not Executives.
Executives account for less than 4% of patients searching for this type of care.*

By Michael Tetreault
Editor-In-Chief
Concierge Medicine Today

AUGUST 17, 2010 – Despite the high-powered executives using concierge medicine, executives of all ages and backgrounds are not the most popular patient demographic searching for concierge medical doctors across America today.

According to Concierge Medicine Today and its research arm, The Concierge Medicine Research Collective, an August 2010 survey of patients across America revealed that top-level executives account for less than 4% of the patients across America searching for this type of healthcare.

"I absolutely thought that the numbers would be higher," said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today (CMT). "With the number of consultants out there saying that [concierge] doctors should gear their marketing efforts towards executives and that a significant number of practices are comprised of this clientele, any physician should come to the obvious conclusion that this audience is not necessarily their primary market."

So, if it’s not executives who are searching for this type of care, who is looking for membership medicine services?

To find the answer to this question, we turned to the most popular concierge physician search engine on the Internet* Concierge Medicine Today's DOC FINDER. They receive requests from hundreds of prospective and first-time patient inquiries as well as current concierge patients looking to make a change.

  • 49% - of all concierge physician searches by patients received are for an Individual;
  • 23% - of all concierge physician searches received are for a Couple, with no children;
  • 21% - of all concierge physician searches received are for Families, with children;
  • 4% - of all concierge physician searches received are for Business Owners/Top Executives;
  • 3% - Allowable Margin of Error +/- 3%.

The information stated here provides more evidence that concierge medicine is not just for the deep-pocketed executive. In fact, we have recently learned that over 50% of concierge medicine patients make a combined household income of less than $100,000 per year.3

This data should be very encouraging to the public, as well as the practicing concierge or membership medicine physician in America. This concept, initially thought of by many as healthcare for the rich -- is now accessible and very affordable for couples, seniors on Medicare, young families and individuals.

If you would like to locate a concierge physician in your area, click here. Or, to learn more about the benefits and services these physicians provide to their patients, go to our patient education and video reserouce center, www.MyMD.tv. This new site has videos, blogs, articles and even a search engine you can use to locate a concierge doctor near you.

MyMD.tv, is an educational and informative web site and blog that allows former patients of concierge doctors, prospective patients and even current ones to watch videos and learn more about membership-based medical practices. The site includes a blog, commentary from physicians and patients, healthcare executives and more!

Sited Sources Include: Concierge Medicine Today, August 2010; The Concierge Medicine Research Collective, August 2010; Alexa Internet, Inc., August 17, 2010; Elite MD, Inc., August 15, 2010

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August 18, 2010
Truthfully, what's most important to patients about
the concierge doctor?

by Michael Tetreault, Editor-In-Chief of Concierge Medicine Today
Source: The Conicerge Medicine Research Collective & Elite MD, Inc.

I’ve always been of the persuasion and believe that Concierge Medicine has a story to tell. That story is that concierge [or as they are more fondly referred to by media outlets and patients alike…membership medicine] practices, provide an affordable, cost effective and personal relationship with a doctor. Furthermore, I believe it is also a life-line to those primary care physicians across America considering alternative business structures for their practices. It’s very attractive to almost any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.

But what truly goes through the minds of the public when they are choosing to use a doctor or medical practice like this? As the administrator of DOC FINDER and our educational publications, I can tell you that we talk to and receive hundreds, and now thousands of inquiries and visitors to our site from prospective patients and current patients who are telling us what exactly is most important to them about membership or 'concierge' medicine.

To provide our readers, the media and others with more educational and factual insight into the psyche of the concierge healthcare patient (ages 18-98) of present day, we asked our research arm, The Concierge Medicine Research Collective to assist us in surveying prospective patients and current patients of these physicians 'What is most important to you when choosing a"concierge" physician near you?' NOTE: This survey was conducted between April 2010 to August 2010.

The results of our survey revealed the following answers:

  • 38% - 24/7 Access is most important;
  • 18% - Same Day Appointments are very important;
  • 13% - Next Day Appointments are important;
  • 9% - It's important that my doctor participate in Medicare;
  • 6% - It's important that my doctor participate in most insurance plans;
  • 3% - Prescription and refill requests, when applicable, over the phone;
  • 8% - Other.

Concierge Medicine Today and its research arm, The Concierge Medicine Research Collective, is happy to provide our readers with educated insight and access to our polls and surveys. The information gathered and organized above is done so by these independent agencies and they are not affiliated with any physician or physician association. Knowing this, our readers can rest assured that this survey and data does not represent a specific group, practice or person. It represents the general public and their overall perception of the concierge medicine environment in Amercia in 2010.

Furthermore, we now are providing even more evidence that concierge medicine is not just for the deep-pocketed consumer or person(s) so reliant on insurance that they will not choose this healthcare delivery model. In fact, we have learned that over 50% of concierge medicine patients make a combined household income of less than $100,000 per year.*

In conclusion, things are looking up for the public-at-large in America seeking alternatives to their personal or family healthcare. What most people initially thought was healthcare for the rich and famous is now accessible and affordable for Archie and Edith Bunker and Joe the Plumber. If you'd like to locate a concierge physician in your area or learn more about the benefits and services these physicians provide, go to www.MyMD.tv. They have videos, blogs, articles and even a search engine you can use to locate a doctor near you.

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Last Updated: August 6, 2010
'Royal rip-off'
Hayden Christensen sues USA Network
over 'stolen' TV series

By BRUCE GOLDING | Posted: 2:25 AM, July 7, 2010 | Source: New York Post

The Force apparently wasn't with "Star Wars" actor Hayden Christensen when he pitched an idea for a new TV series to the USA Network.

The Canadian-born star and his older brother yesterday filed suit in Manhattan federal court against the cable outfit, charging that it stole their idea for a comedic drama about a "concierge" doctor who makes house calls to the rich and famous.

The brothers claim that USA's "Royal Pains" -- which is in its second season -- is a shameless rip-off of "Housecall," which they offered to the NBC subsidiary in 2005.

