Monday, July 4, 2011

Concierge Medicine: Who Benefits?

There have been a few recent articles discussing the issues associated with what is referred to as “concierge medicine.” In this type of practice a doctor will promise to provide quality office service at a fixed fee. This is typically the domain of the general practitioner who might promise next day appointments, email access, extensive wellness guidance, along with typical things that can be handled in a doctor’s office such as simple tests and x-rays. Medications, specialists, and hospital care are extra charges, so a patient needs a form of insurance in addition.

There is an article in Businessweek about an outfit called Qliance Medical Group and its founder, Dr. Garrison Bliss. Bliss aims at what is probably an upper-middle-class clientele. The Group consists of three clinics with eight doctors and two nurse practitioners. Patients are charged between $50 and $130 monthly, depending on their ages. The doctors are limited to no more than 800 patients, whereas a typical practice might include over 2000.

Who benefits from this? The doctors should be happy with this arrangement. They avoid the hassle of dealing with insurance companies, they have a guaranteed healthy income, they probably have shorter hours, and they can chose to devote more time and attention to each patient. The patients, if they can afford the extra charge, should be receiving better care, or at least more personal attention. Qliance claims that its patients incur lower medical costs than the general population. That could well be true, but small samples of filtered patients can lead to unreliable results.

Let’s assume the doctors are happy and the patients are happy; the real question is should the country be happy with this development?

There is another article that was provided by the Associated Press. It discusses a concierge operation called MDVIP that is a management company owned by Procter & Gamble. The doctors participating in this plan collect $1500-1800 per year from their patients. MDVIP gets $500 of that fee for “legal, regulatory and other support services.” Again, the implication of the article is that the doctors and the patients both like this type of healthcare delivery system.

The author, Ricardo Alonso-Zaldivar, raises a critical issue however. We are entering a period where up to 30 million new people are going to have access to medical insurance. How are we going to handle all these new patients if significant numbers of doctors are restricting their practices to fewer numbers of more affluent patients?

The intention of the healthcare legislation was to encourage the demise of the single doctor-provider and arrive at a more efficient process. Better care would be provided for more people by using a team approach that would delegate activities to the appropriate team member instead of requiring everything go through a given doctor. Most healthcare dollars are spent on a few patients who need a lot of attention—the kind of attention that doctors do not provide, but a team could. The concierge approach is a step backwards in that context. In fact, it looks as though doctors have figured out a way to maintain their lordly role, work less hard, and make even more money.

It appears that the number of concierge doctors is still small but growing. If the number became significant it would be a cause for concern. There already exist healthcare delivery methods that provide more effective care in a satisfactory environment for both doctor and patient. Hopefully, those who are truly concerned with providing better care will find a home in one of these organizations as they become more widely available. Those who are in it for the money will have to remain negligible and irrelevant.

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