Archived Headlines

Three Simple Ways Medicare Can Save Money
Price fixing can be costly. The government should embrace alternatives like concierge physician arrangements.
Medicare should encourage physicians to repackage and reprice their services in ways that are good for the doctor, good for the patient, and good for Medicare. For example, Medicare should encourage concierge doctor arrangements.


On Innovation, Medicare Follows Rather Than Leads – But, Is Medicare More Efficient Than
Private Insurance?
By John Goodman and Thomas Savings | Source: Health Affiars Blog

What about the argument that Medicare is needed in order to spur doctors to practice medicine efficiently? As in the case of Medicare advantage plans, all too often, Medicare is a follower, not a leader, on the innovation front. It is more likely to slow things down than to speed things up. What spurs private firms to be efficient is competition for consumers, not regulation.

In health care, many private sector entities are already doing what the administration says needs to be done:
    • Concierge doctors are consulting by email and telephone, keeping electronic medical records (EMRs), prescribing electronically and offering same day or next day appointments.
    • Walk-in clinics are posting (transparent) prices, using evidenced-based medicine by following computerized protocols, and keeping EMRs as well.
    • Cosmetic and Lasik surgeons routinely offer “bundled” prices, compete for patients based on price and quality and have lowered the real price of their services over the past decade


Patient-centered medical homes gaining ground
A survey finds widespread adoption and interest in the model, but establishing one poses risks.

By Emily Berry, amednews staff. Posted Aug. 10, 2011.

AUGUST 10, 2011 – Among 341 practices that responded to a survey by the Medical Group Management Assn. in March and April, 67.8% were either on their way to becoming a patient-centered medical home or interested in becoming one.

An additional 21.4% already were accredited or recognized by an insurer or national body as meeting the definition of a medical home.

The patient-centered medical home practice model has been successful because it is both independent and compatible with the Patient Protection and Affordable Care Act, including the accountable care organization model, said Dave Gans, MGMA’s vice president of innovation and research.

“Whether part of an ACO or part of a standard fee-for-service arrangement, a patient-centered medical home still functions well,” he said.


Friday, August 5, 2011 12:00 pm | Updated: 3:41 pm, Thu Aug 4, 201
With uncertain healthcare, concierge medicine a growing patient alternative
By Patrick McNamara | Inside Tucson Business

Dr. Steven Knope, a board-certified internist and sports medicine expert opened one of the first concierge practices in the country in Tucson, AZ in December 2000. Knope converted his internal medicine practice to a concierge practice at the request of patients. Clashes with bureaucratic health maintenance organizations also helped him decide to eschew the standard insurance-pay model.

“From my perspective, the most unethical practice is to work for insurance companies or HMOs that ration patient care for their own profits,” he said.

For him, a concierge practice not only frees him from the reigns of HMOs and insurance providers that seek to micromanage patient care, it allows him to spend more time with patients and demand more of them in terms of following medical recommendations.

And, Knope said, the future of concierge medicine looks bright.

“I would say that President Obama has been the best thing that ever happened to my practice,” Knope said.


TECHNOLOGY | AUGUST 4, 2011 | An important update about Google Health
Google Health will be discontinued as a service.

Posted by Aaron Brown, Senior Product Manager, Google Health and Bill Weihl, Green Energy Czar

The product Google Health will continue service through January 1, 2012. After this date, you will no longer be able to view, enter or edit data stored in Google Health. You will be able to download the data you stored in Google Health, in a number of useful formats, through January 1, 2013.

“We’ve observed that Google Health is not having the broad impact that we hoped it would. There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. That’s why we’ve made the difficult decision to discontinue the Google Health service.”


Concierge Medicine Clinics Breaking the Norms of Canada Health Act
Submitted by Nimisha Sachdev on Wed, 08/03/2011 – 06:35 | Source:

There are lots of benefits of “concierge medicine” clinics but the main problem to avail this is the cost, as it is quite expensive. But patients are not entertained unless they pay for the annual fee, and on this, a parent complained, the Ontario College of Physicians and Surgeons, to pull Dockrill’s license, where his son was getting medical services. Even these clinics are breaking the norms, set by the Canada Health Act, which has asked clinics not to charge hefty amount from patients.


CANADA | AUGUST 2, 2011 |
Should expensive ‘concierge medicine’ clinics be allowed in Canada?
August 2, 2011 3:59 PM | By Community Team | Source: CBCNews |

“Concierge medicine” clinics that charge monthly fees for 24-hour access to doctors and other health practitioners are raising questions about whether such services are allowed under the Canada Health Act.


Should “concierge medicine” clinics be allowed in Canada?
I’m Not Sure.


‘Concierge medicine’ a controversial trend in Canada
Source: CTV Staff | With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip

Tue. Aug. 2 2011 8:20 AM ET – For years now, some Canadian patients have been taking advantage of “concierge medicine” clinics, paying an annual fee for 24-hour access to a physician, nutritionists and other services. While these clinics gets patients out of crowded emergency rooms and away from over-burdened family doctors, they may also run afoul of the Canada Health Act, which says user fees or extra charges must not impede access to health services.



FOR IMMEDIATE RELEASE | Monday, Aug. 1, 2011
AAFP Statement:
Debt Ceiling Proposal Contains Pitfalls to Patients’ Access to Care

Roland Goertz, MD, MBA |
President, American Academy of Family Physicians

“The debt ceiling/deficit reduction plan being considered by Congress offers a potentially false promise to patients. It guarantees benefits but, by ignoring Medicare physician payment issues, it potentially denies the actual medical care those benefits cover.