The Christensens claim a USA exec told them "that, prior to learning about 'Housecall,' he was unaware of concierge doctors and that he thought it was a fascinating idea."

A USA spokeswoman declined to comment.

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Posted August 4, 2010, at 3:03 PM ET
Rich Doc,
Poor Doc

Do cheaper doctors provide inferior care?

By Brian Palmer | SLATE

Many health insurance companies have responded to health care reform by pushing cheaper plans with a smaller selection of doctors, reports the New York Times. Do these cheaper doctors provide inferior care?

No one really knows. There are mountains of studies on the relationship between systemic health care costs and quality of care. (Most suggest that we're not getting a very good deal in the United States.) But those reports typically focus on unnecessary procedures and prolonged hospital stays. Few researchers, if any, examine whether highly paid doctors provide better care than their bargain-basement colleagues. In any case, you shouldn't assume that pricier doctors will be better for your health.

The rates a physician can squeeze out of an insurance company have more to do with market power than quality of care. Some hospitals, with their vast network of affiliated doctors, now dominate particular markets so thoroughly that they practically dictate their own fees. The company that manages the Massachusetts General and Brigham and Women's hospitals in Boston, for example, has been accused of establishing a monopoly over Beantown medicine. While those hospitals are among the finest in the country, the 4,000 individual doctors in their system earned their high reimbursement rates by joining the right network, not necessarily by providing better care than their Boston-based colleagues.

In addition, a doctor's ability to build a large client base—and gain leverage for negotiating with insurers—might have little to do with patient outcomes. Studies have shown that patients' hospital preferences are more responsive to improvements in amenities like wireless Internet and on-demand video than the likelihood that the hospital will help them get well.

If you're bargain-hunting, you might consider a large university hospital, where some of the world's finest physicians accept the cheapest insurance plans. Many doctors at the Johns Hopkins Hospital, for example, accept Medicaid's pitifully low reimbursement rates.

The lack of data on this topic isn't surprising. It's not always easy to figure out how much a doctor gets for an appointment or procedure. Large insurance companies typically offer take-it-or-leave-it prices to smaller offices, but hospitals and large physicians' practices haggle over the reimbursement rate for everything from a primary-care visit to freezing a wart. The negotiated price usually isn't made public, since neither party wants to undermine its negotiating position with third parties, making analysis of an individual doctor's compensation somewhat difficult.

It's also tough to measure the performance of individual physicians. The most common way to assess health care is to measure big-picture statistics like life expectancy or infant mortality rates, or how likely it is that someone will survive after having a heart attack. It's impossible to assign responsibility for any of these statistics to an individual doctor, because they depend on the performance of a large number of health care workers. Your likelihood of surviving a heart attack, for example, might depend on how fast the ambulance gets you to the hospital, how accurately the cardiologist assesses the state of your arteries, whether the anesthetist effectively monitors your vitals during a bypass operation, and how skillfully your surgeon repairs the damage, not to mention the work of countless nurses and pharmacists. Even the janitor who scrubs your room clean of bacteria plays a role. Outcome data speak to how well the system is working as a whole, but they can't say much about one doctor or another.

None of this means that you should automatically select the low-premium, small-network health insurance option. Sure, the doctors in the plan might be every bit as thorough as the concierge physicians down the street. The problem is that you might never get to see them. Many patients complain that none of the doctors in their limited network will accept new patients.

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Posted August 4, 2010, at 11:43 AM ET
Warner Norcross Launches Health Care Reform
Practice Group

Warner Norcross & Judd LLP has established a Health Care Reform Practice Group to assist employers, insurers and health-care providers in preparing for – and complying with – the sweeping changes to health insurance and health care-related programs enacted by the U.S. Congress.

Members of the firm's Employee Benefits and Health Law practice groups have joined forces to provide counsel on issues arising from the Patient Protection and Affordable Care Act, which was signed into law this spring. The legislation is designed to change health insurance coverage practices and create health insurance exchange markets. The act requires individuals to carry health insurance and requires employers to offer group health benefits – or face penalties.

The new group has two areas of focus. The Employers' Task Force has expertise in employer-sponsored group health plans. The Health Care Providers' Task Force is available to help physicians, medical practice groups, biotechnology companies and others move forward under the new laws.

"The PPACA will be phased in over the next few years, with some immediate reforms taking effect as soon as September," said Sue Conway, a Warner Norcross partner who concentrates her practice in employee benefits law. "While many significant changes will not take place until 2014, others are more imminent. Employers and health plans should begin preparing for them now.

"Our new practice group brings together attorneys with experience in group health plans, tax, employee benefits, health law and related areas to help businesses navigate the increasingly complex issues created by recent health reforms. Warner Norcross has analyzed the package of bills and regulations and can provide practical, proactive solutions to help companies move forward with confidence."

Major changes to the law include:

  • Mandated insurance coverage for all Americans by 2014
  • Penalties for large employers who offer no or unaffordable health coverage by 2014
  • Refundable tax credits and reduced cost-sharing requirements, as well as an expansion of Medicaid, to offset expenses for those with lower incomes
  • Establishment of health insurance exchanges for families and small employers
  • Elimination of certain restrictions, such as pre-existing conditions, for employer-sponsored health plans
  • Elimination of life-time coverage limits
  • Extension of coverage for children up to age 26
  • Uniform benefit descriptions to allow employees to more easily compare coverage options
  • New reporting requirements
  • New programs that offer tax credits on health insurance premiums for small employers
  • Early retiree reinsurance

"While these changes are being phased in gradually, individuals and businesses cannot afford to postpone planning for the necessary changes to their employee health plans," Conway said. "Many of the provisions are complicated and will require modifications to existing plans. Companies that do not comply with health reform face stiff financial penalties."

