Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Friday, February 21, 2014

Concierge Medicine

Among the many problems surfacing from the rollout of Obama Care are controlling the cost of services provided by a limited number of carriers or Providers of care. Exchanges, which were designed to be competitive have fewer carriers willing to participate, and sometimes only willing to participate in urban settings where they can contract cheaply.

Meanwhile the Providers, who were approached by carriers they were familiar with found themselves asked to take lesser pay for services, since the ACA shaved the margins of the carriers, added taxes to support the Act, and wrote into law greater risks, Benefits, and caps to Administrative costs.  This has caused the Providers to make one of three business decisions:  retire, group to reduce their overhead, or limit their practice and set an acceptable annual income.

One manner to do the latter was to incorporate into Accountable Care Organizations, which I have written about in the past, but which are essentially the grouping of hospitals, General and Specialist Physicians and even ancillary personnel and services, accepting set fees and performance measures, which they distribute among themselves.

A second choice and one that grew more than 25% in 2011 and probably more in 2012, is what is termed Concierge or Direct Patient Care practice.  An easy way to think about this is that a Physician decides on a workable number of patients he can provide personal care to, and pares his practice to that number. For the most part these are Internal Medicine or Family Practice doctors, but there are commercial groups, such a One Medical in NYC, the Bay Area, Washington DC, and even in LA and Orange Counties, and MDVIP, primarily on both coasts.

Fees vary widely, some as low as $195/year; others perhaps $5,000 annually.  This is explained for the most part by whether the doctor continues to bill for services (or expects the patient to submit to a carrier) or whether most services are provided with no copayment.

The attraction to the patient is access, personal contact, and emphasis on wellness.  Most DPC or Concierge practices guarantee appointments within 24 hours of request.  Most also work with patients through email or texting. Follow-up after appointments is a definite plus. Many MSAs through employers will allow use of pre-tax dollars for services provided through DPCs or Concierge.

For the physician advantages include: a feeling of better contact with the patient, fewer forms and less third-party regulation, a more predictable income and in some cases, a path towards retirement.  This latter is an attraction that is influencing dentists and even Pediatricians into the concept.

Whether this alternative is a good choice for you is a matter of personal choice.  The controversy on the issue is that it would seem to establish a two-tiered healthcare system, benefitting the wealthy. The fact of life is that as the weaknesses of the Affordable Care Act become more evident, the choice to physicians may become moot.

In my next post I will convey why seeing the play Matilda made me think of my wife Mary in a new light.  I hope you'll join me.

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