States With Laws On Retainer Practice
By Doug Trapp, amednews staff. | Source: AMEDNews | Posted Aug. 1, 2011.

Some of the measures were in response to rulings by insurance commissioners that retainer care had to be regulated as insurance.

Allowed physicians to provide primary and preventive health care for a prepaid fee through a three-year pilot project that began in 2007. The pilot was extended for one year and expired on June 30, but the three existing retainer practices were allowed to continue.

Permitted retainer practices but specified that these practices cannot submit claims or discontinue care to patients based solely on health status. Practices can turn away patients if they reach capacity and can accept payment from some third parties, such as employers.

OREGON, 2011:
Exempted retainer practices from meeting insurance code regulations if the practices are certified by the state. Certification in part requires that the practice cannot have been licensed as an insurer, must provide only primary care, and must disclose to patients that the practice is not insurance.


Direct Primary Care Model: Cutting Out The Insurer
A provision in the health reform law might provide a big boost to a little-known type of primary care.
By Doug Trapp, amednews staff. | Source: AMEDNews | Posted Aug. 1, 2011.

NOTE: The following are excerpts from the Aug. 1st, 2011 Article. Click “READ FULL STORY” below or CLICK HERE to Read Entire AMEDNewsArticle

AUGUST 1, 2011 – A small but enthusiastic minority of primary care physicians believe they have found a practice model that can save money, improve patients’ long-term health and drastically reduce administrative hassles: direct primary care.

But the model could become more popular in a few years. Under a provision in the health system reform law, direct primary care practices will be able to participate in health insurance exchanges that will launch by 2014. Those marketplaces are expected to provide coverage choices for tens of millions of uninsured people, as well as for many others who get their coverage from other sources now.


The practices still face significant obstacles to expanding…

But employers increasingly are looking for other options to deal with rising health insurance premiums. Direct primary care practices hope to become one such attractive alternative.

“I’d be hard-pressed to call it a large evolving trend,” said Roland Goertz, MD, president of the American Academy of Family Physicians. Still, he knows of family physicians who have switched to direct primary care and report that they are happy with the decision.


Trouble severing the insurance cord

Some direct primary care practices continue to accept patients with traditional health insurance. These physicians concede that such a hybrid practice is not ideal, but their economic situations require compromise.


Hopes for more regulatory backing

Dr. Wood and Dr. Hendler said they ran afoul of their state insurance commissioners not long after starting their direct primary care practices. Regulators ruled that they were offering health insurance and would have to be regulated as such.

So physicians in these states lobbied their legislatures, which adopted measures allowing direct primary care practices with certain requirements, including that they explain the limits of the coverage. The laws and other actions by state regulators helped blaze a path for the practices. U.S. Sen. Maria Cantwell (D, Wash.) and other members of the Washington state delegation helped insert the direct primary care provision into the health system reform law.

Direct primary care champions such as Dr. Bliss, of Qliance, are eagerly awaiting HHS regulations defining exactly how the practices will merge with wraparound coverage and be sold in exchanges.

The first HHS proposed rule on the exchanges, released July 11, indicated the department would prefer a single payment for the direct primary care and the wraparound coverage.

Dr. Bliss said this fee should simply pass through health insurers to the direct primary care practices, otherwise health plans could have some control over the practices’ finances.


Not everyone is sold on the idea yet.

Direct primary care might not be viable on a large scale, said Robert Berenson, MD, a senior fellow at the Urban Institute and a member of the Medicare Payment Advisory Commission. For example, some people still will need to see specialists and go to hospitals, increasing the chances that there will be gaps in care unless the wraparound plans are very well integrated with the primary care.

Dr. Baskin acknowledged that the jury is still out on whether spending more on primary care actually saves money in the long run. Also unclear is how much the combination plans will cost consumers.

But Dr. Bliss said experience shows that the math might prove relatively simple. “You don’t have to load down all the doctors with huge panels in order to make this work economically.”


S.1098 BILL TRACKER: Family and Retirement Health Investment Act of 2011
A bill to amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. According to GovTrack.US this bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and review them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: August 2, 2011 11:18am]

Last Action: May 26, 2011 – This bill was read twice and referred to the Committee on Finance.


What To Consider Before Making The Leap
The American Academy of Family Physicians advises doctors who are considering converting to a direct primary care or other type of retainer practice to ask themselves a number of questions, including:

Do I have a plan to transition my patients who won’t pay the fee?

Am I willing to be on call 24 hours a day, every day?

What services do I plan to offer?


Helpful Resources

Direct Primary Care Coalition (

The Concierge Medicine Research Collective (

“The Difference Between Direct Primary Care and Concierge Medicine” Nov. 13, 2009 (

Concierge Medicine Today (

“Direct Patient Provider Primary Care Practices: Annual Report to the Legislature,” Washington State Office of the Insurance Commissioner, Dec. 1, 2010 (

American Academy of Private Physicians (

“Retainer-Based Physicians: Characteristics, Impact and Policy Considerations,” National Opinion Research Center at the University of Chicago and Georgetown University, October 2010 (

Durham, NC Based Physician Finds Happiness In ‘Concierge’ Medical Care
By Laura Oleniaca | The Herald-Sun

JULY 30, 2011 – Durham-based internist John Kihm, M.D., has seen his dream medical practice come true. The 53-year-old doctor said he also wants other physicians to have that, too. So last year, he launched a business to help other physicians convert their practices to a model called concierge medicine. Kihm converted his own practice about two years ago after searching for a model that would get him off what he called the “hamster treadmill.” With a practice with 1,400 patients, he said he was working about 14 hours per day. He said the insurance business model of medicine that he was practicing was volume-driven, with the number of patients he saw driving revenues to meet overhead costs and determining profit. “I was able to do that, but I was not happy,” he said.


