Patient Struggles To Justify Concierge Medicine Practices

New business models for doctors may make it harder for your family to get quality medical care

By Jessica Santina

This article was published on 11.28.13.


I had a terrible case of insomnia. It was early October, and I had gone four nights without ever falling into a deep sleep. I was exhausted, terrified I would never sleep again, and desperate for some help. So I called Reno Family Physicians to schedule an appointment with my doctor, Paul Smith, to find out what was happening to me.

But when I asked to schedule an appointment with him, I was told some surprising news: Dr. Smith, who had been my primary care physician since 1999 and my daughter’s doctor since she was born in 2009, had joined a program called MDVIP. Through this more personalized program, the scheduler explained to me, Dr. Smith would be providing more one-on-one patient care. Each appointment would be a full half hour.

“That sounds great!” I said, thinking back over the many times in recent years when our appointments had lasted all of five minutes.

“The practice is limited to no more than 600 patients,” the scheduler continued, “and the cost is $1,650 per year, which is not billable to insurance.”

“That’s in addition to the cost of the services?” I asked.

“Yes, and insurance would apply to those,” she explained.

It didn’t take long to do the math. Because I’m self-employed, I pay for individual insurance that covers me and my daughter, and I could barely pay for that each month. Despite the fact that we had loved Dr. Smith, we would not be following him to MDVIP.

The practice fortunately has several other doctors, one of whom was available to see me that day. But I was officially in the market for a new primary care doctor and, perhaps, a pediatrician for my daughter. I started collecting recommendations from friends, one of whom mentioned that I was the third person she’s spoken to that week who had lost a doctor to “one of those VIP plans.”

It was then that I became really nervous. Could I potentially run into this issue with any doctor I found a connection with? Fewer patients and a steep annual fee seemed like a nice deal. Would doctors soon be dropping like flies from standard practices as they too chose what seemed obviously to be a more appealing option?

I felt a rise of panic in my chest. Now that the law said everyone would have insurance, it seemed as if insurance would no longer be enough. And with doctors already being in short supply, who would that leave for the rest of us?

Turns out, the more I started sharing my experience with others, the more people I found who’d had experiences similar to mine. In fact, one friend introduced me to a co-worker, April Flynt, whose whole family had also recently lost their longtime family physician, Dr. Merritt Dunlap of Carson Medical Group in Carson City, when they simply couldn’t afford to follow him to MDVIP.

“It was heartbreaking,” said Flynt, 40, whose husband and two children all had seen Dr. Dunlap. “It was a tough decision, because we felt we had a good relationship with that doctor, and the philosophy [of MDVIP] sounded like something we would benefit from—additional care and more time with the doctor.”

Nonetheless, she couldn’t find a way to make the annual fees work.

“As a young family, we could spend that $3,300 in a much better way. (The cost is $1,650 per adult—kids up to age 26 are included under MDVIP’s family plan.) I don’t spend that much on medical care. We’re healthy, we get regular check-ups, and we just go in for the occasional allergy shot or flu. So it doesn’t seem beneficial to me.”

Meanwhile, Flynt is frustrated at having to start all over with a new doctor. And until they select a primary care physician, they’re unable to get certain kinds of care, such as her husband’s allergy shot, even from other doctors at Carson Medical Group. Right now, the family is actively seeking a physician with whom they feel a connection, and they haven’t found it yet.

I find myself in the same boat.

Concierge medicine,” as it is being called, is growing by leaps and bounds. And this growth is expected to continue as a response to the Affordable Care Act.

Concierge medicine is several different ideas rolled together,” Larry Matheis explained to me by phone from Las Vegas. Matheis has been executive director for the Nevada State Medical Association for the last 25 years, and says this shift in health care has been brewing for a while. “It’s about doctors dropping out of the current system and developing their own book for business, in effect, with select patients to whom they give more service and are more available, without having to deal with insurance or, in some cases, Medicare or Medicaid. They tailor their practices to a relatively small number of patients who are willing to pay on a monthly or quarterly basis, for services they need or for routine care.”

In 2012, the Physicians Foundation published “A Survey of America’s Physicians: Practice Patterns and Perspectives.” The national, biannual survey, which had 13,575 respondents, addressed issues such as morale, opinions on health-care reform, and the state of medical practices today.

The numerous findings of the study are alarming:

• Physicians are seeing an average of 16.6 percent fewer patients per day than they did in 2008.

• More than 60 percent of respondents would retire today if they could.

• More than 26 percent have closed their practices to Medicaid patients.

• In the next one to three years, more than half of respondents planned to cut back on patients, transition to part-time hours, switch to concierge medicine, retire or take other steps that would reduce patients’ access to care.

• More than 62 percent reported providing patients with at least $25,000 in uncompensated care each year.

The majority of physicians reported being unhappy in their work, wouldn’t choose to practice medicine again if they were starting out today, wouldn’t recommend the profession to their children, and were not optimistic about the effects healthcare reform would have on their practices.

“The practice of family medicine and general care has changed a lot,” said Dr. Daniel Spogen, chair of the Family Medicine Department at the University of Nevada School of Medicine in Reno. “It used to be that families paid cash unless it was an extraordinary kind of visit. But it was affordable. When I started practicing medicine [in 1983], I think it was $35 for an office visit.”

But then came managed care in the mid ’90s.

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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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