tryo brennan of aetna?

“Could we not just as easily criticize all the subspecialists, dermatologists, radiologists, etc. for not entering primary care?”

I do. I believe the high cost of care and the poor quality of American medicine(I can offer citiations if you need them) can be directly laid on the fee for service structure and the proliferation of Medicare driven highly compensated procedures.
So, as you are arguing in trying to maximize the benefit of self interest, that is, patients motivated by their pocketbook will be more likely to have healthy behaviors, so the American Medical system has had the migration of physicians to high paying specialties that reflects their own self interest…..
Of course market forces are at work. They always will be. But medicare has driven the rewards by it’s Committee developed prices, and concierge care is a weak atttempt to use these forces for the good of the primary care doctor, who doesn’t have a competitive procedure.
see: “Demand the supply”,
http://www.poemd.blogspot.com

Sorry. I just have a different vision of what health care should be. You might want to read “The Citadel” by Cronin. Early 20th century medicine in England. Now THAT was concierge care…..

As immediate past-president of SIMPD, I felt important to make some comments about Troy Brennan’s comments (which are welcomed)..
Over the past 4-5 years, the SIMPD movement has changed. (We were the American Society of “Concierge” Physicians. The term Concierge was termed originally because some of the earlier models were started in areas oh higher net wealth…However, some of have very fair pricing. (eg…my new patient this week with IDDM.HgA1c 13/HTN/Cholesterol-350 pays ~$225/mo cash for his cigarettes and I charge him ~$117/mo…) There are many Emerging Practice Styles involved in SIMPD…The residents and students involved are excited that Phyicians are actually taking back medicine instead of complaing about it…See below..
Also, you may be interested in a 5 minute interview omn our website..www.simpd.org…Our Next Annual conference is May 4-6, 2008 at the Venetion in Las Vegas…The “how to” conference May 4 is really helpful for those interested in doing this and those that want to fine tune their practices…We share our knowledge…
The government, insurers, employers and Congress have NO CLUE how to fix your practices….
I would be very interested to see how many patients Troy is seeing a week in his primary care practice and what kind of pricing system he has…how many staff…overhead…etc…Please respond..
Chris Ewin, MD

________________________________________________

EMERGING PRACTICE STYLES:

Direct Practice Models and SIMPD

Faced with continued declines in reimbursement, rising practice costs, and growing pressures to see an ever-larger number of patients just to break even, more and more primary care physicians are starting to realize that they have been working for the wrong employer for too long. Physicians should be working for patients, not the insurance industry or the government. And patients should be determining where, when, and how they get their care…not the government or insurers. Third parties are the problem. They are data collectors and they want physicians to do the work for them much like the pharmacists do for the pharmacy benefits organizations. It’s inefficient and the patient-physician relationship suffers.

The Society for Innovative Medical Practice Design is a physician-led 501 C (6) trade organization of healthcare providers who advocate a direct financial relationship with their patients in order to restore the integrity of the patient-physician relationship. These “direct practice” models include:

• Fee for service model (traditional) – patients pay a set fee directly to physicians for visits or other services.
• Fee for care model (retainer) – patients pay a fee, often based on age and paid monthly, quarterly or yearly, for unlimited access to a primary care physician. Patients get access to the physician’s cell phone, home phone, free e-mail, and same day service. Because physicians in retainer or concierge models treat far fewer patients than those in a traditional practice, they are able to spend much more time with patients. Appointments are obtained faster as well, and patients spend less time in the waiting room.
• Fee for non-covered service model (hybrid) – a hybrid model wherein physicians charge access fees for services that Medicare and insurers won’t pay. They usually bill Medicare and insurance companies for patient visits.

Our primary care model has been broken for more than 40 years, and it is only going to get worse as fewer and fewer medical students enter primary care disciplines. Direct practice models offer a solution for improving access to high-quality primary care while reducing costs. Why? Having health insurance does not provide anyone with access to quality healthcare. Patients need a medical home. They need someone to call ‘their doctor,’ someone who is well-trained, trusted, and board-certified and can guide them through the system…a project manager in business speak. Traditionally that has been a primary care physician – a doctor trained in internal medicine, family practice, or with the aging of the baby boomers, a geriatrician.

Direct practice models can attract more young physicians to primary care practice because they demonstrate that primary care can still be practiced in a way that is professionally and financially rewarding. Such models get physicians out of the business of “hamster medicine” and away from the prospect of spending countless hours on paper work and data entry. Instead, they can spend their days building close relationships with their patients.

Overhead is reduced by as much as 20 to 50 percent when a practice is not dealing with insurers and multiple billing systems. Mountains of paperwork and countless phone calls regarding coverage and reimbursement issues are eliminated, so the practice can function with less office staff and smaller offices.

The Role for Legislators and Insurers

Physicians need to take the lead in establishing direct practice models, and hundreds have done so already. There are roles for legislators to stimulate acceptance and growth of direct practices by physicians and patients. Congress should pass laws that allow annual pre-paid physician fees to be included as qualified medical expenses on health savings accounts. Such incentives could simplify the way healthcare is billed and paid for and ultimately reduce costs. Patients would have one bill on pre-tax dollars that covers unlimited access to primary care without the hassles of third parties.

