Saturday, March 17, 2012

Concierge Medicine

Money may not buy happiness, but it can pay for you to avoid the hassle of a doctors or hospital waiting room. Well-off executives and their families increasingly are paying tens of thousands of dollars a year for high-end medical services. "Wealthy people want to have a little exclusivity and want better service than they can get at their normal health-care facility, and they're willing to pay for it," said Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, a Roseland, New Jersey-based accounting and consulting firm.

Concierge medicine, a doctor on a retainer, in other words, the ability to have access to their physicians anywhere, anytime is on the rise in America. 64 percent of all doctors believe that concierge medicine has the best chance of financial success today. In addition to concierge medicine, the wealthy have a variety of plush options to choose from when it comes to their health care. Some hospitals are competing for wealthy clients by offering perks like butlers, fancy beds, beautiful views, and fine food. Some of New York-Presbyterian's luxury hospital rooms can cost patients $1,000 to $1,500 per day. Guardian 24/7 is a company that installs emergency rooms in homes, yachts and planes, and can equip them with X-ray machines, CT scanners, ultrasounds and blood-analysis technology, said Sean O'Mara, cofounder of the firm. The equipment alone may cost as much as $1 million, he said.

There’s nothing radical about the idea that profit can be made from an enhanced patient/doctor relationship. We have “executive health” clinics with extensive physicals, preventive screening, and a bit of pampering, offering everything from electrocardiograms to a complete blood chemistry. Executive physicals, however, tend to be one-shot deals: You meet with a doctor, undergo a battery of tests, then return to the care of your regular physician. Concierge care typically offers a version of that physical, but the physician conducting the tests becomes your doctor.

In the journal Annals of Internal Medicine, Michael Stillman, a Boston-based, non-concierge doctor, questioned the motives of concierge doctors. Concierge medicine is “a product to be sold, not unlike an expensive car or a high-end kitchen appliance,” he explained.

The payoff for the doctor can be attractive: A $1,500 retainer for a practice of 600 grosses $900,000. “That’s serious money before you even say hello to a patient,” says Peter Lavine, an orthopedic surgeon and president of the Medical Society of DC. Family doctors are amongst the lowest-paid physicians, making $171,000 to $186,000 a year. Faced with low reimbursements, general practitioners often pack as many patients into a day as possible. Even then, they may put in long hours, hustling through ten-minute appointments to maintain a practice that gets by on thin margins. In the past ten years, the number of medical-school graduates who choose residencies in family medicine has dropped by half. Doctors in training choose specialties that promise more money—particularly those physicians-to-be who’ll leave medical school in debt.

Part of the rush toward high-end, private services may stem from a growing gap in the availability of health-care providers. There was a shortage of about 13,700 physicians in the U.S. in 2010, which may rise to about 91,500 in 2020 and 130,600 by 2025, according to estimates by the Washington-based Association of American Medical Colleges. And the increase in doctors moving to a concierge or retainer business model could reduce access further, said Julia Paradise, an associate director in Washington at the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. "It's just math," Paradise said. "If the physicians who are practicing take fewer patients, it reduces access in the wider population and it generally limits access to people with very substantial resources."

"In a hospital gown, we are all created equal," reads one firm's website marketing material.But that is not enough for some. Peter Hoedemaker, chief executive officer of the Bellevue, Washington-based company. "There are different levels of hotels, and different levels of cars," Hoedemaker said.

Concierge care will sharpen the already divide between the haves and the have-nots. A study in the U.K. found that managers live three years longer on average than workers with routine tasks. In addition, Harvard graduates live ten years longer on average than men living in inner-city Boston, according to a study from researchers at the university. Three in ten Harvard graduates lived to age 90, while the average American lives for 78 years, the study found.

SOYMB recognises that the concierge model of care is attractive. It offers a case study of what primary care should look like. Being more-personalised might lead to early detection and proper treatment for diabetes, heart disease, hypertension, and other chronic illnesses that left untreated can require surgical procedures and hospital stays. Its preventive screening catches diseases early and lowers the death rate for patients. To-day health care delivery is fragmented. You might see an internist, an endocrinologist, an orthopedist, and a rheumatologist or pulmonologist. Yet rarely does any single doctor adequately monitor the progress of a patient.

“We all agree that you need to be able to really coordinate the care of your patient,” says Lori Heim, president of the American Academy of Family Physicians. “If you do that, you will have a tremendous cost saving in the future. It’s a whole lot cheaper for me to manage my diabetics than to pay for an amputation or dialysis.” But Heim is skeptical that the concierge model could be made affordable on a widespread scale. She’s talked to many doctors—particularly in rural areas—who’ve researched the idea and find they could never make it work financially.

“Concierge care is great, but who can afford it?” says Dr. Barbara Starfield, co-director of the Johns Hopkins University Primary Care Policy Center. “It’s not a solution for the country; it’s a solution for rich people.”

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