* * *

About Warner Norcross & Judd

Warner Norcross & Judd LLP is one of the leading law firms in Michigan. With nearly than 220 attorneys in Grand Rapids, Southfield, Sterling Heights, Lansing, Holland and Muskegon, Warner Norcross is a full-service provider of legal services. Nearly half of our partners are listed in the 2010 edition of The Best Lawyers in America. Warner Norcross has been recognized for business excellence and workplace flexibility with an Alfred P. Sloan Award, as a national leader in client service among law firms by BTI Consulting, as one of the nation’s leading employment law firms by Workforce Management, as one of the 101 Best & Brightest Companies to Work For in both West Michigan and Metro Detroit and as one of the Best Michigan Businesses by Corp! Magazine. The Firm represents local, statewide, regional, national and international clients in all areas of business and civil law.

Mary Ann Sabo
maryann@sabo-pr.com
Sabo Public Relations
T 616.485.1432

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July 23, 2010
Suggested Modifications To FFNCS Concierge Practice(s) As A Result of Healthcare Act

By John R. Marquis (jmarquis@wnj.com)

Warner Norcross & Judd LLP
www.wnj.com

After the publication of my recent article about the new Patient Protection and Affordable Care Act (the “Act”), some concierge physician clients have discussed with me how best to handle the new annual Personalized Prevention Planning Services (“3P Services”) created by the Act. I suggested in that article one method (which I will explain in more detail here) to accommodate these new wellness/preventive services within the normal structure of a “fee-for-non-covered-services” (“FNCS”)ii practice, but it would require a fundamental change in the financial structure of these practices.iii

From a legal standpoint, FNCS practices are based on the principle that a physician may bill Medicare only the approved rate for a given service and cannot charge the patient anything for the service other than an applicable co-pay and deductible. Of course, this rule applies only to
services that are actually covered by Medicare; it does not apply to services that are not covered.

The concluding element of this legal syllogism is that if the service for which a fee is paid is not covered by Medicare, the physician is not restrained by the Medicare laws as to what she can charge the patient.

Most FNCS practices today are built around an annual wellness physical (that is, one prompted not by any injury or malady but one simply scheduled on a periodic basis) and a personalized wellness plan. The following is language used in typical agreements:

READ FULL STORY >>

SIMILIAR STORIES:
June 25, 2010, CMS issued proposed rules relating
to the new Health Care Act and the new
3P Services for Medicare patients.

Click HERE for the rules.

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July 15, 2010
More Physicians Turning to Hybrid Concierge to Help Maintain Practices/Ensure Continuity of Care for All Patients

By Financial Post Online & Concierge Medicine Today

According to a 2010 independent analysis by The Concierge Medicine Research Collective, approximately 80% of the concierge medicine physicians operating in the U.S. today work inside a business model called a Hybrid. A Hybrid concierge medicine practice is where physicians charge "access" fees for services that Medicare and insurers won't pay for, such as email access; phone consultations; newsletters; and bill Medicare and insurance companies for patient visits.

Concierge Choice Physicians, the nation’s largest hybrid concierge medicine company, announced today the signing of its 155th physician practice and expansion to 16 states, most recently Missouri, Tennessee and the District of Columbia. The milestone marks a 50 percent increase in the number of physicians offering the hybrid concierge model in just one year’s time.

Physicians offering CCP’s hybrid model now care for more than 300,000 traditional and concierge patients – more than any other full concierge model company in the nation. CCP is the second largest company providing concierge practice management services in the nation. In September, the company will be expanding its main office by 50 percent to accommodate its expanding staff and physician panel.

While CCP offers a full concierge model to a small percentage of participants who request that option, its primary focus is pioneering its hybrid model. The ability to maintain the integrity of a traditional practice while offering a concierge option to patients is a key differentiator between the hybrid and full model of concierge medicine.

CCP’s hybrid model gives patients the choice to continue in a traditional approach to primary care or to join the concierge model. No patient is forced to choose between taking the concierge option, or find a new doctor. As a result, the hybrid model does not take good doctors out of the system; it encourages them to continue to provide care to all their patients.

Typically, in a conversion to a hybrid model, about 5 to 10 percent of the practice opts to join the concierge program, giving the physician a needed private, non-taxpayer funded source of revenue. Concierge Choice is currently the only major network model to offer a hybrid option.

“The last year has been a roller coaster ride for physicians,” notes Wayne Lipton, founder and managing partner of CCP. “Most physicians today want to stay in practice; they want to care for all of their patients. Reimbursement uncertainty, cuts in payments from private insurers, and rising overheads are making it difficult for many physicians to maintain their practices. The hybrid model provides a private source of revenue that helps physicians create and sustain a viable medical practice while continuing participation in government and private plans.”

Under the CCP program, patients can obtain same-day appointments, convenient scheduling and often 24-hour direct phone and email access to their physician. The hybrid model also offers medical and personal services that generally are not covered by traditional insurance plans or Medicare, such as lifestyle counseling, and in-depth preventive services with specialized tests. The fee averages about $150/month, annually less than the cost of a standard “executive” physical. Children up to age 25 may participate under their parents’ program at no additional charge.

Safeguarding Private Practice

Lipton also notes that a key feature of the hybrid model is that it enables physicians to stay in private practice. “A growing number of physicians today are joining corporate-owned medical groups to avoid the increasing frustrations and burdens of private practice in today’s marketplace,” he said. “We need systems that allow physicians that want to remain in solo or small practices to have that option. Private practice physicians know their patients and are uniquely qualified to provide the care needed in their communities.”

An Emphasis on Prevention and Wellness

Hybrid models also emphasize prevention and wellness – both key features that lead many patients to join. “In healthcare today, physicians are often forced to simply provide episodic care,” notes Susan Wilder, M.D., a primary care physician offering the hybrid model and also the Medical Director for CCP. “Patients join the hybrid model because they want a relationship with a physician that knows their unique personal health story and that can help them get healthy and stay healthy. While I provide all my patients with the exact same care, I simply have more time to help my concierge patients focus on health and wellness – it’s what they want and what I want as a physician.”

For additional information or to locate a physician in a specific area visit www.choice.md.