From ‘fee-for-service’ to ‘no-fee-no-service’ medicine.
One doctor spells out the perils of the course American healthcare is on.

By Richard Amerling | Hartford Business Journal Online

AUGUST 1, 2011 – After graduating medical school, young doctors must complete residency training in a hospital. Traditionally, most were eager to enter private practice. Not any more: They increasingly seek jobs that keep them within a hospital or clinic system. More alarmingly, we are witnessing a mass migration of physicians in private practice moving back within the hospital walls.

In 2005, doctors owned more than two thirds of medical practices. By 2012 over 60 percent of doctors will be salaried employees, and a third of these will be working for hospitals. A Medical Group Management Association survey of 58,000 physicians found that 55 percent of practices were hospital owned in 2009, up from 30 percent five years earlier.

Clearly the largest driver of this mass migration is money. Practice expenses are rising along with or faster than the general inflation rate, and reimbursement rates have not kept pace. Overhead costs exceed 60 percent of practice revenue on average. Medical malpractice premiums in some specialties have gone up 10-20 percent annually. Financial pressures imposed by the third-party system are literally forcing doctors to give up their independent practices and move into the hospital setting.

Passage of PPACA has accelerated this trend. Doctors can see increasing regulation, reporting requirements, mandatory e-prescribing and electronic health records, coming at them. Many are making a rational decision to pass these hassles and expenses to a larger organization.

The major downside of this trend will be the loss of the fee-for-service payment model, which has long been a target of central planners. Paying physicians a fixed salary results in work avoidance and will have a devastating effect on patients’ access to care.

If current trends continue, private medical practice will be reduced to those in direct pay and concierge practices. The good news is that these models are increasing, and if left unfettered, will provide excellent, reasonably priced and timely care to millions of Americans. However, it is unlikely these practitioners will be able to handle the load. Many millions of patients will be seen in hospital clinics, in Accountable Care Organizations (the new, unimproved HMOs), or in emergency rooms, where care will be fragmented, regimented, and more expensive.


Cultural concierges help smooth language barriers
By Karen M. Cheung | FierceHealthcare

JULY 28, 2011 – A staggering 90 percent of clinicians say language barriers have compromised care in patients with limited English proficiency, and 86 percent said cultural barriers compromised care, according to a QuantiaMD Report released in late July.

To address the needs of ethnic populations, some hospitals are experimenting with cultural concierges. For example, Advocate Lutheran General Hospital in Park Ridge, Ill., last month implemented a four-person cultural concierge program for its Korean, Polish, Russian, and Hispanic patients, according to a Chicago Tribune article yesterday. Unlike standard hospital translators, the cultural concierges address patients’ specific cultural concerns. For instance, Korean women after childbirth traditionally eat a special soup, an option now offered on the hospital’s menu.

“If patient safety and quality improvement initiatives have taught us anything, it’s that the root causes of adverse events and sub-optimal outcomes are almost always system failures,” said QuantiaMD Editor-in-Chief Michael Paskavitz in a press release. “And this study has clearly identified a major failure in the system that supports physicians and patients, which is access to resources that address the cultural diversity of today’s patients.”


MDs building concierge, cash businesses with patient-friendly promises

By dbeaulieu| Fierce Practice Management

JUNE 22, 2011 – From longevity to 24/7 physician access, the promises from a growing crop of concierge and direct-pay practices are not just grabbing headlines, but also the attention of an impressive clientele of patients willing to pay retainer fees out of pocket. And if a Senate bill proposing to roll back recent restrictions on HSAs and FSAs passes, the market for high-touch services, such as extended-length consultations and wellness counseling, may expand even further.

“Our goal is to be much more accessible than the average physician,” Haggerty told the Daily Press. “Usually you just don’t have the time to sit down and listen to the patient, to do some research if necessary, and have a good conversation about everything that may be affecting their health. We want to be able to provide that.” Both Haggerty and Beamer told the newspaper that the practice was growing slowly but steadily.

According to American Medical News, The Family and Retirement Health Investment Act of 2011, introduced by Sen. Orrin Hatch (R, Utah) in late May, would clearly allow HSAs, FSAs, and other tax-exempted accounts to be used to pay for direct primary care, concierge care, and other similar retainer care services. With confusion reining thus far on the issue, plan administrators have been making the final expense eligibility determinations and have not reached a consensus, said Norm Wu, president and CEO of Qliance Medical Management Inc., a Seattle-based practice that offers medical homes with unlimited primary care for a monthly fee.


