Concierge medicine is the all the rage but rather should we be enraged about it?

Is Concierge Medicine simply an under-the-radar way of letting CM members “jump to the front of the line” silently creating a dual system of care based on ability to pay a “private” surcharge? (A)

A stated goal of the Affordable Care Act is to “Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured.” (B)

Obamacare was enacted to give millions of people access to health care. That is, to change the system where those who had insurance walked in the front doors of the health care system, while those without insurance were relegated to the Emergency Room (and then chastised for ER “abuse”) or just didn’t get care.

Some background.

“The Association of American Medical Colleges estimates that there will be a shortage of 91,500 doctors by 2020 as the Obamacare insurance coverage provisions are implemented and 30 million Americans become eligible for health insurance coverage.” (C)

So let’s talk about Concierge Medicine.

“In this type of medical practice (also called boutique medicine, retainer-based medicine or direct care), doctors — mainly in primary care — see fewer patients so they can spend more time with ones they do see.

For their part, patients pay an out-of-pocket fee that typically ranges from several hundred dollars to $15,000 annually. In addition to longer visits, patients receive a comprehensive annual physical examination, a commitment to shorter waits and, in many cases, the doctor’s cellphone number and email address so they can get in touch quickly.

Concierge medicine is not a substitute for health insurance. The retainer, no matter how steep, does not cover out-of-office visits to specialists, emergency room care, hospitalization, major surgery or high-tech diagnostic tests, such as CT scans and MRIs. The fee is not reimbursed by either private health insurance or Medicare, although patients’ health savings accounts may cover some of the cost. (D)

Some concerns about CM.

Although Concierge Medicine is a “business model” it markets itself as a clinical model. “The American Academy of Private Physicians (AAPP) is a nonprofit organization founded in 2003 for the purpose of supporting and fueling the growth of medical practices that provide “concierge” and other forms of personalized, value-based medical care. AAPP members are united by their common efforts and dedication to making medical care more accessible and convenient to patients by redefining and re-pricing medical services in ways that are not possible for medical practices that rely solely on insurance payers for their revenue.” (E)

“Concern for quality of care the patient receives should be the physician’s first consideration. However, it is important that a retainer contract not be promoted as a promise for more or better diagnostic and therapeutic services. Physicians must always ensure that medical care is provided only on the basis of scientific evidence, sound medical judgment, relevant professional guidelines, and concern for economic prudence.” (F)

“Typically, the concierge medical practice is on safer legal ground when it includes only medical services that are typically non-covered by insurance. The insurance legal problem is most thorny where Medicare is involved. If the concierge practice charges patients an access fee for services that are covered under Medicare, federal enforcement authorities could see this as violating Medicare rules. In such case, the safest legal strategy may be to simply opt out of Medicare.” (G)

And food for thought:

“Simply running away from the problems and inefficiencies of our current health care system and into the comforts of “retainer medicine” does little to advance health and well-being for the vast number of patients or address some of medicine’s biggest challenges (e.g., cost and access). These are difficult times for physicians and patients alike. We must be careful not to compromise on our commitments and renew our efforts to find sustainable solutions that support physicians in the advancement of the health and well-being of all patients.” (H)








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