Roy Exum: "Concierge" Medicine

Monday, August 2, 2010 - by Roy Exum
Roy Exum
Roy Exum

I am by no means a medical expert, especially with the healthcare industry in such a swirl no one can explain it. But I hold the opinion there will never be a "nationalized healthcare" plan that will fit every American, not as long as some of us drive more-expensive cars, live in bigger houses, and go to private schools. Face it: life itself will never be the same for everybody.

That point was best brought home early Sunday morning when an article in the Huntsville (Ala.) newspaper caught my fancy. It seems there is a physician two hours away from Chattanooga who now specializes in what is called "concierge medicine," a boutique practice that charges about $1,000 a year for VIP healthcare.

What this means is that for an annual fee - one that must be paid in cash rather than through health insurance or Medicare - the patient gets the doctor's personal cell phone number with the privilege of calling it 24 hours a day, seven days a week, and the promise he'll immediately answer it.

Further, they receive a Mayo Clinic-type of physical every year and a doctor who will promise not to rush through appointment, nor ask patients to suffer lengthy waiting-room delays, and diligently follow even the smallest medical problems.

The way I understand it, the basics still remain. VIP patients will still pay what their insurance does not. They'll still be responsible for their "co-pays" and the percentage of the bill not included in their varying coverages. They'll just become "Very Important Patients" who don't have to wait their turn. And they will still be referred to specialists the doctor thinks are the best.

According to the story, Dr. Richard Spera, a general-medicine doctor, already has 57 patients who have signed up, and at $1,000 per human he's already clearing almost $60 grand in "new cash." He has other patients eager to sign up, too, and already there are approximately 5,000 "concierge doctors" in over 30 states because the idea is so lucrative.

Meanwhile, other Huntsville physicians, increasingly frustrated with harried lives that include daily wrestling matches with reams of paperwork and who are forced to carry huge patient loads, are eagerly studying the trend and several say they are ready to do the same thing.

Steve Doyle, writing in the Huntsville Times, quoted Dr. Spera as saying, "At many medical offices, you kind of get the same experience as when you go to the Department of Motor Vehicles to get your license renewed. That's not a satisfactory position for patients."

"And as a physician, it's hard to feel like you're doing good for people if you only have 10 minutes to spend with them," Dr. Spera explained. ""People want a doctor to sit down with them and really take the time to talk about their medical problems."

Now, the doctor who treats Dr. Spera when he gets sick is a GP physician named Jon Moody. Dr. Moody told the newspaper reporter he's going to do the same thing but that his fee will be $1,500 per year. Dr. Moody said, "It's been humbling how well it's been received. I will be much more available to patients because of the reduced size of the practice. I'm excited about it and looking forward to getting started."

Apparently the "concierge medicine" trend is just coming to Alabama - Dr. Spera being the first outside of Birmingham to sign on with a management company called MDVIP. Based in Florida, MDVIP asks its doctors to cut down to 600 patients (some now have over 2,000) and what they try to sell the patients is preventative medicine instead of the obvious lure of on-call privileges. MDVIP already boasts 125,000 subscribers.

The stickler is that if a certain doctor's patients can't find the $1,500 in cash, the doctor cuts them from his service. Add the fact that in Huntsville right now there are 44 family-practice and internal physicians who are accepting new patients, but only 25 will take Medicare patients and just four will take those on Medicaid. Guess who is getting pinched out?

David Spillers, the CEO of Huntsville Hospital, is studying the trend with a wary eye. For instance, he said, "I don't know that anybody can say that this is good or bad - it's just a different model, and I think we're going to see more of it."

But he also said something more ominous. "Clearly, if there were a massive move by physicians (to become concierge providers), healthcare for Medicare and Medicaid patients is going to be delivered in the emergency rooms and urgent care centers. We will be overrun."

Every day doctors are dropping Medicare and Medicaid patients, citing the fact the government slashed 21 percent of reimbursements in April and the burdensome paperwork that now borders on insanity. But then the low-income patients turn to the hospitals for care and Spillers, as well as every CEO of any hospital in the United States, can't provide any more indigent care.

What is apparent is "concierge medicine" cuts away the dead wood (non-paying) in a medical practice. It is also apparent that if a good internal medicine physician builds a client base of 500 patents, each paying $1,000 and up to be "Very Important," no longer will family-practice doctors be among the lowest paid in the physician food chain.

Just you watch, this one will soon be playing - and paying - in a town near you.

royexum@aol.com



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