On the insurance side of primary care, the financial efficiency of direct practices is optimized by eliminating the middle man and the unnecessary burden of massive coding and micro-billing. Direct practice physicians should avoid contractual relationships with insurers that reestablish their power to control and suffocate primary care. There is no good economic reason for insurers to be involved in financing primary care except to maintain their control of every medical transaction. In all respects, it is money wasted on both the insurance and physician sides of the equation. It almost doubles the cost of primary care with no value added.

Healthcare should be covered the same way your house is. It is one of your biggest assets. You buy catastrophic insurance for the big events, like a fire, but you don’t use it to mow your lawn. You pay out-of-pocket for routine maintenance. The same is true with automobiles. You don’t use insurance to buy gas. Applying the same ideas to healthcare, patients would buy catastrophic insurance to cover the costs of specialists and hospitalizations, but would pay out-of-pocket for the services of a board-certified family physician, internist, or geriatrician to take care of 85 percent of their needs and keep them OUT of the hospital.”

Great Care for Dollars a Day

Easy access to quality care is affordable, but someone has to pay. And it can be cheaper than cigarettes. People will pay $5 a day for a pack of cigarettes, which amounts to more than $1,800 per year. It is up to the consumer to determine if that money is better spent on securing 24/7 access to a trusted, board-certified physician.
But it is up to physicians to make these models available to their patients. The time to act is now to transform primary care in this country. Physicians need to act decisively to take back the high ground and find a way to offer patients excellent care at a price which they can afford. Otherwise, the future will be guided by insurance companies, government and employers, and will likely produce medical care that is even more dysfunctional as the number of medical students choosing a career in primary care declines. What a tragedy.
Chris Ewin, MD, FAAFP is from Fort Worth, Texas and started One To One MD in 2003. He is immediate past-president of SIMPD and can be reached at cewin@121md.net.

For more information about direct practices, visit http://www.simpd.org. or call 877-448-6009.

Chris Ewin, MD, FAAFP
Immediate Past-President, SIMPD
http://www.121md.net
http://www.simpd.org
817-423-5121 off

Is Dr. Brennan lecturing physicians on proper medical practice morality and professionalism in his role as Chief Medical Officer of Aetna? It would seem to me that his fiduciary duty to his employer,a very large medical insurer,would not allow him to do anything but criticize arrangements between physicians and patients that are completely divorced from and not under the control of insurance.Acting in the capacity as Aetna CMO his comments are understandable.I have a problem with his conflating medical professionalism with what is in the best interest of the insurance business.

Such practices are rarely available to lower-income patients, and if the approach were widely adopted, the primary care workforce would become grossly insufficient to care for the entire population.

If something is not widely available to lower income people, that does not mean that something is evidence of racism. I doubt that a black executive or upper-income person would be denied as a patient as long as he was willing to pay. Are the executives of Mercedes Benz or yacht manufacturers racists too or are they just selling products tailored to a certain demographic? Maybe we should all drive Fords and only use canoes. If someone wants to pay for this medical service, they should be able to. If there are not enough people willing to pay, this style of medicine will cease to exist along with yachts and expensive cars. It’s called….capitalism.

To me, automatically equating lower income and sickness with black people is more racist than anything else. Each black person is an individual, ya know.

Nurse K..Thx for your insight..Fee For Care models are not necessarily for the “rich”. It’s up to the marketplace for patients (consumers) to value what is best for themselves. Many of my patients have no jobs, no income, etc…But they choose to spend $225/month for their cigarettes…It’s funny the insentive for them to help them stop when price is only $117/month..Health care does not have to be expensive and tit’s the consumer, not the insurers or the government who should determine the value and the price…

By the way, we have gotten away from the term “concierge practice” although some use the name in different markets..As noted above…se use the term “direct practices” b/c we have a direct finacial relationship with our patients…Chris

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I left a busy group practice in Fort Myers, Florida in 2005 to start my house-call based concierge practice. Originally I tried to deal with insurances but since none pay for house-calls, and Medicare only reimburses minimally, I couldn’t make it viable. In our area it’s not uncommon for me to drive 30-45min between visits and I typically spend 45-60min with a patient. Hence I was drawn to the concierge business model. I am still the ONLY concierge physician in South-West Florida exclusively making house-calls in Lee and Collier counties.
No mistake, my services are a luxury item and convenience for most of my patients. I charge $2000-$6000 a year per person, depending on age, size of family, and location.
I know it’s not the answer to our health care crisis, but I certainly love my job again! Besides I get to see my kids more.
Two other key points for the lay-person to understand. Just because I charge above what insurance pays, doesn’t make me rich. I actually made less than our city pays bus drivers for the past 2 years, although admittedly the potential is significant. Also, even though most of my patients are the “rich and famous” of our area, doesn’t absolve me or any concierge physician of our responsibility to the community. In fact this is a responsibility of each of my patients as well.
I continue to be an active office in the US Army Reserve, chair the Health Advisory Committee of the Lee County School District, volunteer as a Guardian ad Litem serving abused and neglected kids, teach Head Start program moms about child care, etc…
No, concierge medicine isn’t for everyone, but it certainly has worked for me and my patients.

Andrew Oakes-Lottridge, MD
Personalized Health Care, Inc.
(239)694-6246
http://www.DrAndy.us