Concierge medicine a sign of trouble in family practices
NOVEMBER 1, 2013 – Has it really come to the point where your independent family doctor needs an extra retainer to survive?
Much as we hate to admit it, that may indeed be the case.
Medical practices, as everyone knows, are not created equal. In the U.S., specialists with extra years of training who heal injuries and cure diseases with surgical prowess and high-tech equipment command higher pay.
General practitioners, who promote wellness through prevention and getting to know patients as whole persons, earn less — much less. Insurors pay per procedure, not healthy outcomes, a system that penalizes family doctors who spend more time per visit when their patients need it.
But that was a tradeoff many were willing to make until the extra costs of computerized record-keeping, processing insurance claims and malpractice insurance ate up even the little profit they were making.
As we have reported, some family doctors have switched from solo to group practices or clinics. They let NACA or FMC or North Country Healthcare manage the insurance claims and pay the overhead while they concentrate on seeing patients.
But others have hit on a way to stay independent and even provide better care, albeit for a reduced number of patients and at a higher cost for each one of them. It is called “concierge” or personalized medicine, and Dr. Neal Mogk is one of the first GPs in Flagstaff to openly embrace it.
As Mogk told the Daily Sun, for an extra $600 a year, he will provide longer office visits, guarantee same-day visits for urgent problems, take patient calls 24/7 and even make house calls. The annual retainer allows him to reduce his patient roster to spend more time with each one while still paying his fixed overhead costs.
For patients who can afford the extra $50 a month on top of whatever insurance premiums, co-pays and deductibles they are paying, a concierge family practitioner might seem like just what the doctor has ordered. Even if you only need to see him twice a year, if both those occasions are emergencies that get you to the head of his appointment line and then off to see a specialist that same day, the $600 might be worth it.
But then there are those patients who want to stay with Mogk but either didn’t get their names in on time or feel they can’t afford it. He will make another non-concierge doctor in his office available to them — but it won’t be same, depending on how long they have been their doctor.
As for the community at large, it should be noted that if every family doctor imitated Mogk and cut their patient rosters, there might be a shortage of doctors for awhile. The group practices in town or those affiliated with the hospital and clinics would likely pick up the slack in time or more GPs might open practices.
Concierge medicine, however, is not that far off from the health maintenance organization model pioneered by the Kaiser clinics in California several decades ago. A set monthly fee covered most visits and procedures no matter how cheap or inexpensive they were. Patients weren’t guaranteed they would see the same doctor at each visit, but they weren’t limited in their visits and access to a range of wellness programs, either.
The extra fee that Mogk is charging is also divorced from the fee-per-procedure model and tied to a standard of care that Mogk believes will yield better outcomes for his patients. It’s just too bad that the system of health insurance in this country won’t pay based on that higher standard.
Family doctors who can survive only by scaling back their practices and charging more is not a formula for universally better care in a country where more and needier patients deserve just that kind of health care, not fewer.