Comments on: More on retainer medicine

By: The Covert Rationing Blog » Blog Archive » Patients, Doctors, and Remote Third Parties

Thu, 27 Dec 2007 15:32:30 +0000

[...] their behavior, and re-establishing their practices (and revitalizing their profession) with a new commitment to the doctor-patient relationship. If not, then perhaps some new profession will establish itself (call it “personal healthcare [...]

By: Steve Lucas

Steve Lucas — Tue, 25 Dec 2007 13:38:53 +0000

A couple of more nuts and bolt issues. My understanding is MDVIP uses a 500 patient panel in its business model charging $1,000-1,200 per year. How does this doctor’s fees compare?

Another issue is the “fired” patient. This easily could have been for just cause, but I have often found a disconnect between what a doctor says about patient care, and what happens in the exam room. One common experience is that the doctor’s want total control of a person’s life: “You will do as I say, or find another doctor!”

I do believe that fee for service is the wave of the future, either a retainer service or cash based practice. We have to remove the above mentioned “jam’em in” mentality.

Steve Lucas

By: pcb

pcb — Tue, 25 Dec 2007 00:57:14 +0000

Agree with most of this. Any practicing outpatient physician in a typical insurance payment based practice would agree with this. It is interesting the observation that as much time is spent managing care out of the office as is seeing patients face to face. It’s a clear indication that adequately managing a patient’s care takes time outside of office visits and that aspect of care is severely lacking in our “jam ‘em into the schedule” way of practicing. We pay for episodic units of care and don’t pay for follow up outside of the office visit, so we get episodic units of care with no follow up outside of the office visit. Imagine that.

Be careful on comparing rates of admission or overall outcomes, however. These are carefully selected, motivated patients paying out of pocket for their care. Comparing them to a “normal” group of patients and saying outcomes are better is a little decieving. Retainer patients, grouped together, would probably have better outcomes than the norm no matter what system they were in due to their overall interest in taking charge of their health and actively seeking a rational system.

Anyway, great post overall.