About Concierge Choice Physicians

Concierge Choice Physicians™ is a private company headquartered in Rockville Centre, New York. Concierge Choice Physicians offers a hybrid medical practice option so that doctors can practice both traditional and concierge-style medicine within a single practice. The company works with medical practices in Florida, Arizona, California, New York, New Jersey, Connecticut, Delaware, Virginia, Missouri, New York, Massachusetts, Texas, Maryland, Illinois, Tennessee and Nevada. For more information, visit www.choice.md or call 877-888-5590.

Read more >>

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Sebelius Discusses Benefits Of New HHS Website, healthcare.gov

Medscape (7/8) featured a guest commentary by HHS Secretary Kathleen Sebelius who discussed the new website, www.HealthCare.gov. Sebelius said that this site "will help answer...questions and give consumers a powerful new tool for navigating our health insurance markets." It "will also give consumers the ability to see all their public and private health insurance options in one place for the first time ever. The Website is already loaded with data from more than 1000 insurance carriers in addition to government programs like Medicaid and [Children's Health Insurance Program] CHIP." Notably, "it's all personalized so people can see the plans offered in their community that make sense for their situation."

Sebelius Seeks Partnership With Health Insurers. Reuters (7/9, Richwine) reports that Sebelius, who has recently been critical of health insurers, is now seeking a partnership with them in the interests of patients who could benefit from coverage even before the healthcare law takes full effect in 2014. During an interview with Reuters, Sebelius said that she has suggested to insurers that imposing high premium rates on customers also harms the industry. Sebelius said, "Some of those strategies I think are not particularly good business models. If they lose more and more market share as we move toward 2014, it's not really good for them."

Read More >>

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Health Care Reform and the Community Cardiologist:
2010 and Beyond

By Samuel Wann, MD; Suzette Jaskie, MBA

Source: Cardiology Today

The community practice of cardiology has undergone massive reorganization over the past 5 years. Much of the change predates Public Law 111-148, the Health Care Reform Act passed by Congress in early 2010. This sea change in the private practice of cardiology is related both to the increasingly unfavorable economics of independent practice and reaction to big-picture health care reform.

The trend toward hospital employment became a stampede on Jan. 1, when CMS enacted drastically reduced payments for in-office echocardiograms and nuclear stress tests, and eliminated codes for consultations. Even worse, MedPac, an influential panel advising Congress on Medicare, has recommended complete elimination of the in-office exemption for physician-owned imaging services. Payment for the technical as well as the professional component of echocardiograms and nuclear cardiology procedures performed in their offices has been a major source of revenue for independent cardiologists, who are faced with ever increasing overhead to pay for complex billing services, malpractice insurance and an electronic health record.

As expenses continue to increase and revenues decline, it is little wonder than an estimated 50% to 75% of all cardiologists in the country will be hospital employees by the end of 2010, up from less than 25% just 5 years ago. According to MedAxiom, which recently surveyed 5,400 cardiologists in 300 practices, cardiologists who have become hospital employees have seen their incomes stabilize, or even increase slightly, while independent practitioners continue to experience a steady decline in income.

Economics aside, the transformation from independent practice to hospital employment can offer real advantages to both cardiologists and hospitals when both parties have developed a joint vision of care models and global care delivery paradigms, truly sharing responsibility for decision-making based both on what is best for individual patients and for the health care system as a whole. A continuing challenge in virtually all integrated practices is the fusion of a facility-centric model with a physician-centric model, sharing not just governance, but control of everyday activities.

Nearly everyone agrees that the quality of health care benefits from a team approach, with seamless exchange of electronic data, systematic monitoring of appropriate resource utilization and realistic measurement of the quality of care delivered using clinical rather than billing data. The current legislative, legal and regulatory environment favors initiatives from integrated systems of hospitals and employed physicians. It is more difficult for hospitals and non-employed physicians to collaborate in order to meet ongoing demands for increased quality and decreased costs of health care.

Cardiologists who have already become hospital employees report that it can be challenging to maintain intimate, personal relationships with long-term patients and their families in an institutional setting. Referral patterns and office operations are often disrupted. It is not easy to integrate the wide breadth of preventive, primary and specialty services that mark a truly efficient and effective health care system and retain high service standards. Cardiologists and hospital administrators alike are struggling to adapt to the changing realities of health care delivery, with emphasis on accountable care and alternative compensation models that may replace fee-for-service and payment based on the volume of services provided. Practices with a long history of working closely with administration report that it is easier to integrate and share responsibility and authority between clinicians and administration than with those who have previously had a more adversarial relationship.

Due to various local environmental and personal factors, a substantial minority of cardiologists do not anticipate hospital employment. Smaller groups and solo cardiologists are less likely to become hospital employees. California has a physician-supported law that prohibits the corporate practice of medicine, impeding the formation of direct financial relationships between physicians and hospitals.

Cardiologists in a few affluent urban communities now refuse to accept Medicare, which prohibits billing patients directly for more than the 20% co-pay of the Medicare fee schedule charges. Richard Wright, MD, and colleagues at the Pacific Heart Institute in Santa Monica, Calif., continue to accept the Medicare fee schedule, but recently instituted a modified form of “concierge” medicine. To make up for continually declining practice revenue, patients in his practice are charged a yearly fee of $500 to $7,500 for priority access to non-covered services such as coumadin clinic, screening and wellness counseling, same day office appointments, night and weekend ER availability, 24/7 telephone access and other services not covered by Medicare.

Few community cardiologists are prepared to opt out of Medicare, but many do restrict the number of new Medicare and Medicaid patients they see. It is increasingly difficult to make up for losses incurred in caring for Medicare and Medicaid patients by charging more for privately insured patients.

Perhaps of more immediate importance to cardiologists than Public Law 111-148 is the failure of Congress to permanently resolve the sustainable growth rate problem, which is now potentially a $300 billion obligation. Congress has excused physicians every year from provisions of the law, which limits increases in physician payments to no more than the yearly increase in the nation’s GDP. Hospitals and the rest of the federal budget are not subject to this restriction. A permanent erasure of this hypothetical “bill” is now a priority for Congress. Physicians could face another 20% to 30% reduction in their payments from Medicare if the sustainable growth rate is allowed to take effect.

