Uncommon Practice
Posted by: Scott W. Graves | 07/31/2007 10:10 PM
By Jennifer Bohler
You feel sick. You call your doctor (hopefully you have become sick during normal business hours) to make an appointment for sometime late next week when your condition is going to be either a lot better or a lot worse. Appointment day arrives and you take a half day off of work. After two hours in the waiting room, a nurse escorts you to a small examination room--where you wait for another 15 minutes for the doctor to arrive. In a flash, the examination is over and you are ushered back to the receptionists' desks where a woman, speaking some variation of English/Insurance-ese generates a ream of paperwork printed in triplicate. You figure out who owes what to whom, given a handful of goldenrod copies for your records, and shown the door.
There was no time for pleasantries as they may have interfered with the doctor's ability to examine the other 15 to 30 patients he needs to see just to stay in business.
Patients across the country can relate to the frustration of long waits and the absence of a real connection with their own doctors. It turns out many health-care providers feel the same.
This flawed system is in part the result of capitation, a system of reimbursement where health-care providers are paid for their services per client served per time period. For example, after an insurance company is billed for your office visit, they reimburse the doctor a fixed amount determined by a payment formula. This fixed amount has been on the decline since 1994 when health care was deregulated. The American Medical Association reports that according to the Congressional Budget Office, Medicare physician payment rates are expected to decrease by 10% in 2008. According to the 2006 Medicare Trustees, these payments will decrease 40% by 2015. While payments to doctors decline, business costs like malpractice premiums continue to rise.
AT YOUR SERVICE
Enter what some call the "concierge doctor," a term coined by the media to describe a new category of health care for the 21st century. Concierge practices have been popping up all over the U.S. in increasing numbers over the last decade, including Orange County.
Although there are a few models, most concierge doctors, who prefer to be called Retainer-based or Patient-driven doctors, charge an annual retainer not covered by insurance. Annual fees ranging from $1,500 to $20,000 depending on convenience, access, and in some cases, pampering. The retainer reduces a doctor's dependence on insurance reimbursements, gives the doctor greater freedom to see fewer patients, and offers the patient more personalized service.
Under the typical model, the patient of a concierge doctor receives access to their doctor at all times--day or night, weekday or weekend through cell phone and email. Patients receive same-day or next-day appointments that are on-time (enter Hallelujah chorus here). Those who are too ill or physically unable to visit an office can enjoy the benefit of house calls and anyone in need of specialty care, i.e. hospital visits, or specialist visits, have the comfort of a concierge doctor's coordination and accompaniment.
Many say it's like having a doctor in the family. Most importantly, this type of doctor has more time to spend with an individual to address more specific health issues, like preventative medicine.
According to the American Society of Concierge Physicians, there are three recognized methods of concierge service.
METHOD ONE
The patient pays a higher fee for the combination of services rendered and the convenience of personalized service. Insurance is not billed. This method has come under scrutiny as it has been accused of acting as an insurance company. This can probably be classified as the "retainer-based method," which can cost anywhere from $1,500 to $20,000 per person annually, depending on your choice of care.
METHOD TWO
Called the "fee-for-access" method, it clearly separates the convenience charge from the service charge by billing a patient's insurance company for medical services and charging the patient directly for convenience and access privileges, usually around $65 - $100 a month.
METHOD THREE
Called "fee-for-service," a patient pays a doctor directly per visit for services rendered. Patients can decide whether or not they wish to submit their bill to their insurance company to be reimbursed and in many cases, the doctor offers to submit the bill on a patient's behalf as a courtesy. Patients are charged the same amount an insurance company would be billed and not charged an additional convenience or access fee.
Dr. Lisa Hirsch, an Orange County health-care provider, reclaimed the reigns of her practice from insurance companies ten years ago.
"I couldn't afford to keep a practice open where I thought my patients would receive the optimum in care," says Dr. Lisa Hirsch of Newport Women's Health & Wellness. An accomplished Gynecologist, Dr. Hirsch was fed up with insurance company bureaucracy. Reimbursement went down by 75% in 1994, she says, and has continued to decrease to critically low levels.
"Some plans now pay 10% of what they paid in 1994 so we're talking about a huge decline in reimbursement so it's forcing doctors to do very high volume or just stop practicing medicine."
