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We Believe Concierge Medicine Has A Story To Tell. We Are The World's Premier News Source For All Things Concierge Medicine.
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September 3, 2010 By Michael Tetreault 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.
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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September 3, 2010 by Michael Tetreault, Editor-In-Chief
of Concierge Medicine
Today 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:
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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August 10, 2010 by Brian Forrest, MD | Source: KevinMD When I started a cash-only, direct-pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life. I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose a productivity bonus. Nine years later, my practice Access Health Care in Apex, North Carolina is living proof that primary care physicians can provide better care to more patients more economically while making significantly more income if we start answering to our patients instead of answering to insurance companies or government bureaucrats. Our model attracts a lot of interest:
As word about my practice began to spread, I began answering questions from other physicians looking to start or transition their own practices following our Direct Pay model. Over the past five years, those questions evolved into a consulting practice helping over 75 physicians across the country, in specialties ranging from family medicine to ophthalmology. In the wake of health care reform, and with physicians facing financial stress from reduced reimbursements and increasing Medicare recovery audits, interest in alternative practice models is surging. It is time to get off the treadmill of factory medicine, and return medicine to doctors and patients. Brian Forrest is a family physician and is the founder of Forrest Direct Pay.
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Last Updated: August 6, 2010 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 Do cheaper doctors provide inferior
care? 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. July
23, 2010 By John R. Marquis (jmarquis@wnj.com)
Warner
Norcross & Judd LLP 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 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: SIMILIAR
STORIES: Click HERE for the rules.
June 8, 2010 Source: Concierge Medicine Today Utilizing a blended rate based upon national averages for current fees charged for concierge medical care, an estimated 9,285,714,286 people could be provided concierge medical care with the 13 trillion dollar debt. Carrying this out 928,571,429 people could be provided this care for 10 years. These figures are based upon information obtained through average pricing surveys conducted Concierge Medicine Today.
June 1, 2010 Greenbrier Clinic Joins The Global Prevention Network™ Dallas/W. Va. (Vocus/PRWEB ) -- U.S. Preventive Medicine®, the leader in disease prevention services, has announced that Greenbrier Clinic has signed a participation agreement with the company to become a worldwide referral partner for members of The Prevention Plan™ seeking executive health, preventive medicine interventions and specialty follow-up care.Under the agreement, Greenbrier Clinic will become a participant in The Global Prevention Network™, a select group of preeminent health care institutions with recognized research, preventive services and executive health programs in the U.S. and internationally. Affiliates in The Global Prevention Network enable U.S. Preventive Medicine to provide both national and global prevention solutions for individuals, employers, and government entities, and serve as educational partners in U.S. Preventive Medicine’s international outreach efforts. Located in the West Virginia wing of the renowned Greenbrier Resort and Conference Center, the Greenbrier Clinic was formed in 1948 by progressive business leaders who understood that healthy executives are the cornerstones of healthy corporations. The clinic combines a relaxing environment with unparalleled diagnostic evaluation and care. "U.S. Preventive Medicine is committed to providing our members with access to the most respected health care institutions around the globe. With a rich history that began in 1778 with its White Sulphur Springs, the Greenbrier has embodied the concept of wellness for over 230 years. Today, the Clinic offers the most advanced diagnostic equipment and expertise available. The Greenbrier Clinic will be a strong addition to our growing network of distinguished preventive and specialized care affiliates,” said Christopher Fey, Chairman and CEO of U.S. Preventive Medicine. “The Greenbrier Clinic, this country's pioneer of preventive medicine, is very excited to affiliate with U.S Preventive Medicine. Since inception in 1948 our medical staff has always advocated the importance of preventive medicine and impact this has on longevity. Many major corporations, government dignitaries, professional sports figures and celebrities have frequented the clinic over the past 62 years," said H. Ed Jones, Administrator of Greenbrier Clinic. “Historically, most of our established patients return every year for their annual evaluation. Our oldest patient has never missed his annual health evaluation in 55 years,” said H. Ed Jones. The Global Prevention Network provides The Prevention Plan members concierge service directly to the finest health systems in the world for executive health, early disease detection assessments through advanced diagnostic technology, and specialized follow up care. Other network affiliates include the Cleveland Clinic FL, Mayo Clinic FL, Mt. Sinai Medical Center, Massachusetts General Hospital, Cedars-Sinai Medical Center, Scripps Health, American Hospital in Paris and Parkway Health in Singapore. U.S. Preventive Medicine pioneered The Prevention Plan™ product suite to address the growing health care needs nationwide and internationally. From wellness and chronic care management to The Prevention Plan Prime for seniors, The Prevention Plan offers a comprehensive suite of tools across the entire preventive health care continuum. Other proprietary innovations include the: 1) Prevention Score™, a tool that tracks an individual’s prevention efforts and key health indicators throughout the year; 2) ROI Calculator that integrates comprehensive national data analytics with a company’s specific information to predict how much the organization can save over time with The Prevention Plan products; and 3) ROI Guarantee to offer clients a reassurance agreement that defined goals will be realized. About U.S. Preventive Medicine U.S. Preventive Medicine® is leading a global preventive health movement focused on saving lives and money by keeping people healthy and better managing chronic conditions before they progress. The company provides an integrated continuum of prevention programs—primary, secondary and tertiary—that are based on the clinical science of preventive medicine. The Prevention Plan™, the world’s first preventive health benefit, moves beyond traditional wellness to identify each individual’s top health risks and design a customized plan of action supported 24/7 by nurse coaches. The company is accredited in wellness and health promotion by NCQA and disease management by URAC. About Greenbrier Clinic The Greenbrier Clinic’s state-of-the-art diagnostic equipment assures maximum comfort and safety to patients as well as accurate, early diagnosis of medical issues. The medical staff fosters a personal relationship with patients, which builds trust and enhances patients’ understanding of their health. The Clinic’s emphasis on preventive health counseling encourages healthy people to safeguard their most valuable asset, which benefits both the individual and his or her employer. Visitors can enjoy all of the resort's luxurious amenities, including three championship golf courses, tennis facilities, the Greenbrier Spa, and the superb Greenbrier cuisine.
