Patient
Procurement STARTING,
GROWING OR SELLING YOUR
CONCIERGE MEDICINE PRACTICE...
A
number of challenges face physicians who currently maintain
or are transitioning their practices to a concierge medicine
model. Meeting set patient participation thresholds is
a tremendous challenge for most physicians. The concept
of concierge medicine is not yet commonly known or understood
by most people.
The
concierge medicine legal and regulatory landscape can change
from one month to the next. If you are starting a concierge
medicine practice...you should really check in here for
more information.
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.*
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
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.
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."
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.
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
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:
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.
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."
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
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.
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.
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
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.
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.
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.
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.
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.
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.
"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.
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.
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.
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.
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.
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