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When to Dump Primary Care Physicians PCPs? from Forbes.com

Is there Proof that Concierge Medicine is Better?

Dr. Heyman is unaware of any studies evaluating the outcomes of patients with concierge physicians versus those without, but says the smaller patient load can allow for a more personalized approach. Still, he says, physicians “should provide the same quality of care to all patients regardless of the model of care in which they are practicing.”
http://www.simpd.org/nationalcarenetwork/indexdir.cfm
How It Works
At Dr. Howard Maron’s Bellevue, Wash.-based practice MD2 (pronounced MD squared), individual patients pay an annual fee of $15,000 while a family of four pays $25,000. This covers the cost for every service that takes place in the doctor’s office.

If a patient needs a special test, like an MRI or biopsy, patients then use traditional insurance to pay for it. This model, which Dr. Maron helped to pioneer in 1996 as the founder of MD2, is the standard for concierge practices.

MD2’s fees are more expensive than most, but pricing depends on the location and size of the practice. MD2 doctors practice in Bellevue, Seattle, Chicago, Portland, Ore., and San Francisco; at each location a doctor handles just 50 families. Dr. Knope charges $6,000 for an individual and $10,000 for a couple and has 150 patients.

Similarly, the Boca Raton, Fla., company MDVIP, a network of more than 280 concierge physicians who have no more than 600 patients each, charges between $1,500 and $1,800 per patient, reducing the cost to as little as $125 per month.

There are an estimated 1,000 concierge physicians in the U.S., and the Society for Innovative Medical Practice Design, an organization of doctors who promote a direct financial relationship with patients.

http://www.forbes.com/2009/01/14/concierge-family-doctor-forbeslife-cx_rr_0114health.html?partner=forbeslife_newsletter

457 thoughts on “When to Dump Primary Care Physicians PCPs? from Forbes.com

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  257. My regards to Thomas W. LaGrelius MD FAAFP for clearly stating what is good and what is bad in Healthcare Industry, practices, and wishes of people and Doctors so that those living in United States get best health solutions from providers and time has changed for “Kiss and a prayer” Days in US history of Healthcare.

  258. Thanks MD Doc Thomas W. LaGrelius President of FAAFP for your valuable time,energy, research analysis, and presentation of facts and figures in this article and providing insight to us on how HealthCare Insurance System should really work and What is best for American people, the people who crave for and spend most all over the world including United States of America itself for best solutions. As President of the Society for Innovative Medical Practice Design, your notes, examples,and guidance will help us create a real scenario instead of Concierge Medicine or the one that includes 1000 patients for White House Doctor.

  259. As President of the Society for Innovative Medical Practice Design, mentioned here and in the Forbes article let me comment.

    Your summary makes is sound like concierge medicine is very expensive. It can be, but it usually is not. The average fee for concierge medicine is about $150 per month and the average number of patients in each physician’s practice is about 600. The range is as low as $39 per month to over $1,000 per month.

    I know of no concierge practice with less than 50 patients (except the White House physician of course who has only one) or more than about 1,000. My own practice is typical with a cap of 600 and a monthly fee between $75 and $150 per month age adjusted.

    These fees thus average about $5 a day and can be under $2 a day. This is lunch money. Most Americans can easily afford it. What they cannot afford is the hamster wheel care they are typically getting outside concierge medicine. Such care is responsible for many medical errors. Medical errors kill over 80,000 Americans annually. Such errors are rare in concierge medicine. Evidence of this includes the fact that to date, not one concierge doctor has ever had a malpractice action filed in the entire history of the movement.

    What happens when you try to call your doctor on a Sunday? Can you reach him? Will she respond to your needs promptly? A concierge doctor does and you can usually reach him immediately. Most of us give our personal cell and home phone numbers to our patients, or at least a quick pager number.

    Last Sunday I came into the office to evaluate a patient with stomach pain who turned out to have an acute gall bladder. We had it out and the patient home in one day. He never even saw the packed emergency room where dozens of patients were spraying viruses into the waiting room air because they had no accessible source of primary care other than the ER, which is not a good place to go for such care. Today, a Saturday, I went in to change a dressing that had come off (put on in a consultant’s office not mine) and to diagnose a case of acute gout. It is rather rare that I have to do such things, but I do them immediately when needed. Does your doctor?

    What happens when you call your doctor on a weekday for an appointment? Is it the same day or the next day? Is it on time? Is it unrushed? It will be if you have a concierge doctor.

    Or is your appointment days later? Do you sit in a crowded waiting room for an hour or more before being placed in a cold exam room to wait longer? Does the doctor spend less than ten minutes with you? Does he always uncover and examine the area you are complaining about? Or does he stand by the door with his hand on the knob rushing to get to the next exam cubicle? If you ask about a second or third or fourth problem will he cheerfully deal with it at the time? Or will he ask you to make another appointment since he is out of time for you?

    Does your doctor insist you get a careful annual wellness evaluation spending much more than an hour with you personally and outline a wellness plan for you? Does she follow through on the plan? She will in a concierge practice.

    Or do you have to ask him to do the exam? Does it consist of a brief “kiss and a prayer” exam with most of your clothes on and a blood and urine sample? Do you have to call the office over and over to get results, or do you just assume that no news is good news? This is not a safe assumption. Tests do get lost. None of that will happen in a concierge practice.

    So for the price of lunch at a fast food outlet, or in some practices for the price of a brown bag lunch, you can get the kind of care normally reserved for presidents and kings. You really can, but you do have to be willing to pay for it directly and not through your health plan. You see the health plans have destroyed the Marcus Welby practice you used to know and created the hamster wheel practice you see today, so don’t expect much help from that direction.

    Do you want hamster wheel care or concierge care? It’s the price of lunch. Is it worth the price? You decide.

    Thomas W. LaGrelius, MD, FAAFP
    President SIMPD http://www.simpd.org
    Owner SPFC, Torrance, CA http://www.skyparkpfc.com

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