May
21, 2010 By
Michael Tetreault 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.
May 20, 2010 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
19, 2010 Source: The Capital | Annapolis, MD Many Maryland physicians feel that health insurance regulations negatively impact their ability to treat patients, according to a survey released yesterday. MedChi, the Maryland State Medical Society, conducted the survey in April after ongoing complaints from members about health insurance practices. Officials asked a sampling of 132 members in different specialties how insurers' rules - such as preapprovals for tests and medications - affected their services. The 15-question survey found that doctors feel they are burdened by the demands of insurance companies and have considered leaving the state because of it. "It's even worse than we thought. The protocols are really harming patients because they are true barriers to them receiving care, and it transfers the costs from the insurance companies to the patient," said Gene Ransom III, MedChi executive director. "These measures are really harming the patients' access to care. It's a real barrier and it's a real problem." The survey comes as state officials are developing ways to prepare for federal health care legislation. The newly formed Maryland Health Care Reform Coordinating Council has been established to identify how health care reform would impact the state. The group is expected to issue a report in July. As a result of the survey, MedChi officials are urging the council to identify ways to eliminate or streamline these insurance protocols. They are also petitioning the Maryland Insurance Administration to do a comprehensive review of the preapproval process as well as develop patient protection standards. Officials from CareFirst BlueCross BlueShield - the largest insurer in the Mid-Atlantic region - declined to comment on the survey's results. Last month, the physicians were surveyed to determine how health plan requirements are impacting patient care. A majority of those surveyed have been in practice for more than 20 years and most came from family medicine or the internal medicine field. Among the survey's findings were: Nearly 63 percent felt that requirements for preapproval for services have a very negative effect on their ability to treat patients. Nearly 60 percent said insurers frequently delay or deny prescription medications or diagnostic testing. Nearly 50 percent said that it takes two to five hours a day for the staff to meet insurance requirements. Roughly 77 percent said they considered moving their practice to another state, retiring early, leaving the profession or establishing a fee-for-service arrangement to avoid health insurance requirements. Dr. Ronald C. Sroka, a primary care physician in Crofton, was among the doctors who participated in the survey. He said it's not unusual for his staff to get bogged down trying to get preapprovals from insurance companies, in addition to handling calls from patients and fulfilling other needs. Many times, the insurer has ordered prescriptions or tests just because they are cheaper, not because they are more effective, he said. "What we have is an insurance company playing doctor based on the cheapest test that we can do, or the cheapest medication we can prescribe," said Sroka, past president of MedChi. That becomes a bigger problem for physicians because they are going to be the ones held legally responsible if the correct tests aren't performed, he said. "The doctor is the one held legally responsible. The insurance company is off the hook because they did not say, 'You can't do the test.' They merely said, 'We won't pay for it.' " Sroka said he's been trying to retire for the past eight years, but has been unable to do so because he can't find a replacement willing to practice in the state. He has considered offering concierge medicine - charging patients a flat fee of $1,500 a year for services - but decided against it because some of his patients wouldn't be able to afford it. "When you take care of people you've known all of your life, you can't do that sort of thing," Sroka said. "I'm very frustrated and I'm very demoralized and I want to quit medicine. But I promised my patients I would find someone who is very good before I leave." To see the full survey, visit www.medchi.org/news-and-bulletins/surveys.
May
19, 2010 — 1:23pm ET By
Debra Beaulieu | FieceHealthcare As growing numbers of physicians tire of keeping up with the increasingly frantic treadmill of traditional practice with the near-constant threat of doing it for less and less pay, it's possible concierge medicine may become less boutique and more mainstream. The American Academy of Private Physicians, the trade group representing the concierge care movement, says more than 1,000 doctors have gone this route, slashing their patient loads to offer VIP service to those who pay a fee, reports the Fiscal Times. According to an American Academy of Family Physicians survey, 1.2 percent of respondents say they practice concierge, boutique or retainer medicine. The numbers may still be small, but many physicians who've made the switch report that the grass is greener, in terms of both their personal and financial fulfillment. While most of the nation's primary-care physicians await month-to-month news of a looming pay cut, nearly 60 percent of all current concierge physicians are doing "better" financially than a year ago, while 29 percent indicated no change and 13 percent said they fared worse, according a February survey by the Concierge Medicine Research Collective, an Atlanta-based independent healthcare research center, a recent HealthLeaders Media article reports. Some areas may be particularly ripe for a revolution--or perhaps mutiny--as physicians face millions of newly insured patients with which to keep up, suggests a piece on Dallas news outlet WFAA.com. In Texas, physicians are currently abandoning all involvement with Medicare at a rate of 100 to 200 per year, according to the Houston Chronicle. But while concierge care may be good for doctors and the mostly middle-class patients who are willing to pay for it, some say it creates an unfair two-tiered health system of the haves and have nots, the Fiscal Times points out. "The majority of us think it's an unethical and ultimately selfish way to practice medicine," Dr. Micheal Stillman, an internist at Boston Medical Center, told the website.
