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The controversy of concierge medicine
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Steve Chiotakis: Imagine having unlimited access to your doctor. Some physicians do offer that, for a fee. But this "concierge" or "boutique" medicine is drawing some controversy. Maryland is the latest state to consider regulating fee-for-service medicine. Tamara Keith reports.
Tamara Keith: Doctor Alan Sheff was under a lot of stress. He had more than 3,000 patients, and was getting squeezed by declining insurance reimbursements.
Dr. Alan Sheff: I was going to leave medicine. Carpentry started to sound like a very good career option to me.
So he did something dramatic. He shut down his practice in Bethesda, Maryland, and re-opened it offering more personalized care -- what many call concierge medicine. Sheff's patients pay a $1,500 annual fee. They get a comprehensive annual physical for that. Other appointments are billed through insurance the usual way.
[Dr. Alan Sheff greets patient Marianne Bastnagel]
Marianne Bastnagel is getting her physical. She has a strong history of cancer in her family and says she wants a doctor who consistently monitors her health. Sheff says that since he now has 80 percent fewer patients, he can take more time with them.
Marianne Bastnagel: This is old-time medicine. This is a giant leap back in time to the way things used to be 15 or more years ago.
But the giant leap is generating lots of controversy. The Maryland Insurance Administration is now weighing whether concierge practices should be considered insurance, and subject to regulation. The debate has cracked open an even bigger issue: whether fee for service medicine is contributing to a shortage of primary care physicians.
Baltimore's commissioner of health, Dr. Joshua Sharfstein, thinks it does. He says when a doctor converts to a concierge practice, a couple thousand patients are displaced.
Dr. Joshua Sharfstein: There are high rates of preventable hospitalization in the area and that's sort of saying that already we have a relatively weak primary care system and if suddenly you have hundreds of patients needing to find primary care doctors, that's going to make it even weaker.
That couldn't be further from the truth, says Darin Englehart. He's president of MDVIP. It's helped set up a couple hundred concierge-style practices, including Dr. Sheff's.
Darin Englehart: Intuitively, we believe that if you have great physicians and you give them more tools and more time to focus on prevention and early detection, you should be able to see reductions in hospitalizations. But it's been very gratifying for us to be able to actually document that.
There's no official count of how many practices have switched to the concierge model. But MDVIP claims 100,000 patients and growing.
In Bethesda, Maryland, I'm Tamara Keith for Marketplace.
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There should be no controversy over this.
It IS all about priorities. People should be free to spend their money the way they like. I choose to spend it on my health by joining up with a concierge physician. Someone else can choose to spend that money on an extra vacation.
Doctors should be free to practice how they want. Market forces will dictate if they survive or not. If people aren't willing to pay this money, then all these concierge practices will wither and die. However it seems that people are enthusiastically willing - concierge medicine is growing quickly.
<a href="http://www.mymd.us">
MyMD</a> is where I chose to join. It might not be for everyone, but it works for me. This is America. It's a free country. Let us do what we want.
As president of SIMPD, the Society for Innovative Medical Practice Design, the professional society open to all concierge and other direct practice doctors I want to confirm that the reason health care is so fragmented and disrupted today is the lack of excellent primary care America once had. That fact in large part results from the devaluation of primary care and its extremely low pay status under the third party and Medicare dominated payment system we now suffer under
The concept of "medical home" is a critical one. Every American needs one, a place they can access top notch primary care immediately and fully like one can access a concerned family member. And they need to buy that home directly, not with other people's money. When they do so the cost can be very low to the patient and the benefits very high to patient, primary care doctor and society.
The only payer willing and able to pay what a medical home will cost is the patient. Interest in concierge medicine is therefore rapidly growing. Starting with the first such practice about twelve years ago in Seattle and growing exponentially, there are now thousands of such practices in the USA, some are associated with franchises though most are independent. No mater what the government does, that is where the action will be in the future as our numbers grow from the current thousands to tens of thousands to hundreds of thousands.
Direct practice doctors and those who wish to adopt the direct practice model can join the society and get many benefits including up to 55% discounts on malpractice insurance, practice marketing help, national care networks and many other services. Our society is rapidly growing its membership. Direct practice doctors have much more time with their patients, make a better living, and virtually never get sued. That is why we get huge malpractice insurance discounts.
