High-end medical option prompts Medicare worries

[highplainsdem]

Source: Associated Press

High-end medical option prompts Medicare worries
Posted: Apr 02, 2011 7:51 AM CDT Updated: Apr 02, 2011 7:51 AM CDT
By RICARDO ALONSO-ZALDIVAR
Associated Press


WASHINGTON (AP) - Every year, thousands of people make a deal with their doctor: I'll pay you a fixed annual fee, whether or not I need your services, and in return you'll see me the day I call, remember who I am and what ails me, and give me your undivided attention.

But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama's health overhaul.

The spread of "concierge medicine," where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.

Medicare recipients, who account for a big share of patients in doctors' offices, are the most vulnerable. The program's financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.

-snip-

Read more: http://www.wdam.com/Global/story.asp?S=14370435

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The article also mentions a Procter & Gamble subsidiary, MDVIP, a management company that represents the largest group of concierge physicians in the country. MDVIP takes $500 of the $1500 - $1800 that concierge physicians usually charge as an annual fee. They offer the doctor legal and other support services.

This is the first I've heard of such a management company. I've been hearing about concierge physicians for a while, but with this Procter & Gamble subsidiary now profiting from them, I'm sure there's a lot of sales pressure on doctors to make this switch.

[dixiegrrrrl]

1. So the idea seems to be spreading enough that money vultures can feed on it.

Interesting.
then, once the plan takes hold, and enough people are in it, the usual greed will take over and each year's
"premium" will increase and increase and.....

[RKP5637]

4. It's the same old game played with a different angle. It's like 'protection money.' Pay me

and I will protect you (healthwise). In my book it's extortion.

[dixiegrrrrl]

6. Well....isn't what insurance polices do?

Same premise, except then insurance companies find a way to NOT deliver the promised protection.

[RKP5637]

7. Yep!!! It's all a protection game, same game, with a new twist for more money. A protection

game surcharge. The entire system needs to be trashed. I thought in 2008 we were moving toward a radically new system, but IMO same old stuff.

[russspeakeasy]

15. Same shit different day...Gimme $ and the problem goes away.

[karynnj]

18. Actually, this does less

You pay the fee and can get the doctor's care when you need it. Unless there is more to this, it will not cover a specialist, medicine, tests, or hospitalization. If that is true, it seems high for anyone without some chronic problem.

[dixiegrrrrl]

19. So just an "access " fee for the lucky rich?

[hack89]

23. Not just the rich

There are a lot of professionals and dual income families who could afford this.

[MineralMan]

2. I can see this as a problem, but it may be a self-limiting one.

How many people will pay that annual fee for access to their physician? Not many, I think, and that should limit the number of practices that use the model.

Looking at my own area, which is the Minneapolis/St. Paul metro area in Minnesota, access to primary care physicians for those who have health insurance is easy. Numerous multi-discipline clinics throughout the area offer same day appointments with primary care physicians. That's an indication that there are enough internists and family-practice doctors available to the community - at least for those with health insurance.

And that includes Medicare. None of the clinics I'm aware of turn away Medicare patients. In fact, I asked my own primary care doctor about that. He told me that Medicare patients are sought after, since the clinic is assured of payment. He said that Medicare pays the overhead for the clinic and most of the doctor's salaries. Non-Medicare patients are the profit center, but they aren't numerous enough to support the entire practice.

Now, that's a major metro area, and one that is doing OK, economically, for the most part. But, that system does not serve uninsured patients well at all. It's difficult to find appointments if you are on Medicaid or have no insurance. Most people in that situation end up using the many Emergency Rooms in the many hospitals in the area as their primary care doctors, and that's a big, big problem.

In smaller communities, I can see this concierge medicine cutting into access to care, though. I don't live in an area like that, so I can't speak with any experience on how it might impact access for people living in smaller cities and towns.

[elleng]

16. I agree. My doc closed her office (lease expiring) and looking for new situation,

thought of signing on with one of these concierge shops. She wrote to her patients, asking if we'd follow her. I said thanks but no thanks, and apparently so did others, as I just heard that she's still looking.

[RKP5637]

26. My doctor quit her private practice/group and went with a hospital as a staff doctor. She

said the private practice was getting too taxing and the costs outrageous, plus dealing with the insurance companies and all. And she was a top notch doctor who thought healthcare in this country is completely screwed up. She was getting fed up with the entire mess.

[Grins]

17. It depends on how it's structured.

In the United States, this is a shitty idea.

In the UK - it's pretty good!

What they call "concierge" is what the British have via their National Health System (NHS), only they call it "capitation".