Posted on May 18, 2010 at 10:31 PM By Janet St. James | WFAA
SOUTHLAKE — Few physicians can dedicate the time and attention to patients that Marcus Welby MD famously did in that 1970s television series. Dr. Robin Hall in Southlake does. She's part of a booming health trend called concierge care. In soothing spa-like surroundings, Dr. Hall provides medical care 24-7, house calls, same-day appointments at the patient's convenience, and more. "If I diagnose someone with cancer, and they want me to, I will go with them to the oncologist office to ask questions on their behalf that they may not think to ask because that's a very emotional diagnosis," she said. For this VIP care, Dr. Hall limits her practice to fewer than 200 patients. Each pays an annual membership fee, starting at $2,000 cash. She does not take Medicare, Medicaid or private insurance. Patients, however, can use those health plans to fill prescriptions or see a specialist. Despite that out-of-pocket expense, concierge care is in high demand because of health care reform. "I do think that as more and more people are insured and there's less and less time for people to be seen, more and more people will seek this out," says Dr. Hall of DestinationHealth.com. "Because more people are going to be insured, it's going to be even harder to access care in a timely manner. If individuals already think they have to wait to see a doctor — not only just for the appointment, but in the waiting room, too — that may increase." In fact, ten potential patients have scheduled a tour of her upscale Colleyville office this week, which has most of the same medical amenities as a traditional family practice. Most of her incoming patients are not the affluent elite, but from the middle class, who want to select a personal physician before health care reform limits choices for them. There are now about 5,000 boutique medical practices in the country. More than 1,000 opened within the last year, according to the Society for Innovative Medical Practice Design. Many more are expected in coming years, as health care reform laws take effect. Under the law, Americans will be required to carry insurance, but physicians won't be required to accept it. Debbie Wessel has insurance, but was sick of being treated like a number in a large family practice. "We never had the one-on-one relationship with the doctor," Wessel said. "We never saw the same doctor twice in a row, and they just were not familiar with our charts." It's a situation she suspects will become worse as millions more suddenly-insured patients crowd waiting rooms. Critics say boutique medicine will only exaggerate the health insurance crisis. Many doctors may leave traditional family practices — widening the gap between the affluent and the poor. Dr. Hall cut her practice to about one-fifth of what it once was so she could provide better all-around care. She may not be Marcus Welby, but she believes health care is headed back to the future.
Posted May 18, 2010 at 9:21 p.m. By Emily Peters
/ 325-676-6776 Hundreds of doctors in Texas are dropping out of the federal health care program for senior citizens as physician reimbursements for Medicare decline, but Abilene’s elderly report they haven’t felt the impact quite yet. More than 300 Texas doctors have stopped serving patients with Medicare in the last two years, including 50 in the first three months of 2010, according to the Houston Chronicle, which compiled the data for a report published Tuesday. The drop-offs follow years of declining Medicare reimbursement from the federal government. Doctors are now facing another potential 21 percent cut in 2010 in the amount of money they will receive for treating each Medicare patient. Congress has voted three times to postpone the cut, which is now set to begin June 1. Big Country doctors haven’t started a trend of dropping Medicare service, but many have started restricting the number of new Medicare patients they take, said Dr. Maureen Trotter, a private pathologist and president of the Taylor-Jones-Haskell County Medical Society. “Some physicians are saying they have to wait for one Medicare patient to move to a different city or a different world before they can accept another,” Trotter said. “Right now, they’re not making any money off them with their office costs and overhead.” Abilene’s Dr. Austin King allows his office to only accept three new Medicare patients each week. Fortunately, patients don’t wait longer than two or three weeks so far, he said. “We started this in the past year when it looked like the government was possibly going to reduce reimbursements 21 percent,” Austin said. “If you get too many Medicare patients, you can’t make it financially.” Instead of dropping or limiting Medicare coverage, some Abilene clinics are making cuts elsewhere in attempts to continue offering the program. The Abilene Diagnostic Clinic laid off seven workers in early April, partially because office costs rise as Medicare reimbursements dwindle, said Lisa Blackwell, the clinic’s human resources director. She added that the office has also has adjusted supply orders. “Our doctors are not going to stop seeing Medicare patients,” Blackwell said. “That’s why you have to get creative with other things.” The increase in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified the state’s Medicare carrier they would no longer participate, up from seven in 2006. The numbers grew to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 doctors to drop out in 2010. “This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.” U.S. Sen. John Cornyn said the inability of Congress to reform Medicare is leaving “seniors without access and breaking the promise we made to them.” “The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn. Despite the Texas trend, a group playing poker at the Rose Park Senior Citizen Center Tuesday said they have not yet encountered problems finding Abilene doctors to take their Medicare coverage, but they would face tough times if they couldn’t rely on their government benefit. Carol Parrott found a specialist in the last year to give her monthly shots to help macular degeneration in her eyes, and she’s not sure what would happen if Medicare didn’t cover it. “I’d have to take it out of my savings until it was gone,” she said. Mary Steed said in recent years, she has been a patient of multiple doctors who retired. She doesn’t want to be searching for a new doctor in an era when many are reluctant to sign up new Medicare patients. “When I started going to the doctor I see now, I made sure to ask him if he was going to be around a while,” she explained. “He said yes.” Trotter said Big Country patients are at an advantage because many have built long-term relationships with their physicians, who are unlikely to cut them off. However, she said she expects many doctors won’t have a choice if Congress allows the 21 percent cut. She said an uproar would be imminent. “I think the Tea Party would pale in comparison to disgruntled senior citizens because they make up a large group that votes,” Trotter said. “I don’t think they throw bottles on the street like Greek youth, but they vote and they write letters to their congressmen, and those congressmen would get some letters.” This article contains information from the Associated Press.