All these factors contribute to uncertainty in the job market. Some cardiology fellows who are finishing their training in the summer of 2010, are finding previously “firm” job offers have been withdrawn by economically stressed practice groups. Longer-term demographics lead to predictions of a work force shortage, as older cardiologists retire, employed cardiologists choose to work fewer, more regular hours, and the population ages, needing more cardiac care. However, the frequency of percutaneous interventions and coronary bypass surgery continues to decline. Even the number of patients admitted to hospitals for acute MI has declined dramatically in the last 5 years. Our success in reducing CV morbidity and mortality is largely attributed to primary prevention, not complex cardiac procedures. Hospital-employed hospitalists and physician extenders may also lessen the demand for cardiologists.

Other major news affecting cardiologists is the pending appointment of Donald M. Berwick, MD, as administrator for CMS. Berwick is president of the Institute for Healthcare Improvement and an accomplished activist in reducing medical errors. A pediatrician, he was the first independent member of the board of trustees of the American Hospital Association. At his institute’s annual conference in December, Berwick issued a challenge to health care providers: “Over the next 3 years, reduce the total resource consumption of your health care system, no matter where you start, by 10%. Do that without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve.”

Writing about the British health care system, Berwick has said, “At last a nation where health care is a right and carrying a semi-automatic machine gun is a privilege, and not the other way around.” We are in for an interesting ride.

Samuel Wann, MD, is a cardiologist with the Wheaton Franciscan Medical Group in Milwaukee and is the section editor of the Practice Manage and Quality Care section of the Cardiology Today Editorial Board. Suzette Jaskie, MBA, is the CEO of West Michigan Heart in Grand Rapids.

 

Medicare:
The Architecture of a
Public Health Crisis

Source: Huffington Post

Tamara McClintock Greenberg
Psychologist, Author, Speaker
July 2, 2010 01:06 PM


For a while, I thought my worries were irrational. One by one, I saw physician colleagues close their practices and open boutique medical concierge services. They decided to stop taking insurance and opened businesses designed to serve the wealthy. Many physicians I have previously referred to now take only cash-paying patients, and have decided to exempt themselves from insurance altogether. This had me worried about how medicine might soon be reduced to a state in which only the most economically privileged can actually seek out and receive medical care. But then I started to see what I had feared most; physicians are slowly and insidiously ceasing to be Medicare providers.

Who can blame them? Reimbursements have declined in recent years and although there have been halts to the "SGR" (standard growth rate) cuts until next November, in which Medicare reimbursement will possibly be cut again--the continued voting in Congress (every month) to put off the cuts feels akin to a stay of execution. The end is going to happen, though it is not clear when. Health care clinicians have been dealing with the threat of these cuts for many months now, and although they have not happened, the ominous threat of yet another income decline seem to have scared a number of providers into no longer taking Medicare. Has the Obama administration not noticed this?

Though Medicare might not seem to be a big issue for those of us under 65, it does, in fact, impact us all. Insurance reimbursements are often based on the Medicare standard rates. So if Medicare cuts reimbursements, this actually impacts most insurance rates. And if doctors don't get paid enough, they limit the amount and kinds of insurance they take.

The unrest for those who accept Medicare is not knowing if and when these cuts will dramatically change the ability to pay overhead for practices. Potentially, those who accept Medicare are going to have to decide if they want to provide very low fee services or if they should save themselves and get out of the system altogether. Indeed, many clinicians are already out. Some of the recent news coverage has included USA Today as well as a British Medical Journal Article published this week.

Physicians seem to be getting out of the Medicare system, and fast. The Medicare issue is a time bomb ticking away under the radar screen of those who can do something about it. If doctors continue to stop accepting Medicare, then what will happen to the millions of people who rely on Medicare for their health benefits? This is not just a question of class, but also a question of public health. What the Obama administration did so brilliantly last fall regarding the H1N1 flu and helping to prevent a wide outbreak might be a purely empty victory in the fall of 2010. If there are less providers accepting Medicare, then fewer seniors and others with chronic medical conditions will be less likely to receive routine medical care such as influenza vaccinations. This could lead to an increase in frequency of influenza outbreaks and preventable deaths.

And with boomers turning 65 (and thus eligible for Medicare) in greater numbers, this hardly seems to the time to experiment with what will happen when increasing numbers of doctors are getting out of the system. While healthcare reform will take care of the very disadvantaged, the middle class is at risk. People who are eligible for Medicare have paid into the system and expect to be rewarded. But if doctors continue to stop taking Medicare, where will this leave people who are neither poor nor rich? And more importantly, if we enter into the flu season in the fall of 2010, and some people cannot find providers because their doctors have decided to stop accepting Medicare, then we are really facing a public health crisis, and one the Obama administration may not be able to solve.

 

May 21, 2010
Poll Finding:
Patient Retention Among Concierge Doctors Two Years Longer Than Traditional Docs

By Michael Tetreault
Editor-In-Chief
Executive Director |
The Collective

ATLANTA, GA - In May 2010, The Concierge Medicine Research Collective polled concierge physicians from across the U.S. Preliminary findings indicate that 60% of concierge physicians retain their member patients for 7 to 9 years and longer. They also found that the national patient retention average for a traditional physician (i.e primary care, family practice, internist, etc.) participating with multiple insurance companies, managed care, etc., retained their patients for about 5 to 7 years. Figuratively, this longer-lasting patient retention information further solidifies concierge medicine's rightful place in the healthcare market. Concierge doctors emphasize that what's important to patients is relationship with their doctor and true cost savings. These are key and critical factors in the renewals of concierge or membership medicine plans that are now keeping the patient coming back year after year.