IPO Preview: WhiteGlov House Call Health


JULY 26, 2011 – Based in Austin, Texas, WhiteGlove House Call Health (WGH) scheduled a $28 million IPO with a market capitalization of $144 million at a price range mid-point of $11 for Thursday, July 28, 2011. The full IPO calendar for the week of July 25th includes 12 IPOs scheduled to raise $2 billion…In the case of most concierge services, their annual fee is generally between $1,500-$3,000 per year, which is not affordable for the average consumer. WhiteGlove has a broad scope of care, and believes it provides 70% of the medical services handled in a typical primary care setting. The most notable differences between the medical services WGH provides and those typically found in primary care settings are: x-rays; ultrasound; suturing; retinal, pelvic, genital and rectal exams; advanced cardiology evaluations; and treatment of chronic depression, chronic pain, addiction or pregnancy.


Doctor awaits word on rape trial appeal
Jury instructions at issue; civil trial delayed

By VIRGINIA HENNESSEY | The Monterey County Herald | Herald Salinas Bureau

JULY 26, 2011 – The Sixth District Court of Appeal is scrutinizing a judge’s jury instructions in the criminal trial of convicted rapist Carl Bergstrom. The former Carmel physician was to have faced another jury Monday in a civil lawsuit filed by his victim, Jane Doe 1. That trial was delayed until March 2012 while the appellate court reviews additional written arguments it requested after hearing oral arguments in May.

According to testimony, he had Vicodin and an unprescribed amphetamine-type appetite suppressant in his system when he was arrested the morning of the assault. It was also revealed at trial that he had traded prescription drugs for cocaine and offered to trade cocaine for sex, both in his office, where he worked as a “concierge” physician with privately contracted patients.

The transactions became public when Bergstrom inadvertently left a dictation recorder running in his office for 5½ hours and sent it to be transcribed. The transcriptionist gave the tape to Community Hospital of the Monterey Peninsula and, when it took no apparent action, later forwarded it to the Medical Board.

Bergstrom cannot regain his license as long as he is required to register as a sex offender. If he were to win on appeal and at a new trial, he would still face Medical Board questions about the drug violations. He is currently housed at North Kern State Prison in Delano.


Concierge practice gives patients a peace of mind

By Patti Singer | Staff Writer | Democrat & Chronicle

JULY 25, 2011 – Dr. Gene Zito is among a small contingent of primary care physicians nationwide who have started concierge practices. Unlike traditional primary care practices with upwards of 2,000 patients and dozens of appointments each day, the concierge model is limited to a few hundred patients who pay to be part of the practice. Zito contracted with MDVIP of Boca Raton, Fla., and started the practice in late June. He has about 400 patients who each pay $1,500 a year.

The concierge concept, sometimes called boutique medicine, has been around for a few years. It’s predominantly been in big cities, although about 10 years ago a Spencerport family doctor had a concierge practice. According to Concierge Medicine Research Collective, there are approximately 2,300 verified concierge doctors out of 67,000 general internists in the nation.

A spokeswoman for Concierge Medicine Today said there are over 22 verifiable or confirmed concierge doctors in the state of New York.


Doctor Is Always In With Concierge Medicine
Patients willing to pay the fee get a doctor on call for them 24 hours a day and house calls if they need them.

By Dale Hutchings |

JULY 24, 2011 – A way of practicing medicine that has only been around a little more than decade, and still unknown to probably most Americans, Dr. Robinson feels, in spite of its limited awareness, concierge medicine is not only here to stay, but has a solid future. As she put it, “I plan to be around serving patients with this type of care for many years to come.”


Doctor, home health agency revives house calls

By Melinda Hudgins | Post Columnist | Murfreesboro Post

JULY 24, 2011 – Decades have passed since doctors visited patients at home, but one local physician is bringing house calls back into practice. Murfreesboro physician, Dr. Jim Garner, has expanded his practice to include house calls for clients of Family Staffing Solutions, Inc. on an exclusive basis, according to company president and CEO Becci Bookner.

“The return of house-call visits by a doctor is welcome and needed by many older people in our community who simply cannot manage the trip to the doctor’s office,” she said. “Clients of our company may now again access the familiar and longtime appreciated service of a doctor’s house calls in the privacy and convenience of their homes.”


Reform Means Hospitals Must Reconsider Primary Care Strategies
A key issue to remember: Under health care reform, it is projected that more than 32 million new people will be covered by health insurance, but virtually no new primary care physicians will be trained to serve them.

By Gregory Brodek and C. Mitchell Goldman

JULY 20, 2011 – Thus, it is widely expected that primary care physicians will be in very short supply as health care reform is implemented over the next several years. Hospitals without an effective plan to attract and retain primary care physicians will struggle to compete and survive as the current system moves toward enterprise risk payment models like accountable care organizations (ACOs) and pay for performance reimbursement programs.

Massachusetts is serving as a an unofficial “test” laboratory as it implements a health care reform program that is similar to the federal program. Since the 2009 passage of the Massachusetts Health Care Reform Plan, the waiting time for a primary care physician appointment has increased from 4 to 6 weeks. Many physicians in Massachusetts have chosen not to expand their practices and have declined to participate in Medicaid. So, while some patients may have to wait 6 weeks, the possibility that some patients will have no access is very real. Another factor that will impact the situation nationwide is the growing interest in concierge medicine. Concierge medicine offers primary care physicians an alternative business model that pays them more while working less. Patients pay a fixed sum per year to the primary care physician for preferential appointments, access by text message and more personalized attention from their physician.