May 17, 2010,
11:02PM By Todd Ackerman | Houston Chronicle Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable. Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year. “This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.” More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions. The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.” The opt-outs
follow years of declining Medicare reimbursement that culminated
in a looming 21 percent cut in 2010. Congress has voted three times
to postpone the cut, which was originally to take effect Jan. 1.
It is now set to take effect June 1. The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.” “You do Medicare for God and country because you lose money on it,” said Culpepper, a graduate of the University of Texas Medical School at Houston. “The only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.” Ending Medicare participation is just one consequence of the system's funding problems. In a new Texas Medical Association survey, opting out was one of the least common options doctors have taken or are planning as a result of declining Medicare funding — behind increasing fees, reducing staff wages and benefits, reducing charity care and not accepting new Medicare patients. In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent. The impact on doctors has not been lost on their patients. Kathy Sweeney, a Houston retiree, twice has been turned away by specialists because they weren't accepting new Medicare patients. She worries her doctors might have to drop her if Medicare cuts go through and they can't afford to continue in the program. “I've talked to them about the possibility,” said Sweeney, who sent her legislators a letter calling on them to fix Medicare. “They're hanging in there as long as there's not a severe cut, but just thinking I couldn't continue doctor-patient relationships I built up over years is disturbing. Seniors should be able to see the doctors they want.” The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large. Congress would overturn the cuts, but their short-term fixes didn't keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they'll net $290. If the scheduled 21.2 percent cut goes through, they'd net $72, effectively an 83 percent cut since 2001. The issue caused
the Texas Medical Association to break ranks with the American Medical
Association and oppose health care reform efforts throughout 2009.
Then TMA President Dr. William Fleming said “reform is doomed
to failure” without Medicare reform and called Congress' failure
to devise a rational payment plan “an insult to seniors, people
with disabilities and military families.” U.S. Sen. John Cornyn, R-Texas, said he isn't surprised by the new opt-out numbers, allowing that Congress' inability to reform Medicare is leaving “seniors without access and breaking the promise we made to them.” “The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the Senate for not passing a House bill that would have provided a longer-term Medicare fix. “There hasn't been the political will, but we really have no choice but to fix it.” Cornyn acknowledged the task is daunting. The Congressional Budget Office recently estimated that eliminating scheduled Medicare payment cuts through 2020 would cost $276 billion. The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state's Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out. Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move. “I've been in practice 24 years, and a lot of my patients got old right along with me,” Culpepper said. “It's stressful to tell them you're leaving Medicare and they're responsible for payments if they want to stay with you. You feel like you're abandoning them.”
May 18, 2010 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 By
Kevin, M.D. 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 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. April 30, 2010 Download the latest HealthLeaders Media Breakthroughs report "The Impact of Personalized Medicine Today," (This PDF will require 2-3 minutes to download) for a look at how progressive health systems, medical researchers, and physicians are working together to bring the practical benefits of personalized medicine to the frontlines of healthcare delivery. Personalized medicine is where genetic testing, health IT, and patient-centered care intersect—and where high-value healthcare will live in the foreseeable future. Beth Israel Deaconess Medical Center, The Ohio State University Medical Center, Partners HealthCare, and Vanderbilt University Medical Center share insights and the lessons learned that will help you explore the current and near-term impact of personalized medicine, determine whether your healthcare information technology foundation is ready for the opportunity, and see where lab research and clinical practice are overlapping. Right now in progressive health systems medical researchers and physicians are laboring jointly to bring the practical benefits of personalized medicine to the frontlines of healthcare delivery. Personalized medicine is where genetic testing, health IT, and patient-centered care intersect—and where high-value healthcare will live in the foreseeable future. In this HealthLeaders Media Breakthroughs report, leading hospital systems—Beth Israel Deaconess Medical Center, The Ohio State University Medical Center, Partners HealthCare, and Vanderbilt University Medical Center—share insights and the lessons learned that will help you: * Explore
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April 29, 2010 A longtime pediatrician, Natalie Hodge, MD, was living the life of primary care despair. For years she rushed from patient to patient in her office, giving them a few minutes here and there, doing a ton of insurance paperwork, and then decided enough was enough. Like many physicians, she felt drained and lost. "People calling, people answering phones, people scheduling, people verifying eligibility, people checking on insurance, people . . ." she says. You get the picture. It wasn't her style to sit still. Eventually, she founded Personal Medicine, essentially a concierge medical service, which avoids third party payers as much as possible, and adds its own unique touches, like specialization in house calls, and thriving on "virtual" communication. As she sees it, the mix is the bedrock for a "new reality for the future of primary care medicine," built around "emergent technologies." Curtailing insurance has cut costs about 80%, she says. There are growing numbers in the medical arena interested in what she has to say. She was interviewed by the Associated Press, made a presentation to the Mayo Clinic, and in a