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Patient Interest In Locating A Concierge Physician Up Nearly 300% In 2010

Concierge Medicine Today receives requests every single day from people who are wanting to locate a concierge doctor in their area. Since January of 2010, our DOC FINDER Program has become one the hottest and most popular search engines for people looking for either another concierge physician or wanting to explore the benefits and cost-effective services these physicians provide.

Find A Concierge Doctor

 

May 20, 2010
Morning Read: Concierge medicine multiplies

By Brandon Glenn | MedCity News

Concierge medicine multiplies: The number of doctors who practice concierge medicine, which involves foregoing insurance and charging higher prices to patients for better service, is small but likely to continue growing. Only about 1,000 doctors in the U.S. have joined the movement, but many physicians who’ve made the switch report that the grass is greener, in terms of both their personal and financial fulfillment. But many complain that concierge medicine creates a “two-tiered” health system of haves and have-nots. “The majority of us think it’s an unethical and ultimately selfish way to practice medicine,” said one internist.

 

May 18, 2010
Two Tiered Medical Care for Haves and
Have Nots
As doctors leave the system, patients scramble to find care

By ADAM GRAHAM-SILVERMAN, The Fiscal Times

Not long after Cynthia Thek gave birth, her gynecologist opened a new practice in Englewood, N.J. Gone was the traditional waiting room, replaced by a reception area with spa-like ambience. Instead of a hospital gown, patients got a plush bathrobe. “It’s a beautiful space. The staff is superfriendly. You don’t feel rushed by the doctor or even the staff,” Thek, 32, explained recently. “However, [the doctor] also stopped accepting any insurance.”

Thek stuck with her doctor, Jennifer Ashton, for one post-delivery visit, paying $250, about half of which her insurance reimbursed. But when she learned that care for her next pregnancy would run $8,000 to $10,000, much of it not reimbursable, she decided to look for a new OB-GYN.

A small but growing number of physicians are pursuing Dr. Ashton’s approach: abandoning traditional insurance-based practice to offer VIP treatment, including more time with patients, in return for upfront fees. In one common setup, often called concierge or retainer-based medicine, a primary care doctor charges an annual fee ranging from $1,000 to $20,000 just to get in the door. When doctors shift to this model they can cull their patient loads, selecting only those who can foot the bill. The services they provide often include a deluxe annual physical, 24-hour direct cell phone access to a doctor and escorts on visits to specialists. Some doctors still accept insurance and Medicare and bill normally for routine care. Others, like Dr. Ashton, opt out of that system in order to charge what the market will bear. Ashton did not respond to requests for comment .

The Haves, the Have-Nots

Doctors say the concierge system makes life much easier for them and assures better care to their remaining patients. "At the end of the day, you can look yourself in the mirror and you know that you did a good job with the patients you saw," said Dr. Steve Reznick, a Boca Raton, Fla., physician who cut his roster of patients from 3,500 to fewer than 400 five years ago. "You couldn't do that seeing 40 or 45 senior citizens a day in the past." While that may be true for the doctor and remaining patients, it's not always easy for the thousands who didn't or couldn't pay, and who had to find a new doctor. Some health care experts view this as an ominous trend that could exacerbate socioeconomic disparity in the health care system in light of a looming doctor shortage. They say this development could be especially troublesome once the new health care law adds millions of Americans to the health insurance rolls and sends them looking for doctors. "Doctors love it. But in fact, from a societal point of view it's a tragedy," said Dr. Richard Cooper, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

The health care legislation recently signed by President Obama is aimed at lowering costs and adding insurance coverage for more than 30 million people by 2014, including 16 million new Medicaid members. But it does not account for the projected shortfall of 35,000 to 44,000 new primary care doctors, nurses practitioners and physician assistants that are choosing alternate disciplines because of increasing workloads, low reimbursements, a paperwork burden and a huge gap in pay compared with medical specialists.

The Doctor is Out

A 2009 survey of general practitioners by the American Academy of Family Physicians showed that 42 percent were not accepting new Medicaid patients. 65 million Americans are already living in areas the government has deemed short of primary care practitioners. And they’re not the only ones dropping out of the system. Recently, Walgreens and two other pharmacies in Seattle, Wash., decided to deny coverage to new Medicaid patients because of low reimbursements. And in a shocking move by one of the most revered hospitals in the country, The Mayo Clinic shuttered its Medicaid facility in Phoenix, Ariz., because it was losing too much money.

Dr. Marc Siegel fired a warning shot about the doctor dearth in an op-ed in the Wall Street Journal last April. “With more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have,” he said. He cited a 2008 report by the Medicare Payment Advisory Commission stating that 28 percent of Medicare beneficiaries had trouble finding a primary care physician; another survey that year by the Texas Medical Association found that only 38 percent of primary care doctors in Texas took new Medicare patients. Texas is not alone, as more and more physicians try to find acceptable ways to practice medicine without feeling like they’re being exploited.

Top-of-the-Line Care for Top-of-the-Market Fees

Concierge-style medicine is one way that overloaded doctors have chosen to respond. The American Academy of Private Physicians, the trade group representing the concierge care movement, says more than 1,000 doctors have gone this route. By another measure, 1.2 percent of respondents to AAFP's survey say they practice concierge, boutique or retainer medicine.

While fee-for-service, or “private,” doctors have long existed, primary care doctors began converting to the concierge model about 15 years ago. Companies came along to help doctors set up these practices and handle the administration. The largest, MDVIP, has more than 380 doctors. Reznick says all the physicians in Boca Raton have adopted this model, meaning that most patients face a payment just to get in a doctor's door. (This rise of high-cost medical services was accompanied by low-cost fee-for-service programs aimed at the poor or uninsured.)

In 2002, MDVIP attracted the attention of several Democratic members of Congress, who questioned whether concierge physicians were essentially charging seniors for services that Medicare already provided at established rates. That would be illegal. In a letter and subsequent documents, Health and Human Services secretary Tommy Thompson said that this model was fine so long as the fee was for services that were not covered by Medicare. With the exception of one case in 2004, in which a concierge-style doctor in Minnesota paid more than $50,000 to settle a claim that he violated his agreement with Medicare, HHS has left these doctors alone.

