Old-Fashioned Medicine Back Again
Reviewed By Michael Smith
He wasn't scheduled to have surgery for another few days, but the back pain was too much for Howard Levine to bear. So he called his doctor, and within hours, he checked into the hospital and underwent the necessary operation.
Levine's case wasn't life threatening, yet he received first-class treatment because he subscribes to a service called MDVIP, which promises a deluxe, old-fashioned type of medical care for $125 a month. The fee reportedly goes toward expenses not covered by regular health insurance. It guarantees 24-hour access to doctors in person and by phone, email, or fax. It also offers personalized help with prescriptions and referrals, travel medical services, and a private reception area.
MDVIP is one of a number of so-called "boutique medicine" or "concierge" practices that have cropped up nationwide in the last few years. Several other such companies, such as one known as MD2, have set up shop in Seattle and in Arizona. Annual retainer fees for each practice vary from as little as $900 to as much as $20,000.
"If I were to call up my doctor now and tell him I wasn't feeling well, I bet you I'd see him within an hour," says Levine, who beams at the idea of no longer waiting to make an appointment. "Here, I just get that personalized service that I love."
The 69-year-old restaurant owner is far from being the only one attracted to such pampering. Boca Raton-based MDVIP has enlisted 2,000 paid members since it opened up in March of 2001, and the company, with offices in Florida, New York, Massachusetts, Maryland, and Southern California, is looking to expand its network of doctors.
It's About Choice
"We think that this is about choice," says Andrew Ripps, the CEO of MDVIP. "We are working to create a niche solution for people who value wellness and prevention."
The solution appears to be just what many doctors have been aching for. Beleaguered with paperwork, with rising healthcare costs that are disregarded by HMOs, and with increasing demands to see more patients, many doctors are looking for a way out.
"There is a whole generation of young doctors who are frustrated, and many older doctors want to go into early retirement. Most didn't go to medical school for that," says William Hall, MD, president of the American College of Physicians and the American Society of Internal Medicine.
He says it's understandable why many doctors would want to go into concierge care and practice old-fashioned medicine, yet he says he fears that if more and more doctors decide to move in this direction, only those who could not afford boutique care would be left, and insurance premiums would go up.
"It would create a certain amount of chaos for our country," says Hall.
Many in healthcare share Hall's concerns. In a December 2001 meeting of the American Medical Association, doctors voiced their opinions.
"Many felt that many aspects of [concierge care] were the prerogative of the physician -- that an organization could structure a practice to fit what the physician's personal needs were or the needs of the practice," says Frank Riddick Jr., MD, chairman of the American Medical Association's Council on Ethical and Judicial Affairs. "But some people were saying that this would restrict access to care if the physicians would only take care of people who would pony up the annual retainer fee."
The American Medical Association does not currently have a policy on boutique medicine, but two groups in the organization are conducting studies on the matter and expect to make their reports by midyear.
Another agency, the Centers for Medicare and Medicaid Services (CMS), is also reviewing the issue. The agency is looking at whether concierge care clinics double bill for services already covered by Medicare and at whether those companies violate laws limiting how much doctors can charge Medicare patients.
A source at the CMS says the group hopes to provide guidance on the matter soon but admits there are some complicated gray areas. One includes whether noncovered items such as nice waiting rooms or prescription services are really additional benefits or part of the doctor's overhead that Medicare already takes into account.
While the experts try to figure it out, patients like Levine say the perks offered by boutique clinics are well worth the expense.
But look carefully at the amenities that you are getting, advises one doctor.
Better Health or Nicer Lobby?
"As a patient, I would care a great deal more about whether or not my provider uses systems that will make my health safer ... than I would that they have a nicely decorated lobby," says Gregg Meyer, MD, director for the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality (AHRQ).
In addition, the jury is still out on whether the clinic environment has an impact on the experience of health, says Meyer. Although there is some literature that suggests a positive environment helps patients, experts don't know yet the scope of the impact. The AHRQ has funded a study on the matter, and results from the trial are expected in the next two to three years.
In the meantime, the presence of boutique clinics is proof enough to convince Karen Davis, president of the Commonwealth Fund, that it's time to redesign the healthcare system. "It reflects the widespread frustration of patients and doctors."
The real threats to public health, says Davis, have to do with the nearly 40 million people that have inadequate or no insurance, and with the number of doctors who are increasingly opting to pull out of managed care.
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