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The Growth Of Concierge Medicine

 Stanley Feld M.D.,FACP,MACE

In the accelerated chaos Obamacare has created for both patients and physicians an increasing number are trying to find ways to maintain their freedom of choice. Patients are recognizing that Obamacare is causing a commoditizing of healthcare and the destruction of the Patient/Physician relationship.

Patients and physicians yearn to have a good Patient/Physician relationship.

Physicians love the practice of medicine but they hate the burden being imposed on them.,

  1. Increased government regulations and requirements,
  2. Increased paper work to prove every clinical decision they make on the patient’s behalf.
  3. The restrictions on their use of clinical judgment.
  4. The increased overhead to comply with regulations of both the government and the private insurance plans.
  5. The decreasing reimbursement.
  6. The lack of malpractice reform.
  7. The pressure on primary care physicians to see 30-50 patients a day to cover overhead resulting from decreased reimbursement.
  8. The inability to spend more time with patients because of this patient volume pressure.
  9. The inability to get to know their patient better because of time constraints.

      10. Their inability for physicians to have empathy for patients after they see the tenth patient   because of burnout.

       11. Their inability to develop a viable patient/physician relationship.

       12. Spending at least three hours weekly dealing with insurance plans preauthorization.

       13. Their clerical staff and nursing staff spending at least fifteen hours weekly obtaining preauthorization from the insurance company or government before providing patient care.

        14.Their ability to keep up and comply with all the bureaucratic requlations and requirements.

An AMA survey of 2,400 primary care physicians believe private insurers and government insurers have excessive requirements for preauthorization for tests, procedures, and medications.  

  • More than one out of three have a rejection rate of 20 percent for first-time preauthorization on tests and procedures,
  • More than half of physicians have a 20 percent rejection rate on prescriptions.
  • About one half of physicians have difficulty obtaining preauthorization from insurance plans.
  • About two out of three wait several days for permission.
  • About the same proportion report difficulty in determining which tests, procedures and medications require preauthorization.

These are just a few of the reasons the enjoyment has been taken of the practice of medicine. Many physicians have said I am finished dealing with all these rules and regulations, the government and the private insurance industry.

Many Primary Care Physicians are converting their medical practices to Concierge Medical Practices.

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.”

What is concierge medicine?

Concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges depending on the business model being used and the retainer charged.

The up front retainer allows physicians to decrease full time staff to a minimum. It decreases the complexity of practicing medicine. Physicians do not deal with insurance companies or the government. They only deal with their patients. This permits physicians to decrease the number of patients they see a day and increase time spent with and relating to patients.

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.”

Concierge medicine is a way of taking first dollar coverage away from the healthcare insurance industry and putting control of care in patients’ hands. It prevents the insurance companies from feeling they own physicians and patients.

If the Patient/Physician relationship is not important too many large healthcare companies. Physician are simply one provider among many such as nurse practitioners, physicians assistants, social workers and pharmacists.

All these healthcare companies are interested in is maximizing their profits from this 2.7 trillion dollar business.

Concierge medicine would not be growing by leaps and bonds if this companies concentrated on the welfare of consumers.

Both physicians and patients are feed up with the development of central control of the healthcare system.

All of us remember President Obama’s lie, “If you like your doctor you can keep your doctor with Obamacare.”

Obamacare was passed because of this lie.

The concierge retainer fees can vary from $500 to $38,000 dollars per year. Concierge medicine will create a two tier Healthcare System. I disagree with a two tier system!

It is occurring because we have a dysfunctional healthcare system. Obamacare is making the healthcare system more dysfunctional.

The healthcare system is not servicing either patients or physicians well. Each is searching for an alternative before Obamacare and the entire healthcare system collapses under it own weight.  

Patients yearn for a positive Patient/Physician relationship. As more physicians are adopting the concierge business model patients are signing up to the surprise of the government and the healthcare insurance industry.

These stakeholders have underestimated the value of the Patient/Physician relationship.

Maybe the trend will wake up the government and the healthcare insurance industry and fix the things that are broken.

Obamacare is not doing it! It is making things worse.

Maybe these two stakeholders will realize that they do not own the physicians or patients. Any attempt to own them is futile. It is not in the American culture being to be enslaved.

The answer is not fancy information systems that do not work perfectly. It is not by creating expert panels to tell physicians what they can do. It is not these panels telling patients the care they can have. Our healthcare system is dysfunctional. The system does not evaluate the quality of care effectively.

All one has to do is look at the VA system’s problems. The VA system’s problems are a disgrace. It should also be a warning about the future of Obamacare.

Obamacare and its bureaucracies are going to create another VA system for all Americans.

The answer is to teach consumers what is good treatment and what is not good treatment. It is to help consumers evaluate their physicians. Price transparency is a good beginning in order to get the stakeholders to start competing.

Tort reform is another good start.

Government could help by teaching consumers to ask the right questions.

It should start realizing that we have to have a consumer driven patient centric system where patients are responsible for their health and healthcare dollars.

The problems in the healthcare system can be solved with a consumer driven healthcare system using my ideal medical saving account.

The public health problems are a different issue. There are three diseases we can prevent. They are obesity, alcoholism and drug addiction. The government must deal with these diseases on an educational and social level.

The government has not done a very good job with any of these three diseases. The prevention of these diseases is a public health problem.

It should not be mixed up with individual medical care. Obamacare does with the causes of these diseases or the environmental cures.

Obamacare is another unsustainable entitlement program. The government should not be creating another unsustainable entitlement program.

It should be creating a program that promotes individual responsibility for health, healthcare, and healthcare dollars.  

Hopefully the growth of concierge medicine will be a wake up call to a misguided Obama administration wanting top down control of the healthcare system.

They must realize that the Patient/Physician relationship is sacred to cost effective medical care.

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

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