Concierge medicine is growing dramatically and is attracting significant investment dollars as recently indicated by the purchase of the largest provider of concierge medicine services, MDVIP, by Proctor and Gamble. A number of other significant competitors in the concierge medicine space are also venture and private-equity backed.

Is a concierge doctor worth the cost?

By Matt Stroud | | Matt is an independent journalist who reports about healthcare, education and prisons. The opinions expressed are his own.

JULY 18, 2011 – In the mid-1990s, two doctors working with members of the Seattle Supersonics designed the plan for concierge medicine. Their idea was to charge as much as six figures per year to provide “highly attentive medicine,” as one doctor put it, to a few ultra-rich patients at a time.

Concierge medicine has evolved since then. Today, concierge doctors often charge patients more reasonable annual fees in place of billing health insurance companies. Incentives include same-day appointments and 24-hour access. Concierge care can cost as little as $600 annually, and studies show it is popularizing: Last year, MedPAC, a Congress-created commission, found that the number of concierge practices had increased fivefold since 2005. According to Concierge Medicine Research Collective, a sister data collection and research arm of Concierge Medicine Today, states that there are approximately 2,300 verified concierge doctors out of 67,000 general internists in the nation.


Monday Q&A: The accidental acquisition [Partner MD]

By Al Harris |

JULY 18, 2011 – Eight years is all it took for Linda Nash to build her business to a point where a deep-pocketed buyer wanted a piece of the action. Nash founded PartnerMD, a concierge medical practice, in 2003 with one doctor and 40 patients. Today the practice has 4,000 patients and nine doctors spread across offices in the West End, Midlothian and McLean. The company’s clients pay an annual membership fee and in exchange receive around-the-clock attention, even getting their doctors’ cell phone numbers with permission to call them anytime, day or night. The company also takes care of the region’s top executives, with corporate contracts to provide primary care to the top brass at Capital One, Brink’s and Dominion, to name a few. PartnerMD also has a new owner, as the company announced last week that Markel Ventures had acquired it for an undisclosed sum. BizSense caught up with Nash to talk about the deal.


Markel Corp acquires PartnerMD concierge medical service
By John Reid Blackwell | Richmond Times Dispatch
Published: July 14, 2011 – Markel Corp. has added a locally based provider of concierge medical services to its growing investment portfolio. The Henrico County-based specialty insurer announced Wednesday that its Markel Ventures investment subsidiary has acquired PartnerMD LLC. Financial terms of the deal were not disclosed.


Concierge care for dual eligibles pushed as cost-cutting measure
Patients who qualify for both Medicare and Medicaid accounted for 27% of Medicare spending in 2006.
By Charles Fiegl, amednews staff. Posted June 27, 2011 | Source: AmedNews

Washington — Current CMS rules don’t make concierge care arrangements impossible, but they are very difficult. Medicare allows participating physicians to charge fees for services not covered by Medicare. But the HHS Office of Inspector General has cautioned participating physicians against charging too much in the process for services reimbursable by Medicare.

For instance, the OIG described one concierge physician who offered coordination of care, a comprehensive assessment and plan for optimal health, and extra time spent on patient care in exchange for a $600 fee. Because some of that was covered by Medicare, the agreement violated Medicare’s prohibition against charging patients more for their care than the Medicare deductible and co-payment.


Small Medical Practices: Adapting To Survive
With more physicians choosing to join or sell to hospitals and larger practices, many wonder if
the traditional physician practice is dying.
By Victoria Stagg Elliott, amednews staff. Posted June 27, 2011

DAYTONA BEACH, FL – When she began medical school, Delicia Haynes, MD, a family physician in Daytona Beach, Fla., envisioned a practice of her own where she could care for those with and without insurance. Dr., Haynes bucked the trend of recent medical school graduates when she opened her solo practice in 2009.

“I started planning while I was in residency, and I have a strong vision for what I want my practice to be.”


Concierge medicine has a cost for all patients
When doctors decide to charge additional fees for top-shelf care, many people can’t afford it.
By Steve Dudley, Special to the Los Angeles Times

LOS ANGELES, CA – Concierge medicine – you may have heard of it – is gaining in popularity. Patients pay a monthly fee directly to the doctor, on top of their regular health insurance premiums and co-pays, to secure better access to the physician. Donald told me that the service was promoted to him as an opportunity to improve the doctor-patient relationship. Instead of juggling more than 2,000 patients, the physician would be able to winnow that number to a very manageable 600, enabling him to devote more time to the select few who opted for premium service.


“Royal Pains” returns to give viewers another dose of summertime entertainment
Posted by Melissa Hayer | on June 27, 2011M at 9:00 am | Royal Pains

HOLLYWOOD, CA – The Hamptons’ favorite concierge doctor Hank Lawson (Mark Feuerstein) is back on call when the third season of “Royal Pains”
premieres on a new night at 8 p.m. Wednesday on the USA network.


JUNE 24, 2011 | POLL | RESEARCH | Source: The Concierge Medicine Research Collective
POLL: What Form of Marketing Have You Found Is Best When Trying To Attract New Patients To
Your Practice?


JUNE 24, 2011 | POLL | RESEARCH | Source: The Concierge Medicine Research Collective
POLL: How Many Concierge/Direct Care Physicians Text Their Patients?


