Comments on: Criticisms of retainer medicine

By: Dr Andy

Dr Andy — Wed, 23 Apr 2008 03:47:35 +0000

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

By: Zola Ivy

Zola Ivy — Tue, 04 Mar 2008 11:56:49 +0000

I try to maximize what the patient is receiving for the concierge fee to include consultation with a dietitian, personal fitness consultation ans massage therapy. I enjoy the time that I am now able to spend with each patient personally overseeing their healthcare. Instead of delegating some of the responsibilities to the office staff for such things as
ordering of diagnositic test and scheduling consultations with specialist, I am able to do these personally.I agree with the comment that patients in this type of practice receive a better continuity of care just for the simple fact
of the physician having more time. I know that others in concierge medicine are studying this fact and preliminary data would
suggest that endpoints are improved such as a decrease in hospitalizations. I will be awaiting further data on this topic.

By: medicine » Blog Archive » Comment on Criticisms of retainer medicine by Medical humanities

Fri, 28 Dec 2007 07:53:01 +0000

[...] Read the rest of this great post here [...]

By: over my med body! » Retainer Medicine Rally With Dr. Centor

over my med body! » Retainer Medicine Rally With Dr. Centor — Thu, 27 Dec 2007 22:04:06 +0000

[...] having a great debate on the subject of retainer/concierge/whatever medicine, starting with piece by Dr. Centor, an internist I high respect. I fired back this piece and now Dr. Centor has responded. I must give [...]

By: Chris Ewin, MD, FAAFP

Chris Ewin, MD, FAAFP — Thu, 27 Dec 2007 21:30:28 +0000

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

By: Medical humanities

Medical humanities — Thu, 27 Dec 2007 21:12:14 +0000

As one who is writing a dissertation on concierge medicine, I find the up-tight responses quite interesting. Potential patients, however, have quite different responses when they ask me “What is concierge medicine?” When it’s explained to them, their eyes light up, and they say “You mean, like it used to be?” Their next response is: “I’d pay for that!” More to the point, retainer medicine is not new. Evidence is found of what is essentially retainer medicine all the way back to the Talmud, and relatively more recently in 13th Century Spain. Nothing is new under the sun. We don’t blink when lawyers or accountants use a retainer; why the negative response for physicians?

By: Nurse K

Nurse K — Wed, 26 Dec 2007 23:45:46 +0000

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.

By: anonymous

anonymous — Wed, 26 Dec 2007 23:21:28 +0000

+1 dr. gaulte

By: James Gaulte

James Gaulte — Wed, 26 Dec 2007 21:33:05 +0000

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.

By: Chris Ewin, MD, FAAFP

Chris Ewin, MD, FAAFP — Wed, 26 Dec 2007 21:06:38 +0000

In terms of Ethics, please note our Ethical Principles on the SIMPD website. Chris Ewin, MD

____________________________________________________________

Society for Innovative Medical Practice Design
Ethical Principles

Preamble

Medical practice presents the potential for situations in which the interests of the physician and the patient do not coincide. Ethical principles have always served to guide physician behavior and to protect patients interest and wellbeing. Every practice model is liable to present ethical challenges, and all physicians, regardless of the way that they are compensated, are bound to follow the same professional ethical principles. Novel medical practice models may present previously unconsidered ethical challenges. These challenges call for new guidelines to clarify ethical physician behavior and to protect patients. Novel medical practice models may also discover new ways to align patient and physician interest and to deliver care with fewer potential ethical pitfalls than existing models.

In its mission to support and promote innovation in medical practices for the betterment of patient care, the Society for Innovative Medical Practice Design affirms the following ethical principles for all physicians.

Statement of Ethical Principles

A physician shall act in accordance with the AMA Principles of Medical Ethics.
A physician in a retainer practice shall act in accordance with the AMA Ethical Policy for Retainer Practices.
A physician shall be keenly aware of potential conflicts of interest which result from receiving third party remuneration, whether from insurers, pharmaceutical companies, from the state or federal government or from research grants. Physicians should make these potential conflicts known to their patients whenever they may affect the ability of the physician to act purely in the patient s best interest.
A physician shall strive to work in practices that align physician financial incentives with patient interest.
Providing uncompensated care, except in an emergency, is not ethically mandatory. However, uncompensated care of the indigent is profoundly praiseworthy. We invite every physician to volunteer to provide such care in an amount that is in accordance with that physician’s highest calling to perform charitable acts.