Insurers, Doctors At Odds Over “Concierge” Care Insurer to drop 4 physicians charging retainers for more personalized care

Stanley Feld M.D.,FACP, MACE

Physicians are smart people. If a physician’s integrity, livelihood and joy of practicing medicine are threatened he will eventually figure out what to do to make life more pleasant. Over the last 15 years physicians’ enjoyment of medical practice has been decreasing.

Some of the reasons are the increasing volume of paper work, decreasing reimbursement, increased delay in payment by healthcare insurance companies, increasing overhead and the pressure of escalating malpractice suits.

Medical practices have attempted to increase efficiency by installing Electronic Medical Records. Many attempts to install Electronic Medical Records have failed at great expense to the medical practice.

Recently Primary Care Internists have attempted to decrease their stress by limiting their practice. They are converting their medical practice to Concierge Care Medical practices. MDVIP has created a national network of 210 physicians so far who practice concierge medicine.

Several models of concierge care decrease the need for a physician to have a large panel of patients, decrease stress and paperwork while creating the ability for physicians to enjoy their medical practice once again.

Healthcare insurance companies are unhappy and are starting to become punitive to patients and physicians who use this innovative approach to medical practice.

“Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.”

“Cigna is also condemning the practice, in which physicians charge an annual retainer of $1,500 to $1,800 for patients who then receive more personal care. The claim is it is in violation of the physician’s contract with the insurer.”

UnitedHealthcare and Cigna think it is improper. The other insurance companies think it is fine as long as the patients know they will no be reimbursed for the physician retainer.

“Humana would not exclude doctors practicing this model of care from our networks,” said Dr. Mark Netoskie, medical director of Humana, Houston. “It is the consumer’s choice whether or not to pay for these additional services.”

“United Healthcare says the concierge model “directly conflicts” with the insurer’s contract with the doctors.”

I think United Healthcare feels threatened by physicians and patients taking control of their medical care needs. UnitedHealthcare will lose control over the healthcare system.

“Concierge medicine is a relatively small movement in the U.S.”

I believe the retainer charged is too high. However, if patients want to pay the fee it is their decision.

“Typically, physicians who charge an upfront annual fee reduce their caseloads, which allows them to make house calls and focus on wellness matters from weight management to depression. Some give patients their cell phone numbers.”

With a smaller panel of patients, physicians will have time to have a therapeutic physician patient relationship once more.

“Proponents say concierge care is a revolt against the modern health care system where diminishing Medicare and insurance payments have forced doctors to herd dozens of sick patients through their offices in five-minute increments every day.”

The concierge system permits the physician give personalized care without the reimbursement controls imposed by the insurance companies or Medicare. Patients enjoy the service because they have a personal physician who cares for them. The physicians enjoy the setup because it decreases the stress they experience in the present reimbursement system.

“Our national network of physicians remain in-network with most of the insurance companies in which they participate, and MDVIP maintains excellent relationships with a number of national and local insurers,” the CEO said.

I can foresee that if the movement catches on it will intensify the primary care physician shortage in America. I do not believe this movement is the answer to Repairing the Healthcare System.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.