Thursday, May 15, 2008

May 15, 2008 - Concierge Medicine?

A couple of nights ago, Claire and I attended an informational meeting put on by our family-practice physician, Dr. David Cheli. Starting this July, he’s associating himself with a nationwide group called MD-VIP. This decision will bring big changes for his patients.

For us patients, there’s some good news and some bad news.

The good news is, Dr. Cheli’s going to be focusing very intentionally on preventive medicine. Each patient will receive an elaborate annual physical, including a host of diagnostic tests. That physical exam takes about one and a half hours, and is – the company claims – comparable to the “executive physicals” long offered by world-class medical facilities like the Mayo Clinic. Each patient gets a personalized website with health-related resources, and a mini-CD-ROM containing personal medical history to carry around and present to emergency-room doctors, if necessary. Dr. Cheli also promises to be available 24/7 by cell phone, and further promises that no patient will ever have to wait longer than one day for an appointment. He’ll continue to take all medical-insurance plans for routine office visits – no change there, he assures us.

Dr. Cheli will continue to have a solo practice, but he’s cutting his roll of patients from 2,700 to 600. That’s what makes the more personal attention possible.

OK, that’s the good news. Now for the bad news. Each patient must pay an up-front fee of $1,500 a year – which (except for, perhaps, a small portion) is not covered by insurance.

Do the math. 600 patients times $1,500. That’s 900 grand. Dr. Cheli doesn’t get all of it, of course. MD-VIP gets their cut, and those elaborate tests associated with the annual physical do cost something. Yet, what he does receive from these annual fees is evidently enough to cut his patient roll by more than three-quarters.

I can understand what’s in it for him. As he explained the other night at the public meeting, he’s been practicing medicine for 31 years. Along with many of his colleagues, he’s feeling increasingly frustrated with a health-care system that forces him to rush through patient appointments so he can spend hours on the phone arguing with insurance adjusters. He knows the type of medicine the system forces him to practice isn’t as good for his patients as the type of medical care he was trained to deliver.

MD-VIP claims their patients’ hospitalization rates are just 65% of the general population. They attribute this to two causes: better prevention, and same-day or next-day appointments (which allow MD-VIP doctors to identify and treat serious conditions in the office, keeping their patients out of the emergency room).

That may be part of it, but I’d be willing to bet that a significant portion of this favorable statistic can be explained by the fact that patients willing to pony up the $1,500 fee are younger and healthier to begin with.

Why do I say that? Several reasons. First of all, MD-VIP relies heavily on the internet. Patients have to be familiar enough with computers to derive the full advantage from this service. While some senior citizens have taken to the internet with a vengeance, a great many still don’t know the difference between hypertext and hyperactive. Second, chronically sick people are more likely to have burned through their financial resources and would have a harder time coming up with the $1,500 annual fee. Third, patients who see the value of preventive medicine, and are willing to pay for it, are more likely to have already adopted positive lifestyle habits. (How many chain smokers or alcoholics are willing to go for this?) Fourth, those who simply have an aversion to going to the doctor are not likely to pay top dollar for the privilege of spending more time doing the thing they hate.

So, Claire and I have a tough decision to make. We both really like Dr. Cheli. He’s been our family doctor for 17 years. He diagnosed my cancer before I was displaying any obvious symptoms. He’s a got a caring bedside manner, and he’s always been responsive to our needs. But, can we find the $3,000 a year to keep going to him?

My medical insurance, provided by the Presbyterian Church (U.S.A.), has a preventive health benefit that reimburses 100% of the cost of an annual physical, independent of deductibles and co-payments. That benefit’s got a cap on it, though, that falls way short of $1,500 for each of us. Most of the MD-VIP fee we’d have to pay out of pocket.

If Dr. Cheli will be able to work with me to overcome my #1 preventive-medicine challenge – losing weight – it will be money well spent. But, will the MD-VIP philosophy really give him the time and resources to do that? Is it really as good as the rosy description on the website claims?

They call this “concierge medicine” (although MD-VIP's website disavows this label, saying they’re “beyond concierge healthcare”). As with any pricey “concierge floor” in a hotel, the question is, “will we get our money’s worth out of the enhanced service?”

Or, is this one of those situations where, as they say, “if you have to ask the price, you can’t afford it”?


K said...

Thanks for the information on concierge medicine. I hope that you and you doctor are able to work something out!!!

We recently wrote an article on concierge medicine at Brain Blogger. Concierge medicine is a rising tred in medical practice. But is it worth the cost or the effort (on the doctors side)?

We would like to read your comments on our article. Thank you.


concierge medicine said...

Concierge medicine is driven by patient dissatisfaction over our present fast-food medical model of HMOs, PPOs and a failing Medicare system. Patients love the time they have with their concierge doctors. Doctors love having the time to do what they were trained to do. Unless primary care medicine becomes more attractive to young doctors, by implementing models such as concierge medicine, no one will opt for a career in internal medicine, family practice or pediatrics and the shortage of primary care doctors will only worsen.

I have experience of a concierge level medication of They are providing me medication with care at the highest level of comfort. The amount of comfort and relaxation provided by these concierge medications makes hospital a better place to visit. Their wellness program allows me to have a direct access to my personal physician via phone and email, but also in the emergency situation which I had because of having a heart attacks, physician came home and also were present in the emergency room to expedite my care. They provided me a patient care concierge who managed all my transportation and accommodation. All this meant a lot to me when it comes to health.

Carl said...

To the writer known as "concierge medicine," I say, concierge medicine is a wonderful thing, for those who can afford it. There are undeniable benefits. When my doctor was considering overhauling his practice to engage in this approach to medicine, I gasped at the annual fee, but my wife and I were ready to pay it, because of the benefits we would receive (it turned out, he did not find enough of his patients willing to make the switch, so he backed off and went back to his usual practice). Still and all, I think a better solution is to overhaul not individual medical practices, but our entire healthcare system into a single-payer system, so all patients will be able to receive a higher level of care.