few weeks she's preparing a speech about her practice before primary care physicians at the University of Kentucky on May 9. She tells me times are good. If anything, these are certainly interesting times for concierge medicine, though whether it is the wave of the future remains to be seen. It's not an easy sell for everybody, either patients or physicians, who number about 5,000 in concierge practices. The medical establishment, too, has viewed concierge medicine skeptically though there are many out there who see it as worthwhile because physicians are continuing to work, and patients will be treated. That's OK, no? Docs want to make money, and in concierge, they are making some headway. In a February survey by the Concierge Medicine Research Collective, an independent healthcare research center based in Atlanta, nearly 60 % of all current concierge physicians are doing "better" financially than a year ago. Still, 29% indicated there was no change; and 13 % fared worse, according to the poll. An attorney, John R. Marquis, has written a paper recently stating that the new Patient Protection and Affordable Care Act "is going to cause serious problems for (concierge) practices and will require them to restructure in order to accommodate it." Fiscal restraints imposed by the law will impact physicians who remain in Medicare and charge a periodic fee as well as those who opt out of Medicare and then charge the patient a fee for providing all the medical care the patient needs, he said. Marquis discusses the health reform impact on concierge medicine physician practices, particularly related to Medicare, in his paper, "New Health Care Act Deals Serious Blows to Concierge Medicine." Hodge said she had been unaware of the paper, but expressed little concern after reviewing it. "We are a network of physicians that create direct patient financial relationships," she says. "We do not have any interest, nor contractual relationship with Medicare or Medicaid. So this has nothing to do with our business. Lawyers also like to create a lot of mystery and fear around Medicare. PM has a contract with patients. PM has a contract with physicians, that's it." She doesn't like the term concierge for what she does, preferring to call it direct medical practice. "We are entering a whole new ballgame for healthcare strategic planning—the post reform era," she says. "The service line strategy moving forward must be integrating cash revenue stream opportunities and (personal medicine) is a way organizations may implement this as the third party payer pie continues to shrink." While running her pediatric practice years ago in St. Louis, MO, she was seeing up to 35 patients a day for about 10 minutes each. "Once I realized how much time my staff was spending on third party payrolls, and then I added that cost up for the year and over the years, it was so sickening," she says. That's when she decided to launch her personal practice, with a "six or seven house call day," she says. She is moving her business office to San Francisco, and hired a CEO to run the company, which includes about 10 physicians scattered throughout the country, as well as the Dominican Republic and Peru. There is one physician based in Chicago who's targeting executive healthcare, another in Iowa focusing on elderly care, she says. "You have a completely paperless loop, between patient and physician," she says. "You have high level communications. Patients supplant their records from Google PHR or Microsoft or whatever. Patients pay membership fees like they do for their cell phones or other Web-based services." The average acceptable price for consumers is about $125 a month, she says. "Patients of course still need some kind of health insurance, but they don't have to be exorbitant," she says. "They need a high deductible plan to cover them for cancer or being hit by a bus or being in the ICU for two months. Remember insurers don't provide services. I provide services. The physician." My former physician, a terrific guy, told me a few years ago he was getting out of his practice, tired of the insurance hassles, and was opting for the concierge route. When he finally left, he invited me to join his other patients as part of his concierge business. After our private conversation, he sent a letter. It was going to be a lot of money, the fixed amount, each month. In return, I would get his personal care, and lengthy individual appointments. I evaluated it. After some thought, I didn't think it was worth it. The last time I left his office, I thought, "Oh well, I'll be looking for another doctor." I have a feeling Natalie Hodge wouldn't accept that, and would keep working to get potential patients like me on board.
Qliance
Nails $6M From Bezos, Dell, Drew Carey for Primary Care That Avoids
Insurance Qliance Medical Management isn’t the richest startup in Seattle, but it may have the most star power behind it. The company, which deals directly with patients and doesn’t accept health insurance for primary care medical services, has nailed down another $6 million in venture capital from a group led by Amazon founder Jeff Bezos, and which included Dell Computer pioneer Michael Dell and actor Drew Carey. Besides those three famous names, Qliance attracted more cash from its existing investors Second Avenue Partners, New Atlantic Ventures, and Clear Fir Partners. The company got started in 2006 with a $3.5 million venture round, followed by another $4 million last July, bringing the company’s total to $13.5 million since inception. Rich Barton, the founder of Expedia and co-founder of Zillow, is another one of the big names that have put money to work at Qliance. The big idea at the company, which we first profiled in December 2008, is a simple and disruptive one to the current U.S. healthcare system. Qliance runs what it calls a “direct practice” in downtown Seattle, which doesn’t accept any health insurance and deals directly with patients. The patient hands over a credit card, and agrees to pay a $44 to $84 monthly membership fee to Qliance for unrestricted access to its primary care medical services. The model allows Qliance to avoid spending its time doing things to get insurers to pay for primary care, which frees up the doctors to spend more time with individual patients. Routine primary care—things like women’s health exams, flu shots, X-rays—make up almost 90 percent of the medical issues that prompt people to see a doctor, Qliance says. Going through an insurer to get these routine things done is sort of like asking your car insurance provider to reimburse you for an oil change; insurance is really needed when you’ve been in a serious accident, Qliance CEO Norm Wu said last