Saturday, May 14, 2011

More Money For Less Work

A staff writer at the San Diego Union-Tribune wrote a glowing tribute to the concept of “concierge medicine” last Tuesday, making it sound like the greatest thing to happen to medical practice since the invention of the stethoscope. I’m not convinced. It may be great for doctors who engage in it, and for their patients, but I see it as a disaster for health care delivery.

The idea is that a patient pays a flat fee, in this case $1800 per year, in cash, in advance and in addition to the “fee for service” as usual, for a very high level of service from the doctor and the doctor, in turn, limits his practice to only those patients who are paying the fee so that he can render that very high level of service. The article doesn’t mention it, but that fee is not covered by any medical insurance. In the case described in the article, the doctor reduced his work load from 2000 patients to 300 patients.

My sister, after reading the article, promptly asked what happens to all of those patients whom the “concierge doctor” does not any longer “have to see.” The answer to that is that they are now seeing a doctor who knows nothing about them and who is now even more frenetically busy than he was before because the “concierge doctor” is seeing 1700 fewer patients. I have no problem with the idea that people who have money benefit from the fact that they have money, in fact I’m all in favor of that, but when they do so to the detriment of those who don’t have money… Well, I do tend to have something of a problem with that.

The article does mention that “Some people say this new medical model creates a two-tier system in which people who don’t pay a retainer fee will wind up with second-rate care,” and then goes on to tell us that we don’t need to worry about that because it is a nonsensical argument.

There’s already a shortage of primary care physicians in the U.S. and skeptics fear that number will continue to dwindle as more doctors go into concierge medicine, creating even longer waits and shorter appointments for traditional patients. However, AAPP’s Blue maintains that there are plenty of doctors satisfied to practice medicine the same way they always have.

AAPP is the outfit that coordinates the concierge plans, and notice that in almost a single breath the writer references both a “shortage of primary care physicians” and a claim that there are “plenty of doctors,” and makes no effort to reconcile those two contradictory statements. In the case of the doctor who is the subject of the article, there are 1700 more patients dumped into a system which has one less doctor, so how can an increase of the concierge plan, which is by definition for primary care physicians, not be harmful to the majority of patients overall?

Arnstein argues that two-tier systems are nothing new in our society. “Some people can afford to fly first class to London, and some fly coach. But, in the end, they all get to London,” she said.

If the plane is full, and there is no question that our health care system is full, and you keep adding first class seats while removing coach seats, you crowd out those who cannot afford first class. Eventually some people do not get to London.

What the writer does not address is that this plan not only doesn’t work toward solving the rising cost of health care in this country, it seriously worsens that problem. This plan is a step in precisely the wrong direction, causing us to systematically pay more for our health care rather than less. It fundamentally allows one doctor to make more money for treating fewer people. What in the hell is wrong with this country that we admire that kind of model? And the issue is worse than a single doctor/patient one.

If 400 patients pay a $1,800 retainer fee, that comes to $720,000 (MDVIP doctors, who must give a third to the group, keep $480,000). This is on top of reimbursements from insurers for standard office visits and exams.

The doctor gets $480,000 per year for doing nothing, bad enough in itself, but at least he/she had to go to college and earn a medical degree in order to be in a position to receive that money. The remaining $240,000 is what “the group” keeps, pure overhead, administrative burden. Useless money spent for no purpose whatsoever, that raises the cost of healthcare for additional paper shuffling and profit.

We already spend more than twice what any other developed nation spends in a health care system that is bloated with greed and designed more to slurp money from the public than it is to preserve health and wellness. This “concierge” model is just another step down that road. It is not a solution to the problem, it is symptomatic of the problem.

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