MARCH 26, 2014 – Growing up, Erin Havel’s family saw one family physician. That doctor gave her mom medical care when she was pregnant, delivered her when she was born, gave school shots, wrote prescriptions for any virus that came up, and helped her grandparents with geriatric care. This was well-rounded family care at its a finest.
However, things changed when her doctor retired. Patients were transferred to a new doctor, with his eyes on the dollar sign.
This new local doctor was just starting out. His office handled everything the original doctor did. But the difference was, now there were nurse practitioners who saw everyone. Erin very rarely saw the doctor. Fair enough, the nurse practitioners, in most situations, knew how to take care of the basics, and got her to specialists if she needed one.
Erin’s hometown used to be a small community that had all the basics, no fluff. Then the town turned up on a national list of top places to raise children. Immediately, her small town became an affluent community with expensive specialty stores, high end eateries, and, admittedly, some of the arrogance that accompanies money. The “been there for 200 years” town folks, including Erin’s family, are still there, but they’re being displaced.
Erin believes this made her small town the “perfect target for the burgeoning concierge medicine model.”
With all the wealth of the town, and an aging population, there is a tendency for people to be afraid of change. The Affordable Care Act, and the debates around it, scared the heck out of many older folks.
Then in walks a company offering a concierge medicine setup for Erin’s family doctor. The doctor chooses 600 select patients from his client list, and those people buy into a VIP program. The program costs about $1,600 a year per person. The breakdown is that $1,000 goes to the doctor, and $600 goes to the company setting up the concierge service. The patients who shell out the cash upfront, can continue to see their doctor. Those patients are special, because others have not been given the opportunity to join the “club” (or declined out of “sticker shock”).
This two-tier notion of healthcare present in concierge medicine is something we’ve distanced ourselves from. As a Direct Care practice, we charge our patients only $600 per year for what we consider the be A SUPERIOR SERVICE.
And get this– we still profit as does any successful business. Which does raise a difficult question: What kind of treatment do “VIP patients” get for that extra $1,000 they are paying?
The answer is, they actually get the exact same coverage they were already entitled to through their regular insurance policy. In fact, all the red tape is still tied around the whole spectacle. To us, concierge medicine wit insurance ties is like being able to cut in line, and get to all the bureaucratic entanglements faster. It’s literally like paying more for easier appointments and more time with your doctor — important things, yes — but at the end of the day, you’re still blindsided by obscured charges. And these VIP doctors still ahve to jump through hoops to get reimbursed for their work.
From the VIP doctor’s point of view, this concierge service allows them to have less clients to care for, without losing income, and that is nice. But it doesn’t change THAT MUCH for their select patients.
In the case of this “concierge medicine” where the only benefit is “access” we have to question the motive. Side by side, compared to Direct Care’s retainer-based model, you’ll notice a major difference. We’re fighting to make doctors “more accessible.” While yes, we can each only see about 600 patients effectively, we can do so with a quality unparalleled in the fee-for-service world.
We also become more than just talking heads, distracted during visits, taking notes so we can make necessary ICD-9 transcriptions in order to get paid… Instead, we become ambassadors for our patients’ health. We provide pills for pennies each, we negotiate for labs and tests that need to be run, so that bills come out in the low hundreds (as much as if your fridge broke) instead of the $4,000 bills for one MRI that we’ve seen.
It’s a fine line, but as physicians, we should be careful that in our pursuit of happiness, we don’t just willfully charge wealthy patients more money so that we can lead more comfortable lives. We need to remember that it’s about how much of an impact we can make in improving patient health.Tweet