Patients can go to SIMPD's web site at http://www.simpd.org for information and to find such a doctor in their own community at the "find a physician" link. This is the ideal way for patients to get personalized, prompt, excellent primary medical care in a unhurried, pleasant setting. Money is actually saved on patient care in such practices because emergency room visits and hospitalizations are drastically reduced due to of the personalized, immediate, detailed care we deliver. The cost of concierge care, which averages about $150 per month, can be as low as $40 per month. This is affordable for most Americans, while the fragmented primary care most are now getting through employers or government third party interference in the doctor patient relationship is penny wise and pound foolish.
SIMPD believes most Americans can eventually be cared for in such direct "medical home" practices resulting in far better care. This will result in lower overall cost and a return of interest in primary care by students who now shun the field as undervalued, underpaid and undesirable compared with other medical specialties which for the same or lower levels of training and effort often pay double and triple what primary care pays inside the insurance system.
If any of you have further interest please contact me through the SIMPD web site. I answer all emails through that site personally.
Thomas W. LaGrelius, MD, FAAFP President, SIMPD http://www.simpd.org 877-448-6009
Owner, SPFC Torrance, CA http://www.skyparkpfc.com
I'm delighted Marketplace covered this important trend. Doctors who work directly for patients and abandon their relationships with insurance companies have a powerful incentive to keep their patients healthy and delighted. The coming shortage in primary care doctors will only be solved by medical students who see doctors (like me!) making a living and loving their work.
One more thing - I think regulators should focus on regulating the wild and wooly and irresponsible financial institutions (like AIG) and leave alone the doctors who are finding creative ways to deliver high quality health care without killing themselves.
This sounds like a great option to me. I am tired of going to the doctor and having her (him) ask me what medicines I have taken before. They don't even take the time to review my file before coming in the room to talk to me. I would love a doctor who actually reads my file and thinks....let me repeat....thinks about my and my health.
Dr. Sheff is collecting $900,000 from his 600 remaining patients, and that to provide a physical to each of them. And then he still uses insurance for everything else.
Sounds like Dr. Sheff has found an interesting business model. Or something.
My physician followed the same path as Dr. Sheff. I decided to stay with my doctor and consider it one of the best decisions I have done for my health care.
I recently turned 50 and know that I need an advocate that is accessible and has the time to spend with me as "age is catching up with me".
The executive physical goes above and beyond what my insurance covered in the past. I use my company Flexible Spending Account to set aside the fee.
I now have access 24/7 and I see a significant change in my doctor. He is much more relaxed and upbeat. He has the time to talk about issues in my life. AND is now "on my case in a more personal way" regarding my weight, reducing stress etc.
As far as the 1,500 dollars...it was a small adjustment in my "fun time" that saves the approximate 100/month. Most people pay that amount for cable service these days!
It is all about priorities.
As far as insurance companies...they should be happy to have a proactive doctor treating their consumers reducing risk of higher medical cost. Members of MDVIP groups are now healthier and more active in preventive medicine.
WIN WIN for patient and insurance company.
Jay B
Houston, TX
My physician followed the same path as Dr. Sheff. I decided to stay with my doctor and consider it one of the best decisions I have done for my health care.
I recently turned 50 and know that I need an advocate that is accessible and has the time to spend with me as "age is catching up with me".
The executive physical goes above and beyond what my insurance covered in the past. I use my company Flexible Spending Account to set aside the fee.
I now have access 24/7 and I see a significant change in my doctor. He is much more relaxed and upbeat. He has the time to talk about issues in my life. AND is now "on my case in a more personal way" regarding my weight, reducing stress etc.
As far as the 1,500 dollars...it was a small adjustment in my "fun time" that saves the approximate 100/month. Most people pay that amount for cable service these days!
It is all about priorities.
As far as insurance companies...they should be happy to have a proactive doctor treating their consumers reducing risk of higher medical cost. Members of MDVIP groups are now healthier and more active in preventive medicine.
WIN WIN for patient and insurance company.
Jay B
Houston, TX
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