Hirsch reports that she and two nurse practitioners would see about 100 patients a day and while they maintained adequate patient care, Hirsch recognized early signs of deterioration and decided to do something about it--she dropped her insurance contracts and became a "fee-for-service" medical practice. The Fee-For-Service method simply charges a patient for medical services rendered instead of an insurance company, much like health care of the past. This method allowed Hirsch to decrease her payroll from thirteen to three, which she says was her biggest expense, and to provide more personalized care to her patients.
"It allows me to be very thorough and have the appropriate amount of follow-up with my patients. It allows me to provide more comprehensive health care."
As a result, patients meet with Dr. Hirsch in person (as opposed to an assistant or nurse practitioner). With more time for each patient, she was able to expand her practice to include nutrition; an important aspect of overall health care and preventative medicine.
"It takes the pressure off of me as far as the amount of time I can spend with a patient. I don't walk into a room knowing I have 10 minutes, I walk in knowing I have the time to provide the care she needs."
CRITICS
Critics call these alternative methods elitist, claiming these practices are widening the gap between those who can afford highly personalized health care options and those who cannot. They feel concierge doctors are approaching health care as a commodity rather than a social responsibility. John Blanchard, President of the American Society of Concierge Physicians disagrees and states on the ASCP website, "Part of the AMA (American Medical Association) guidelines is that this shouldn't represent better quality health care, and I don't think it does. I think it represents better service." Some say this new crop of doctors is a symptom of our deteriorating health-care system rather than a solution.
The controversy may continue on low heat. With only 146 doctors in the country choosing to practice concierge medicine, it is too early to see a tip in the scales. And while it may not solve the many problems the U.S. health-care system poses, concierge medicine certainly offers benefits to those doctors who have embraced it and those patients who can afford it.
Jennifer Bohler is a USC graduate and a freelance writer specializing in issues related to lifestyle, family, and community in the LA and Orange County areas. For additional information, please contact her at jenbohler@yahoo.com
SIDEBAR
Related facts from the American Medical Association:
You feel sick. You call your doctor (hopefully you have become sick during normal business hours) to make an appointment for sometime late next week when your condition is going to be either a lot better or a lot worse. Appointment day arrives and you take a half day off of work. After two hours in the waiting room, a nurse escorts you to a small examination room--where you wait for another 15 minutes for the doctor to arrive. In a flash, the examination is over and you are ushered back to the receptionists' desks where a woman, speaking some variation of English/Insurance-ese generates a ream of paperwork printed in triplicate. You figure out who owes what to whom, given a handful of goldenrod copies for your records, and shown the door.
There was no time for pleasantries as they may have interfered with the doctor's ability to examine the other 15 to 30 patients he needs to see just to stay in business.
Patients across the country can relate to the frustration of long waits and the absence of a real connection with their own doctors. It turns out many health-care providers feel the same.
This flawed system is in part the result of capitation, a system of reimbursement where health-care providers are paid for their services per client served per time period. For example, after an insurance company is billed for your office visit, they reimburse the doctor a fixed amount determined by a payment formula. This fixed amount has been on the decline since 1994 when health care was deregulated. The American Medical Association reports that according to the Congressional Budget Office, Medicare physician payment rates are expected to decrease by 10% in 2008. According to the 2006 Medicare Trustees, these payments will decrease 40% by 2015. While payments to doctors decline, business costs like malpractice premiums continue to rise.
AT YOUR SERVICE
Enter what some call the "concierge doctor," a term coined by the media to describe a new category of health care for the 21st century. Concierge practices have been popping up all over the U.S. in increasing numbers over the last decade, including Orange County.
Although there are a few models, most concierge doctors, who prefer to be called Retainer-based or Patient-driven doctors, charge an annual retainer not covered by insurance. Annual fees ranging from $1,500 to $20,000 depending on convenience, access, and in some cases, pampering. The retainer reduces a doctor's dependence on insurance reimbursements, gives the doctor greater freedom to see fewer patients, and offers the patient more personalized service.
Under the typical model, the patient of a concierge doctor receives access to their doctor at all times--day or night, weekday or weekend through cell phone and email. Patients receive same-day or next-day appointments that are on-time (enter Hallelujah chorus here). Those who are too ill or physically unable to visit an office can enjoy the benefit of house calls and anyone in need of specialty care, i.e. hospital visits, or specialist visits, have the comfort of a concierge doctor's coordination and accompaniment.