But many doctors say that while the current system is not sustainable, drastic cuts in patient load are ultimately misguided. “It’s a short-term solution to say, 'I'm going to cherry pick some people who can pay me a concierge fee,’" said Dr. Michael Stillman, an internist at Boston Medical Center. "The majority of us think it's an unethical and ultimately selfish way to practice medicine.”

Dr. John Goldberg, an internist in the Kansas City area, said he could hardly ask a patient who can barely pay for medication to pay a fee for his care. Juggling many sick patients is just part of a day’s work, he said. “I worked in three or four people [Monday] that didn’t have an appointment Friday when we closed the office,” Goldberg said. “They’re not paying a premium; that’s just the right thing to do.”

The American Medical Association says there's nothing inherently wrong with concierge-type of arrangements. However, its ethics manual cautions that they "not be promoted as a promise for more or better diagnostic and therapeutic services." That puts concierge doctors, particularly those who offer traditional service as well, in the awkward position of trying to promise patients that they're getting something for the extra money while telling the rest they're not giving up any medical services.

Of course some concierge doctors do say they provide services, not necessarily better care. "What I sell my patients is a better day," said Dr. Marcy Zwelling, head of AAPP and a concierge doctor near Long Beach, Calif., who shed most of her 3,000 patients. "Do I think that sitting in a waiting room is bad care? No, but it’s probably a waste of time. I don’t think people die because they don’t have what we do. But do I think my patients live longer? I know they do." There are no peer-reviewed studies of the health benefits of this approach. MDVIP cites its own study showing lower hospitalization rates for Medicare patients who are in concierge practices compared with those who are not. One study from 2005 suggests that the pool of concierge subscribers is less black and Hispanic, and has fewer chronic illnesses, like diabetes, than the general patient population.

Changing by Default, Not Design?

Doctors who have adopted this approach say the current system has forced them into it. To break even with reimbursements from Medicare and private insurance, Dr. Susan Wilder said she used to be able to spend no more than 8 minutes with each patient. "You're forced into a situation of seeing more and more patients in less and less time, and the patients are more and more complex, and the administrative costs go higher and higher," said Wilder, who converted her suburban Phoenix practice to a hybrid in which some patients pay a concierge fee while others do not. Wilder said her longstanding patients know that they get quality care no matter what. "I don’t think they needed any reassurance. I'm not going to dumb myself down to take care of my routine patients," she said.

Reznick, the Boca Raton doctor, said he tried everything to keep his practice afloat. But he couldn’t manage. He now charges an annual fee of $1,800 as well as small payments for office visits.

Like all the concierge doctors interviewed for this story, Reznick found other doctors to take the patients who did not join his program, and kept very ill patients as well as some who could not pay.

Groups that support concierge physicians say the cost – about $4 per day in most cases – is not prohibitive, and that it comes down to a question of choice in the marketplace. "People go to McDonald's; people go to Burger King, you know," said Zwelling. "It's a choice." Darin Engelhardt, the president of MDVIP, said that most physicians who convert are on the verge of leaving medicine altogether, so it's not accurate to say that every conversion means one less doctor in the market. To the contrary, the success of MDVIP's financial model will lure doctors back to general practice, he said.

"On the experienced physician side, we extend the careers of primary care physicians," he said. "And as far as younger physicians go, we've created a model that can prove … that primary care can in fact be viable again."

But for Thek, who quickly found a new OB-GYN who does accept her insurance, it was not worth the price. “I feel like I get the same level of care at the new practice," she said, "minus the spa-like office and the plush bathrobe.”

 

May 17, 2010
Blog Post From
Kevin, MD

By Kevin, M.D.
http://www.medpagetoday.com/Blogs/20134

Much has been made about how primary care is dying in this country. Will its fate be perpetuated with health reform, with over 30 million newly insured patients straining the system?

In a guest post, concierge physician Steven Knope predicts a boon for his practice: "As a concierge physician, people often ask me how this move toward a government-run healthcare system will affect me professionally. Speaking honestly, I tell them that it will help my practice, but I do not think this is good news for the country ... As someone who practices full-service internal medicine, the demand for my services will continue to increase."

It's true that as internal medicine splinters into hospitalists and clinic-only physicians, the demand for the traditional model of internal medicine may increase.

Dr. Knope bemoans the fate for many of his colleagues, saying "their hospital skills have atrophied. They will never practice comprehensive medicine again. For them, the game is already over."

And internal medicine's downfall continues.

 

May 04, 2010
The Practice Of Medicine:
Changes Are Evident -- From
Med School Training And Technology To
Concierge Medicine

News outlets report on issues affecting physician practices:

Kaiser Health News, in partnership with The New York Times, explores what medical students are taught about health care costs: "Doctors in training have traditionally been insulated from information about the cost of the tests and treatments they order for patients — in fact, for decades, the subject was virtually taboo when professors and trainees discussed treatment decisions during hospital rounds. ... Until recently, most schools included little information on financial factors, like how the insurance system works and how treatment costs affect patients' behavior. As a result, most physicians enter practice with little sense of how to make the most cost-effective choices for patients, or how their own decisions affect the patient's — and the nation's — medical bills. … But escalating costs and the national debate over the health care overhaul are forcing medical schools and residency programs to grapple with teaching about the financial side of their profession. Accrediting organizations now require such teaching, and students and residents recognize that they need to understand finances as well as blood tests" (Okie, 5/3).

KHN/The New York Times, in a related story: "Health policy experts hope that technology will become a tool for educating doctors about the cost of care. More widespread use of electronic medical records, they say, will help keep costs in check by providing doctors with precise information on the price of tests and drugs even as they are deciding what to order" (Okie, 5/3).

