Rise in Concierge Medicine Draws Scrutiny

Once again the concierge medicine community draws some questions about its reduced practice sizes and direct pay model. It is unfortunate that the failures of  the health care system as a whole are pinned on doctors and patients that leave the system. Concierge medicine is not for every patient nor every doctor. Patients need care today and doctors have payrolls to meet every Friday, many cannot wait for the Affordable Care Act to fulfill their needs or create a system that leaves everyone satisfied. Concierge medicine and Direct Pay Care practices represent only a tiny fraction of the providers in the system, despite their growing popularity. The real issues lie in a problem decades in the making and will likely take Congress and the health care industry decades to cure. In the meantime there is much they can learn from concierge medicine and direct primary care.

Ali Gorman, R.N. provides a detailed report for ABC Action News Channel 6 on the topic.

Watch Video Spot

PHILADELPHIA – May 6, 2013 (WPVI) — When President Obama unveiled the Affordable Care Act, he said, “You won’t lose your doctor.” However, thousands in our area say they are because their doctors are changing their practice.

The doctors are switching to a concierge or boutique medical practice. Some are doing individually, while others are joining concierge networks, such as MDVIP, Signature MD, or Paragon.

More doctors are choosing to go this way. If you want to stay with them, you will have to pay more to get more time and services. Some patients love it, but others feel left out in the cold.

75-year-old Alan Wolf has been seeing Dr. Dan Lazowick for several years.

Last fall, Dr. Lazowick told Wolf he was joining MDVIP.

It significantly reduces the number of patients doctors have – often reducing their practice to 500 to 600 from the previous 1,500 to 2,000.

But it allows for longer appointments, better access and a wellness program which includes a 90-minute initial appointment.

To continue in the doctors’ practice, it costs $1,650 per person per year – out of pocket.

Wolf says he didn’t want to change doctors, didn’t mind the fee and is happy with the new model.

“I feel I get more sincere attention,” Wolf said.

In fact, when he had a problem a few weeks ago, he got Dr. Lazowick on the phone right away, instead of what he says happens at other practices.

“You can be on the phone for 20 minutes trying to get a human being,” Wolf quips.

Dr. Lazowick says he wanted to get back to the reasons he became a doctor, which was difficult with the way healthcare is going.

He says, “I was on this conveyor belt where I was treating a problem moving to the next.”

Dr. Lazowick is not alone. Many primary care doctors are taking this route. And the pace seems to be accelerating, with the approach of full implementation of healthcare reform in January 2014.

One Philadelphia doctor joining the Signature MD network wrote his patients, “…It is clear that medicine is changing – and not for the better.”

Action News took an undercover camera into a meeting held by another local doctor who is switching his practice to concierge medicine in two months. He explained patients will have to decide: to stay with him, they have to pay the extra fee.

But there would only be room for a third of his past patients. Two-thirds, about 1,000, would have to find other doctors.

Not everyone was happy.

Joan Ehly of Havertown already spends about $6,300 a year for Medicare and supplemental insurance for her and her husband. She can’t afford the extra for concierge.

“That’s a lot of money, for each person, that’s $3,300 dollars for two of us,” she says.

Finding a new doctor can be difficult. Joan spent days calling and visiting doctors’ offices, sometimes being told they didn’t want any older adult or Medicare patients. She rattled off a list of friends whose doctors are also going concierge.

MDVIP has 19 doctors in the Philadelphia area, mostly in the suburbs, with plans to add more. Nationwide, it has grown from 450 to 700 doctors in about 2 years.

Many say the doctor shortage will only get worse, once the healthcare reform law requires everyone to have insurance.

Ehly warns, “Doctors are going to be overwhelmed with patients, so if you don’t move quickly you’re going to find yourself without a primary care doctor.”

Bill Johnston-Walsh, AARP Pennsylvania state operations manager, says, “We want to make sure everyone has access to quality care that they can afford.”

He, too, has heard of more doctors not wanting to deal with Medicare, and is concerned the problem will grow.

Johnston-Walsh says 50 and 60-somethings are already being left behind as the nation emerges from the recession, with diminished earning power.

University of Pennsylvania health economist Mark Pauly says the growing number of concierge medicine-type practices will separate the haves from the have-nots.

And while doctors aren’t making any more money, some corporations stand to make a profit. Procter and Gamble owns MDVIP.

“Some large companies that we assume know what they’re doing are putting a lot of money into this,” Pauly says.

Mark Murrison, MDVIP’s marketing chief, told Action News this is a choice, an alternative in healthcare for people who want a more personalized approach.

“The main problem with the retainer model is that it limits the number of patients that a particular primary care clinician cares for,” says Dr. Richard Wender, the Chair of Community and Family Medicine at Jefferson University Hospital.

He continues, “And all of these patients must be able to afford the retainer. As a result, our availability of primary care clinicians,  particularly for underserved patients, is reduced. And we are already suffering a shortage of primary care physicians.”

Dr. Wender and economist Mark Pauly both favor the Patient-Centered Medical Home model. Instead of severely limiting the number of patients, doctors have about 1500 to 1800 patients – the same number that concierge doctors say overwhelmed them previously. Care is provided in teams, which Dr. Wender says gives patients more access and care, at the same price.

As for whether more doctors will take this route, experts say it depends on how the new healthcare law progresses.

What everyone does agree on is the pressing need for more primary care doctors and nurse practitioners, plus a better system for them to see patients but that will take time.

According to the 2013 survey by Deloitte Center For Health Solutions, the majority of doctors believe their colleagues will either retire early or cut back hours within the next few years.

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About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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