Many say it's like having a doctor in the family. Most importantly, this type of doctor has more time to spend with an individual to address more specific health issues, like preventative medicine.
According to the American Society of Concierge Physicians, there are three recognized methods of concierge service.
METHOD ONE
The patient pays a higher fee for the combination of services rendered and the convenience of personalized service. Insurance is not billed. This method has come under scrutiny as it has been accused of acting as an insurance company. This can probably be classified as the "retainer-based method," which can cost anywhere from $1,500 to $20,000 per person annually, depending on your choice of care.
METHOD TWO
Called the "fee-for-access" method, it clearly separates the convenience charge from the service charge by billing a patient's insurance company for medical services and charging the patient directly for convenience and access privileges, usually around $65 - $100 a month.
METHOD THREE
Called "fee-for-service," a patient pays a doctor directly per visit for services rendered. Patients can decide whether or not they wish to submit their bill to their insurance company to be reimbursed and in many cases, the doctor offers to submit the bill on a patient's behalf as a courtesy. Patients are charged the same amount an insurance company would be billed and not charged an additional convenience or access fee.
Dr. Lisa Hirsch, an Orange County health-care provider, reclaimed the reigns of her practice from insurance companies ten years ago.
"I couldn't afford to keep a practice open where I thought my patients would receive the optimum in care," says Dr. Lisa Hirsch of Newport Women's Health & Wellness. An accomplished Gynecologist, Dr. Hirsch was fed up with insurance company bureaucracy. Reimbursement went down by 75% in 1994, she says, and has continued to decrease to critically low levels.
"Some plans now pay 10% of what they paid in 1994 so we're talking about a huge decline in reimbursement so it's forcing doctors to do very high volume or just stop practicing medicine."
Hirsch reports that she and two nurse practitioners would see about 100 patients a day and while they maintained adequate patient care, Hirsch recognized early signs of deterioration and decided to do something about it--she dropped her insurance contracts and became a "fee-for-service" medical practice. The Fee-For-Service method simply charges a patient for medical services rendered instead of an insurance company, much like health care of the past. This method allowed Hirsch to decrease her payroll from thirteen to three, which she says was her biggest expense, and to provide more personalized care to her patients.
"It allows me to be very thorough and have the appropriate amount of follow-up with my patients. It allows me to provide more comprehensive health care."
As a result, patients meet with Dr. Hirsch in person (as opposed to an assistant or nurse practitioner). With more time for each patient, she was able to expand her practice to include nutrition; an important aspect of overall health care and preventative medicine.
"It takes the pressure off of me as far as the amount of time I can spend with a patient. I don't walk into a room knowing I have 10 minutes, I walk in knowing I have the time to provide the care she needs."
CRITICS
Critics call these alternative methods elitist, claiming these practices are widening the gap between those who can afford highly personalized health care options and those who cannot. They feel concierge doctors are approaching health care as a commodity rather than a social responsibility. John Blanchard, President of the American Society of Concierge Physicians disagrees and states on the ASCP website, "Part of the AMA (American Medical Association) guidelines is that this shouldn't represent better quality health care, and I don't think it does. I think it represents better service." Some say this new crop of doctors is a symptom of our deteriorating health-care system rather than a solution.
The controversy may continue on low heat. With only 146 doctors in the country choosing to practice concierge medicine, it is too early to see a tip in the scales. And while it may not solve the many problems the U.S. health-care system poses, concierge medicine certainly offers benefits to those doctors who have embraced it and those patients who can afford it.
Jennifer Bohler is a USC graduate and a freelance writer specializing in issues related to lifestyle, family, and community in the LA and Orange County areas. For additional information, please contact her at jenbohler@yahoo.com
Related facts from the American Medical Association:
- Congress passed legislation to freeze the expected 5% cut in Medicare physician payments scheduled for 2007.
- 2008's predicted Medicare payment cut: 10%.
- Between 2007 and 2015, Medicare payments are expected to be cut about 40%.
- More than two-thirds of physicians say they will stop accepting new Medicare patients if cuts continue for nine years.
- Physician payments are based on a formula that is tied to the ups and downs of the economy--the GDP, not to the predicted costs of providing care every year.
- Sixteen of the nation's largest health-care organizations have agreed on a proposal that would significantly expand health coverage for America's uninsured.
- Nearly 46 million Americans do not have health insurance.