month at an Xconomy event. Once people use “direct primary care” that avoids insurance, Qliance says consumers can get a catastrophic health insurance policy to cover them in case of a serious accident, or a cancer diagnosis, that is beyond the scope of what a primary care doc can treat. By combining the monthly fee of primary care with the secondary insurance, Qliance contends employers and patients can save as much as 50 percent on their overall health spending, and improve overall health by making it easier for people to see a primary care doc who can help them focus on prevention and wellness. “It’s not often you come across a business model that is truly transformational and disruptive in a sector ripe for reform, but that’s how we view Qliance in health care,” said Melinda Lewison of Bezos Expeditions, in a company statement. “We see significant long-term opportunity in Qliance as it’s easily scalable to other communities and health care reform has added wind to its back with the ability to compete in the insurance exchanges.” The Amazon connection is a pretty clear one. Nick Hanauer of Second Avenue Partners, an early and enthusiastic backer of Qliance, was one of the early investors in Amazon. Encouraging as the financing is, Qliance has had to clear a number of legal hurdles to get to where it is now. The company had to lobby hard in the Washington state legislature in 2007 to make sure lawmakers understood the business model avoids insurance, and therefore shouldn’t be covered by state insurance regulations. Last year, the legislature made it possible for employers and self-insured health plans to pay direct primary health care providers as part of an employee health benefit program, as is commonly done with traditional health insurance. That has enabled Qliance to sign up more than 70 employers to its monthly primary care service, which allows their employees access to primary care clinics in downtown Seattle, Kent, and Mercer Island. The new round of financing will help Qliance take this vision of “direct primary care” beyond Washington state. Wu personally spent a lot of time in the past year paying close attention to the national healthcare reform debate, and enlisting allies like Sen. Maria Cantwell, the Washington state Democrat, to make sure that the new law wouldn’t create any barriers to Qliance’s model (regardless of whether insurance companies might like to stop it). The new law that President Obama signed last month, the Patient Protection and Affordable Care Act, allows states to begin operating insurance exchanges in 2014, which makes it easier for small businesses and individuals to buy health care. What few people realize is that Wu’s advocacy apparently paid off, because “direct primary care” models like Qliance will be able to compete in those state insurance exchanges. You can bet the full $6 million that just went into Qliance that not a dollar would have materialized if the new health reform law had created new obstacles to Qliance’s plan to expand nationally. That’s still a long way off since the company is still in its early days. But the market potential, as Wu noted in our original profile in December 2008, is about as big as it gets. Capturing a meaningful slice of the market—in which 250 million people in the U.S. need primary care services at an average price of about $50 a month—is the hard part. “Our growth will not be limited by market potential, but by our ability to execute,” Wu said in the original story.
Efforts in education, collaboration, and technology are improving care coordination. Care coordination and improving patient care are lofty goals for health leaders today. With better technology and greater health stakeholder interaction, better care can be achieved. The HealthLeaders Media online news team has examined how facilities are working to improve patient care and safety through technology, education programs, and staff interaction. Here are excerpts of articles written by Ben Cole and Julie McCoy. MassGeneral
Program Brings Remote Doctor to A "home-to-hospital"
program in use at MassGeneral
To Reduce Spending, American College of Physicians Will Advise Doctors What's Too Costly and Useless By: Cheryl Clark, for HealthLeaders Media, April 27, 2010 This summer, the organization representing 130,000 internists will publish of a series of papers that will tell America's doctors what they should and should not order in diagnostic tests and therapies, a guideline that strives to lower cost while it eliminates unnecessary care. While the organization will be looking at diagnostics as well as therapies, its first target will be the former. Annals of Internal Medicine
Publishes
Patients
Need Concierge Medicine/Direct Care Doctors
Patient
Procurement Agency Works With Concierge Medicine/Direct Care Doctors
Making the Family Caregiver a Part of the Healthcare Team Janice Simmons, for HealthLeaders Media, January 14, 2010 | | READ FULL STORY Today, more than 30 million family caregivers play major roles in overseeing and promoting the health and quality of life of individuals with acute and chronic illnesses.
Some patients willing to pay for 'boutique' primary care doctors By Tom Murphy, The Associated Press | January 13 2010 | Dr. Stephen Glasser talks with his secretary Joann Peach before seeing a patient at his Baltimore office Jan. 12. Glasser used to care for about 3,500 patients, seeing between 25 and 30 a day. He pared the total down to between 600 and 700 when he converted to a concierge practice six years ago.
SIMPD EVOLVES AND SO MUST APPA December 30, 2009 | News from American Private Physicians Association | READ MORE
LETTER
TO EDITOR: Medicareless, distrust funds and more |
More and more physicians are giving up their current practices and going to "concierge medicine," in which they limit their practice to a lower number of patients who pay a substantial annual retainer fee. It is extremely difficult to find a physician or group of physicians who will accept Medicare patients. Some physicians will not accept Medicare patients or process medical insurance forms. Our current overall health care system is a house of cards that will collapse if pushed much further.
Small
Practices Face Big Challenges In a recent piece in The New Yorker, a physician-author compares the current pilot-project approach to reforming healthcare with efforts in the early 1900s to improve agricultural production. Farmers at the time were struggling with analogous problems—spiraling costs, a lack of "comparative effectiveness research," poor quality rating mechanisms, and industry fragmentation—and only began to see improvements after government-initiated pilot programs spurred innovation....