JUNE 24, 2011 | RESEARCH | BUSINESS | Source: The Concierge Medicine Research Collective
SURVEY: Concierge Medicine Start-Up and Drop Out Rate
What is the drop out rate among physicians across the U.S. who have tried but failed to amake a successfuly transition into a concierge medicine/direct care business model. The states which experience the most frequent concierge medicine start-up failures include Florida and California. Coincidentally, these two states also have the most concierge physicians across the U.S.

What Are Your Thoughts On This Increase…? What Can Be Done?
To Share Your Opinion, Click Here.

JUNE 23, 2011 | BLOG | OPINION
How to See a Doctor—Stat
By Kenny Lin | US Health News
The next time you need to consult a doctor but can’t wait weeks for an appointment, consider choosing a practice with advanced-access scheduling, direct-pay models, or telehealth services. These innovations will never replace the old-fashioned house call, but they are probably the next best thing.


JUNE 23, 2011 | POLL | RESEARCH | Source: The Concierge Medicine Research Collective
POLL: Concierge Medicine Doctors, What Was The Greatest Difficulty You Experienced When You Converted To A Concierge Medicine/Retainer or Fee-Only Practice Model?


POLL | RESEARCH | By Tony Morton | Yahoo!
What’s The Hottest Career Field?
Answer: Health Care.
A noticeable pattern has developed in the health care industry. Workers keep getting hired. Health care providers added 24,000 new jobs in October 2010, according to the U.S. Department of Labor, while averaging an increase of 20,000 jobs per month over the past year. Health care’s hot track record for hiring isn’t a recent occurrence. It’s actually part of a much more long-term trend, says John Canally, an economist and investment strategist at Boston-based LPL Financial.


Physician Integration Economics: How Market Share Is Captured and Retained.
Written by Marc D. Halley, MBA, Peg Holtman, Anthony D. Shaffer, Esq. | Beckers
In the late 1990’s the term “integration,” largely associated with hospital ownership of primary care practices, fell on hard times, being viewed as a failed strategy by many. Hospital-owned medical practices were losing big money. Management teams and consultants alike removed words like “integrated delivery system,” “group practice without walls,” and “MSO” from our vocabularies and we headed off to find the next “silver bullet” to save the day! Some groups of hospital-owned practices were abandoned. Some hospital-owned practices were returned to the employed physicians (it was rumored in some instances for substantially less than the hospital’s initial investment). Other hospitals capital-starved their physician networks, losing the best performing employed physicians in the process. Still others dramatically cut their operating losses by terminating physician employment contracts and closing locations.


Doctors as renegade — accepts cash, checks, eggs or pie, not insurance.
Written by Jennifer Vogel. | Minnesota Public Radio
OSAKIS, MN – It’s more a scene from the days of frontier medicine than from the modern health care system. And that’s because Dr. Susan Rutten Wasson, 42, is a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if she’s not booked up, spends at least a half-hour per visit — compared to the more typical 15 minutes — and usually charges only $50 for a consultation. She takes cash or check, but no insurance — and sometimes accepts gratuities of a dozen fresh eggs or a pie.


Hospitals Tap Telehealth for disaster responseinsurance.
Written by Sara Jackson | Fierce Mobile Healthcare
Disaster preparedness group the Northern Virginia Hospital Alliance has an mHealth weapon up its sleeve for the next major crisis in the region. It’s eCareMobile, a Philips wireless tele-ICU unit, and Washington, D.C.-area hospitals have set up its video-conferencing and other telehealth functionality to allow clinicians to triage patients and communicate remotely with on-site providers during a disaster.


June 17, 2011 | WASHINGTON, D.C. | POLL | RESEARCH
In U.S., Employer-Based Health Insurance Declines
Further Percentage of uninsured adults edges up slightly.
By Elizabeth Mendes | Gallop
Forty-five percent of American adults reported getting their health insurance from an employer in January through May of this year. This is down from 45.8% in 2010, and has been steadily declining since Gallup and Healthways started tracking health insurance sources in 2008.

The issue of health insurance in the United States is far from fading into the background. Currently, 26 states are seeking to overturn the new healthcare law in court. At the same time, nearly every state is scrambling to figure out to how to fund and implement the law amid tough economic times and congressional lawmakers are debating the future of Medicare and Medicaid. The confluence of these issues makes who is covered and how they get their coverage more relevant than ever.

There are two major forces that are affecting where Americans get their health coverage: One is President Barack Obama’s Patient Protection and Affordable Care Act and the other is high unemployment and underemployment. As only certain parts of the new healthcare law have been implemented, the latter issue appears to be the more influential one at this time, with steady declines since 2008 in the percentage of Americans who get their health insurance from an employer.


Health Plans Targeting Docs As They Expand Mobile Strategy
Written by Sara Jackson | Fierce Mobile Healthcare

Insurers have stepped into the shallow end of the mobile pool in the past year, launching apps for largely administrative functions, and mainly aimed at patients. Soon to come, however: Apps created specifically for providers. A host of payers like United Healthcare and HealthNet already provide mobile access to coverage and benefits information, physician directories, health savings account balance totals and even out-of-pocket drug cost data, according to a report by amednews.

Some, like, Blue Cross Blue Shield of Florida and OptumHealth, have added a few fitness/wellness components too, like allergy and weather alerts for members, and gaming-based social media apps for fitness challenges. Even smaller self-insured plans, like the University of Pittsburgh Medical Center Health Plan, offer mobile apps for patients to look up physicians and find hospital locations.