The Washington Post, on how the new health law might change physician practices: "Fifty years from now, it is likely that almost all doctors will be members of teams that include case managers, social workers, dietitians, telephone counselors, data crunchers, guideline instructors, performance evaluators and external reviewers. They will be parts of organizations (which either employ them or contract with them) that are responsible for patients in and out of the hospital, in sickness and in health, over decades." Records will be electronic. "Software will gently remind them what to consider as they treat, and try to prevent, diseases. How the patients fare will be measured and publicized, and used in part to judge practitioners' performance." In addition, the health care law will likely shift the focus of medicine to primary care, and physicians will be better coordinated, and readmissions could be reduced (Brown, 5/4).

AZCentral.com, on the physician shortage and the new health law: "After Massachusetts started rolling out its 2006 law to ensure that nearly every one of its residents had health insurance, the sudden influx of newly insured patients created long waits to see primary care doctors. Now, physicians worry the entire country could see the same thing happen when the recently passed health care law takes full effect in 2014" (Vock, 5/3).

The St. Petersburg Times, on concierge medical practices: The concept is "expanding to a middle class market, as more patients worry about access to health care and doctors look for alternatives to the bureaucratic hassles of private practice. Some concierge doctors accept only cash. Others accept insurance, but charge patients a membership fee. That allows them to limit the number of patients they see at a time when primary care doctors routinely have thousands of patients on their books in order to make ends meet. The American Academy of Private Physicians estimates that 3,500 U.S. doctors practice some form of concierge medicine" (Stein, 5/4).

Meanwhile, dentists "are warning they may become unintended targets of legislation designed to overhaul Wall Street," The Hill reports. "Lawmakers and lobbyists have clashed for more than a year over whether a new consumer financial protection office would cover industries and companies that had nothing to do with the financial crisis of 2008. … Dentists could fall under the Senate financial bill because they often allow patients to pay in installments, [Michael] Graham [managing director of government affairs at the American Dental Association] said. According to a 2009 ADA survey, roughly half of dentists offer this type of billing for three or four months" (Brush, 5/3).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

MORE ANALYSIS >>

 

New Health Care Act Deals Serious Blows To Concierge Medicine

By John R. Marquis (jmarquis@wnj.com)
Warner Norcross & Judd LLP | www.wnj.com

In large part, HHS and its enforcement arms have left legitimate FNCS practices alone. But the Patient Protection and Affordable Care Act (the “Act”)3 is going to cause serious problems for these practices and will require them to restructure in order to accommodate the Act. The Act creates other problems for the fee-for-care model, problems that are not as fixable.

The provisions of the new Health Care Act discussed above are going to have serious consequences for both kinds of concierge medical practices. Those for FNCS practices can be adequately handled by restructuring patient agreements to modify how annual physicals and wellness plans are dealt with for Medicare patients. Fee-for-Care practices have more of a challenge due to the apparent blanket disallowance of Medicare payments for DME and home health orders by opted-out physicians.

READ FULL TEXT | April 22, 2010

 

New Healthcare Act creates some real problems for physicians who have opted out of Medicare.

READ MORE | April 4, 2010

 

We Asked Concierge Medicine's Political Action Arm, The Direct Primary Care Coaltion (DPCARE.org) To Comment On The Recent Healthcare Reform Bill & Its Passage

"These bills are mostly about health insurance reform, not health care reform. Expanding coverage is a good thing. But the underlying cost of health care must be directly tackled over the coming years," said Norm Wu of Qliance/DPCare.org.

 

So You're Telling Me That Nearly 60% of Concierge Medicine Fees Cost Less Than $135/Mo.?

Concierge Medicine provides an affordable, cost effective and straightforward relationship with a doctor. It is also a life-line to those primary care physicians across America considering alternative structures in their practice. Concierge Medicine is attractive to almost any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.

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Boutique Medicine Venture Generates Marketing Intelligence for Procter & Gamble

It is likely that P&G is looking for opportunities to market relevant products to these patients as a compliment to the healthcare provided by the concierge doctor. Pathologists and lab managers may be surprised to learn that P&G, for example, already owns a stake in California-based Navigenics Inc., a company organized to sell genetic testing to the consumers using a web site. In 2008, MDVIP worked with Navigenics to test a genetic test that included markers for gauging a patient’s predisposition to cancer, diabetes, heart attacks and other conditions.

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What Is Concierge Medicine?

Concierge Medicine provides an affordable, cost effective and straightforward relationship with a doctor. It is also a life-line to those primary care physicians across America considering alternative structures in their practice. Concierge Medicine is attractive to almost any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.

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U.S. House & Senate Members Pay Annual Fee For Official Congressional PCP

According to a December 2009 article in the Atlanta Journal Constitution, one of the many perks members of congress may receive is from the Office of the Attending Physician of the United States Congress.

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"Branding" Concierge Medicine --- Terminology Explained

Concierge medicine has had somewhat of a "brand/identity" issue in the media and health care marketplace. It has also been referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; direct primary care and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation.

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The Difference Between Concierge Medicine & Direct Primary Care

Direct primary care (DPC) is a term often linked to its companion in health care, 'concierge medicine.' Although the two terms are similar and belong to the same family, concierge medicine is a term that fully embraces or 'includes' many different health care delivery models, direct primary care being one of them.

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The Concierge Medicine
Research Collective

The "Collective" is focused on gathering and analyzing data from concierge physicians (from various specialties) and consumers of "concierge" services for various organizations that work diligently to provide solutions and cost-benefit information to those seeking more information about concierge medicine services.

VISIT WEB SITE

AAPP (Formerly SIMPD)

The Society for Innovative Medical Practice Design (SIMPD), is a nonprofit organization, was founded in 2003 for the purpose of furthering the needs of physicians interested in innovative medical practices.

LEARN MORE ABOUT AAPP | LOCAL CHAPTERS

The Direct Primary Care Coalition

The Society for Innovative Medical Practice Design (SIMPD), is a nonprofit organization, was founded in 2003 for the purpose of furthering the needs of physicians interested in innovative medical practices.

VISIT DPCARE.org


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