Health Care Reform Irony: Thousands Could Be Denied Low-Cost Coverage By Dr. Garrison Bliss | Posted: December 2, 2009 04:12 PM | If offered the choice, how many of you would sign up for access to a primary care physician 24/7 for a flat monthly fee of $49-$79 per month? Imagine -- no more lengthy waits for a doctor to see you and no more dealing with insurance companies for routine, preventive care. That sounds pretty good, doesn't it?
'Boutique'
patients pay for better access to doctors Washington Times | Nov. 25, '09 | By Karen Goldberg Goff Instead
of leaving medicine, Dr. Sheff made the transition to a retainer
practice. Often called a "boutique practice" or said to
provide "concierge medicine ...
Give
Me a Public Option or Give Me Death? Source:
CBS News| November 23-24, 2009 7:55 AM
MSNBC POLL | NOVEMBER 23, 2009 If you don't choose to pay extra to sign up for "concierge" or "boutique" medical care, should you still get the same access to your doctor's time and attention? MSNBC POLL RESULTS: 57.2% Access to your doctor is a right, not a perk; 37.2% As with all things, you get what you pay for; 5.5%-Not sure; Source: msnbc.com Poll | VOTE | READ MORE |
New
York, NY - Clinic with two doors, a symbol of “...we're biting into the quality of care if you're not paying a premium...That's unethical. It's immoral. It's just flat-out wrong.” By Bill Dedman | Investigative reporter
‘Concierge’
care is just another word for bribe COMMENTARY
| NOVEMBER 23, 2009
Family physician cuts out the middlemen insurance companies and large clinics | READ MORE | STAR TRIBUNE, MINNEAPOLIS | BY KRISTIN TILLOTSON | Tue, Nov 17, 8:13 AM
For an upfront
fee, these doctors are at your service anytime WACO TRIBUNE-HERALD, TEXAS | Sun, Nov 15, 10:42 AM
Medical
start-up puts faith in primary, preventive care Posted: Nov. 14, 2009 | FULL STORY
Connecting the medical-care dots: New Ellis, NY facility aims to make navigating system less confusing | READ MORE | TIMES UNION, ALBANY, N.Y. | CATHLEEN F. CROWLEY | Fri, Nov 13, 5:48 AM
November
13, 2009 | KUOW
News LISTEN To INTERVIEW :: READ FULL STORY
Participatory
medicine - where MDs, hcps & pts work online to help evolve
best evidence...Understanding the best medical options for you Posted November 13, '09 at 1a.m | READ FULL STORY
Dr. Direct: A physician cuts out the middle man: Family physician Dr. Sam Willis delivers primary medical care that's more personal and less costly by cutting out the middlemen - insurance companies and large clinics. | READ MORE | STAR TRIBUNE, MINNEAPOLIS | KRISTIN TILLOTSON | Thu, Nov 12, 4:24 AM
Welcare
Center in Spring House, PA is area’s latest concierge practice Wednesday,
November 11, 2009, 6:20am EST |
New
primary care practice provides 24-hour access to doctors November 9, 2009 | READ FULL STORY
PinnacleCare complements the work of the concierge physicians serving our members by... October 21, 2009 | READ FULL STORY R.I. health care model interests Maine doctors BANGOR DAILY NEWS, MAINE | ABIGAIL CURTIS | Wed, Oct 14, 8:49 AM |
Eliminating all health insurance could make primary care more cost-effective Oct. 13, 2009 | Los Angeles, CA | PRESS RELEASE |
Another
National Association of Concierge Physicians Organizes October 19, 2009 | FULL STORY |
MODERN
MEDICINE / MEDICAL ECONOMICS - Q&A: September 18, 2009 | FULL STORY |
Ten
Symptoms Too Dangerous To Ignore - Forbes.com September 16, 2009 | FULL STORY |
'Medical
Home Model' saves money, boosts quality, study finds cutting patient
loads and making visits longer were also found to ease burnout rates
for physicians.