On the horizon, though, payers are looking to build apps to allow network physicians to communicate via smartphone with patients, send secure messages to other providers and possibly even receive alerts to “gaps in care,” such as a patient missing her mammogram. BCBS of Florida may offer an option for remote patient monitoring, with data sent automatically to physicians, strategic development director Adriana Murillo tells amednews.


JUNE 17, 2011 | SOCIAL MEDIA | TECHNOLOGY | LOS ANGELES, CALIF. | Source: Concierge Medicine Today

S. Calif. Concierge Menopause Doctor Celebrates 5000 Facebook Fans.
Patients don’t normally look for a doctor on Facebook, but that’s changing.
One of the major ways physicians acquire patients (and most patients find doctors) is by referral through insurance companies or government programs. Dr. Shira Miller, a southern California concierge menopause physician regularly posts noteworthy medical studies, inspiring quotes, and answers questions on Facebook, which has earned her both appreciative fans and patients. Recently, Dr. Miller celebrated 5000 Facebook fans, with men and women being represented equally.

Similar to other concierge doctors, Dr. Miller doesn’t work with insurance companies and so she must earn her patients through word of mouth or advertising. The cutting-edge bio-identical hormone replacement therapy she uses for the treatment of menopause and her age management services have gained exciting popularity using an unexpected form of marketing: Facebook.


JUNE 16, 2011 | HOUSTON, TEXAS | Source: Marketwire
University General Health System, Inc. Reports 19% Increase In Audited 2010 Net Revenues
Operating Income Improves to $3.8 Million As Net Revenues Reach Record $56.1 Million
University General Health System, Inc. (“University General”) is a diversified, integrated, multi-specialty health care provider that delivers concierge physician and patient oriented services by providing timely, innovative health solutions that are uniquely competitive, efficient and adaptive in today’s health care environment. University General currently operates a 72-bed general acute care hospital near the Texas Medical Center in Houston, two free-standing emergency rooms, and one ambulatory surgery center, with plans for additional acquisitions and/or facility openings in 2011 and future years.


JUNE 15, 2011 | OPINION | BLOG | Source: MedCity News
Is Obamacare Unconstitutional? Turns Out, It Won’t Matter…
By Dr. Westby G. Fisher is a cardiologist at NorthShore University HealthSystem
Health care is a sensitive issue politically. And as things would have it, it now is a sensitive issue legally. So my thoughts now are not meant to be partisan, but rather a “ground-floor” perspective on what would happen if the Patient Protection and Affordable Care Act were found entirely unconstitutional. So, what would happen?


JUNE 16, 2011 | VIRGINIA | BUSINESS | Source: Daily Press, Dan Parsons
Gloucester doctors open new office to provide 24-7 care
Direct Access Internal Medicine opened its doors on Main Street in Gloucester Courthouse, promising personalized 24/7 care for patients. Dr. Ronald Haggerty and his partner, Katherine Beamer, a board-certified family nurse practitioner, opened Direct Access Internal Medicine in that location last month.

As the name suggests, the pair designed the small private practice around the idea that their patients could receive personal, comprehensive care in a friendly and familiar environment whenever needed and upon request if necessary.

Their new practice is a hybrid between a fee-only “concierge” clinic, where patients are seen anytime for anything, and a traditional private practice that would normally have between 2,500 and 3,000 patients, Haggerty said. Ultimately, they’re looking to have about 800 full-time patients, perhaps 1,000, who would pay an annual fee for 24-7 access to Haggerty and/or Beamer. They promise a 30-minute minimum consultation for existing patients and a full 90-minute initial consultation for new patients.


JUNE 12, 2011 | ENTERTAINMENT NEWS | HOLLYWOOD, CALIF | Source: The Daily BLAM, Kimberly Houston
Julie Benz Signs on to Guest Star in ROYAL PAINS
Hank is a rising star in the New York City medical community, until he loses everything fighting for the life of a patient. With his career stalled and his personal life in shambles, Hank is in need of a new beginning. That’s where his younger brother Evan (Paulo Costanzo) steps in. Fed up with Hank’s personal pity-party, he convinces Hank to join him on a last-minute trip to the Hamptons for Memorial Day weekend. When the brothers crash a party at the home of a Hamptons billionaire and a guest falls critically ill, Hank saves the day. His dramatic medical rescue draws attention from the crowd, and soon Hank’s phone starts ringing off the hook with patients demanding house calls.

Inadvertently, Hank has become the hot new “concierge doctor” in town.

Though Hank is initially reluctant to embrace this new career, with encouragement from Evan and an ambitious young woman who volunteers to be his physician assistant he decides to stay in town for the summer. Once again solving medical crises and helping those in need, Hank is back to doing what he does best. And now he’s reinvented himself as the Hamptons’ hottest new doctor-in-demand.

Julie Benz, the former Dexter and No Ordinary Family actress has signed on to the USA series to play a lesbian farmer who ends up needing help from Dr. Hank Lawson.


Apps let patients view insurance on smartphones.
Health plans hope access will better connect members, doctors and insurers and reduce costs.
Apps for physicians are coming.
Written by Emily Berry | AMedNews
Health insurers are hitching a ride into the physician office — and the exam room — on patients’ smartphones. Some of the largest health plans have developed mobile apps that will give a member access to information from his or her insurer, including drug prices and a network directory. Coming soon will be apps aimed at physicians themselves.