You sign up with a doctor of your choosing and the government - not you - pays that annual fee to the doctor. Not in the thousands, only a couple of hundred dollars.
The key thing they do is that the doctor gets that payment every year as long as the patient is under their care.
Patient dies - no more checks.
Patient get pissed and leaves to go to another doctor - no more checks.
Patient very happy and tells friends who also sign up with that doctor - doctor gets even more checks!!!

So, doctors are incentivized to give great care to their "customers", keep them alive, and provide good service to keep them. Flu season coming up? Have your nurses/staff call your customer base and bug them about getting flu shots. While you're on the phone - got any other problems? Dental problems? Shots up to date? Know about meningitis? Need help stopping smoking? Drinking? New shot out for teenage girls and HPV - care to know how to save her life (for $6)?

I like the French system better, but the British NHS is pretty good. Certainly better than anything in the U.S.

[JDPriestly]

20. Concierge doctors are found in wealthy areas of Los Angeles County.

That is why we seniors need Medicare and especially Medicare Advantage. You never know whether you can find a doctor or specialist who will see you and give you the attention you need.

[RKP5637]

3. These guys should be stripped of their medical licenses. If we had a gov. with

guts, all medical services in this country would be on a fee schedule so as to stop the BS. And the F'en insurance companies would be given the boot. In this country citizens are burned to fuel the flames of corrupt capitalism run a muck.

[hack89]

24. People can sell their services and talents anyway they want

if the government is not going to pay their rent, their malpractice insurance and any of their other expenses, how can it tell doctors how much they can charge?

[RKP5637]

25. Not under the current system, but with the outrageous cost of healthcare in

this county IMO it's time to move to socialized medicine with a payment schedule. Why should our cost be about 50% more than the next nearest country ...

[JJW]

5. A Sad Nation

I'm disgusted by people and politicians who think it is okay to profit off the sick and dying. I don't think we can call ourselves a society until we recognize the human right of health care, the need that we care for the sick, the poor, and the elderly.

Corporations are not persons because they don't care or have values. Sad that our justices are so blind.

[dixiegrrrrl]

8. Blind justice? or bought off justice?

[dkf]

9. This seems less expensive than what we have now.

Why the hate?

[highplainsdem]

10. The concierge fee is on top of all the other payments, not substituted for it.

Patients will still pay for their insurance (and/or Medicare) as well as any out-of-pocket costs and co-pays. This is simply an additional fee being charged so the doctor will limit the number of patients he sees slightly and give each patient slightly more time. One article I saw on this a while back suggested the difference in time would amount to minutes a year, in return for that $1500 fee.

This will also shunt patients who don't want to pay the fee, or can't afford it, to other doctors, increasing their patient load, and that will decrease the care those patients are getting and put pressure on those doctors to become concierge doctors.

And management companies like the one owned by P&G will profit from this change. Once most doctors are using such companies, they'll almost inevitably start raising their fees, forcing doctors to start raising the annual fees to patients.

This is making our medical system more expensive, not better.

[dkf]

12. Actually it looks like it could be either...

Wikipedia:

Some concierge practices do not accept insurance of any kind. These are also referred to as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients.<4> They become "concierge" only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of those covered by insurance plans.<5> This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers.

http://en.m.wikipedia.org/wiki/Concierge_medicine

[whoopingcrone]

11. you don't understand...

The retainer fee pays for "access to" the doctor, not for the "care" you receive.
The cost of "care" is in addition to the retainer-fee and paid for separately by insurance/medicare/you.

[RKP5637]

13. Yeah, now they can try to sell you a 3rd insurance policy. Medicare, then

supplemental, now they can add on retainer insurance ... then on top of the we've got dental and on top of that prescription coverage. Then I've got auto insurance, house insurance and an umbrella policy. And some people have pet insurance. Yep. it's better to live under a rock!!! LOL

[McCamy Taylor]

14. Individuals capitate one doctor or the feds capitate a clinic. No difference here

except that the feds want to have a monopoly on capitation. Presumably so that they can funnel all the patients and money to their big corporate campaign donors.

Hypocrisy.

[999998th word]

27. Your earlier quote'Lipstick on the capitation pig',sums it up perfectly.

and theyre hoping we'll see this as a 'solution' pfffft. That dog dont hunt either.
Rule#1 Insurance companies are unethical +never to be trusted under any circumstances.
Rule#2 See rule#1.

[JDPriestly]

21. I would wager that the doctors who have concierge practices

are more likely to be sued than other doctors.

First, their patients are likely to be wealthier and thus better able to find and pay a lawyer in questionable cases.

Second, when patients pay that kind of money, they expect to be treated with kid gloves and golden stethoscopes. Higher expectations mean less satisfied, more litigation-friendly patients. That's my guess.

So, doctors who do this may not be as wise as they think.

[sendero]

22. If doctors's fees.

.... were a significant portion of one's total health care costs, this might be a good idea.