September 14, 2009 | FULL STORY |
New York, NY - Concierge doctor offers his patients a personal touch September 10, 2009 | FULL STORY | More hospitals looking to merge, buy physician groups September 7, 2009 | READ FULL STORY |
AMA evolves to help the youngest members of our profession enjoy long and successful careers. September 7, 2009 | READ FULL STORY |
Concierge
Medicine and the States September 4, 2009 | FULL STORY |
Steven Knope, MD Overcomes Objections To Critical Statement Made About Concierge Doctors August
27, 2009 | LISTEN
TO AUDIO
Concierge doctors: Real deal behind hit drama 'Royal Pains' August 21, 2009 | READ MORE |
Forbes.com - Intelligent Investing, Expand Primary Health Care: ...If we only do one thing to improve the American health care system, we should expand primary care. August 5, 2009 | FULL STORY |
Economic Report: Inbound Medical Tourism in the United States August 5, 2009 | FULL STORY |
Study focuses on helping seniors avoid rehospitalization July
31, 2009 | FULL
STORY |
USA Network has renewed its breakout freshman hit "Royal Pains." July 28, 2009 | FULL STORY |
Compromising
the Doctor-Patient Relationship: July 24, 2009 | FULL STORY |
Doctors still mystified by what patients owe
| July
21, 2009 | FULL
STORY
Physician and Advocate, Dr. Marcy Zwelling Speaks At National Press Club Conference | July 2009 | FULL STORY
Survey reveals many providers, billers unsure of charges to follow predetermined co-pays. July 21, 2009 | FULL STORY |
Individual Insurance Market Falls Short for Families July 21, 2009 :: FULL STORY
USA Network Invents Concierge Doctor Game July 21, 2009 :: FULL STORY
AMA Health System Reform (HSR) News
UnitedHealth Group, Cisco launch telehealth network July 19, 2009 :: FULL STORY
Senate
Republicans blast bill July 15, 2009 :: FULL STORY
At Least Nine Doctors Who Treated Michael Jackson Under Investigation July 15, 2009 :: FULL STORY
Concierge Models Provide Physicians with Options July 14, 2009 :: FULL STORY
PriceDoc.com partners with Qliance, Anchor Medical Clinic and Guardian Family Care in continued effort to make health care more accessible. JULY 13, 2009 - READ PRESS RELEASE
Southlake,
TX (PRWEB) - Concierge Medicine Takes Front Seat with Health Care
July 8, 2009 :: FULL STORY
Hybrid Concierge Medical Practice Provides More Value, Options to Growing Number of Physicians Nationwide July 8, 2009 :: FULL STORY
Healthcare bills scare even wealthy patients July 6, 2009 :: FULL STORY
Michael Jackson's death puts 'concierge doctors' in the spotlight July 5, 2009 :: FULL STORY
Obama Disses Doctors July 3, 2009 :: READ MORE
Dr. Conrad Murray was Michael Jackson's personal physician, a concierge doctor July 1, 2009 :: FULL STORY
Leadership Day Launches New Legislation For Primary Care July/August 2009 :: ACP Internist :: FULL STORY
Leadership Day Launches Push For Primary Care June 2009 :: June ACP Internist :: READ FULL STORY
White Coat or White Glove: Concierge Medicine 101 June 28, 2009 :: FULL STORY
SIMPD invited to go to Washington, DC and work with the Alliance for Patient Access June 24, 2009 :: FULL STORY
MDVIP Launches Preventive Medicine Pilot Program For Uninsured In Northern Virginia June 23, 2009 :: FULL STORY
USA Network Defines Concierge Doctors May 30, 2009 :: FULL STORY
Royal Pains Premiers on USA Network - Concierge Medicine Gets the Hollywood Treatment May 29, 2009 :: FULL STORY
Consumerism Doesn't Simply Mean Shifting Costs to Members April 29, 2009 :: FULL STORY
Families USA releases uninsured numbers in each state April 8, 2009 :: FULL STORY
Bye-Bye Benefits April 1, 2009 :: FULL STORY
Insurers offer to stop charging sick people more March 24, 2009 :: FULL STORY
The controversy of concierge medicine: Some states have been considering whether to regulate fee-for-service physicians who practice what is sometimes referred to as "concierge" medicine. January 22, 2009 :: LISTEN TO PODCAST
USA Network films pilot on the Hamptons Sept. 8, 2008 :: FULL STORY
Does
Concierge Medicine Transcend Radiology Education Issues in Developing
Countries? June 23, 2008 :: READ MORE
Boutique Medicine: For Your Well-Being? Or the Doctor’s? April 18, 2008 :: FULL STORY
Dr.
Steve Knope Releases BOOK: April 2008 :: FULL STORY
The Ultimate Housecall Is To The White House 2008 :: ACP :: READ FULL STORY
Doctors Without Orders March 21, 2008 :: READ MORE
Is
Concierge Medicine for You? September 21, 2007 :: READ MORE
CNN - Atlanta, GA - Boutique Medicine: When Wealth Buys Health October 20, 2006 :: FULL STORY
NAPLES, FL - Care by the Hour August 30, 2006 :: FULL STORY
WHAT DOCTORS HATE ABOUT HOSPITALS - TIME MAGAZINE April 23, 2006 :: FULL STORY
BOCA RATON, FL - For a Retainer, Lavish Care by 'Boutique Doctors' October 30, 2005 :: FULL STORY
"Retainer-based” clinics…are typically primary-care practices that provide high-end care to a limited number of patients for an annual fee. Concierge doctors see fewer patients and can devote more time to each. Many also take on the role of patient advocate and help identify specialists and treatments when necessary. - Wall Street Journal, February 9, 2005
NEWSWEEK HOUSE CALLS February 7, 2005 :: FULL STORY
Concierge medicine has emerged as a reaction to, if not a revolt against, the managed care medical system that has physicians handling 25 to 35 patients daily, and often spending a mere ten or fifteen minutes on the average visit. Doctors have set up concierge practices in order to dedicate more time to individual patients. - Departures, Nov/Dec. 2004 - READ FULL STORY
Concierge medicine first made headlines in 1996 with the launch of a practice by a former team doctor for the NBA’s Seattle Supersonics, who was convinced that people would pay for the kind of extraordinary care usually reserved for professional athletes. - Fortune, July 18, 2004
NEWSWEEK
- February 7, 2005
The
average primary-care physician now sees a patient every ten minutes,
according to the American Academy of Family Practice…Last year
the Journal of Family Practice reported that more than a quarter
of the primary-care physicians it surveyed expected to quit within
the next two years.
Should you consider concierge medicine? February 17, 2004 :: FULL STORY |
 Marketing Concierge Medicine | Promote Your Practice Too 
Patient
Procurement 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. Legal
& Insurance News 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.
Starting
Your Own
Concierge Medicine Practice THERE ARE MANY APPEALING BUSINESS MODELS... Concierge Medicine Today has formed relationships with proven, trusted and experiened practice conversion companies across the country. 
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