JUNE 10, 2011 | BUSINESS NEWS | MASS. | Source: MetroWest Daily News
STOLL: ‘Programs for People’ Chooses Health
By Cheryl Tully Stoll/Guest columnist/The MetroWest Daily News
Very often we hear the term “treating the whole patient” used regarding best practices and ideals that those in the medical profession would like to strive for.

Unfortunately sometimes there are obstacles in the health care system that make this impractical if not impossible. There is now the advent of concierge medicine, which makes the concept easier; that is only for a financially privileged few who can pay thousands of dollars just to have a doctor available to them at whim and for extended visits and phone calls that go far beyond anything that would be reimbursed by an insurance provider.

This is why it is so refreshing to find a health care program for low-income individuals that despite extremely limited funding, strives for and achieves many of the ideals of treating the whole person.

Programs For People is an independent, self-supporting mental health agency founded in Framingham in 1973 to enable adults recovering from mental illness to achieve success in life. Its services are comprehensively designed to teach coping skills, promote symptom relief, build healthy relationships with family and friends, and to assist clients to obtain, and maintain employment.

Its day treatment program, Framingham Day Hospital, is a pro-active program that can prevent in-patient hospitalization, shorten the stays of those who do require it, and help those living in the community to gain and maintain independence. Since the agency relies primarily upon reimbursement from Medicaid to support its day treatment services, Programs For People’s novel approach that integrates wellness education and focuses on the whole person delivers far more health care than is expected or required. The agency has always strived to treat the person and not just their mental health condition. Fortunately, the agency received a $1,450 “Catalyst Fund Grant” from the Blue Cross Blue Shield Foundation of Massachusetts and a $750 grant from the Framingham Union Aid Association, Inc. to assist with their wellness initiative, “Choose Health.”


TECHNOLOGY | NATIONAL | Source: Concierge Medicine Today
SignatureMD Outfits Affiliated Concierge Physicians With Panasonic’s CardioHealth Station
Panasonic Healthcare, through its affiliate Cardionexus, announced today that SignatureMD, a personalized healthcare services company based in Los Angeles, California, has become the first concierge medicine company to incorporate Panasonic’s new CardioHealth® Station into its standard of care. The CardioHealth workstation is a portable, non-invasive cardiovascular imaging device which helps detect patients’ hidden risk of heart attack and stroke. It will now be available to SignatureMD’s entire national roster of concierge physicians.

With CardioHealth Station technology in their offices, physicians will be able to scan patients for hidden plaque build-up and increased thickness in the artery wall — common signs of cardiovascular disease risk. Testing is non-invasive, painless, and completed in minutes with results that are available immediately.

“Our network of physicians, both primary care and specialists, are eager to take advantage of our affiliation with Panasonic Healthcare and their accelerated access to the CardioHealth Station,” said Matt Jacobson, CEO of SignatureMD. “The CardioHealth Station empowers our physicians to be proactive in the early detection of disease and the long term health of their patients — precisely the goal of a personalized healthcare program.”


JUNE 08, 2011 | PRACTICE NEWS | VIRGINIA | Source:
McLean, Virginia’s Principal Medical Group Employee Earns Student of the Year Award.
Sanford-Brown College awards Demetria Stubbs with top honors
Principal Medical Group announced today that medical assistant Demetria Stubbs earned Sanford-Brown College’s Graduating Student of the Year award and will be placed on the President’s List. Stubbs will be presented with the award during the school’s August commencement ceremony when she receives her associate degree in applied sciences with a focus on medical assistance.

After earning a grade point average of 4.0 for two consecutive semesters, Stubbs is happy to accept this certificate of achievement and begin her career with Principal Medical Group in McLean, Va. David J. Jones, M.D., a primary care, concierge physician with Principal Medical Group.


JUNE 5, 2011 | HEALTH & FITNESS | FLORIDA | Source:
Casting A Broken Bone May Not Be Necessary, A Splint May Be Fine
By Dr. Andy Oakes-Lottridge is the only concierge physician exclusively making house calls in Southwest Florida; with pediatric and adult hospital privileges

It was only three weeks before Christmas when Ryan decided he just couldn’t wait. So with his own money, saved over several years of birthdays, he decided he would go buy himself his very own RipStick.

For those or you who aren’t familiar with Rip Sticks, imagine a skateboard with only one swiveling wheel on the front and one in the back. The rider controls the board by balancing on it, tilting the feet and leaning precariously forward and backward.

Ryan’s first day on the RipStick was also the day of his first broken bone.


MAY 25, 2011 | PRACTICE NEWS | VIRGINIA | Source:
Gold Hermes Creative Award Goes To Northern Virginia Concierge Medical Practice
Many companies use their logo to illustrate who they are and what they do. This is especially true for Principal Medical Group, P.C., which created a logo to communicate its vision for a new model of healthcare.

“Our team wanted a logo which conveyed that comprehensive medicine is made up of multiple building blocks, which together create a strong foundation for patients,” said David J. Jones, M.D., a physician with Principal Medical Group.


Memorial Day TVLine-Up: Your Guide to the Best Holiday Weekend Marathons
The fact that it’s Memorial Day doesn’t mean that you have to hightail it to the beach. On the contrary, you may want to stay home and kick back, spend some quality time with your significant other. By which I mean of course your remote. And if that’s the case, you (and it) will no doubt be particularly interested in this list of TV marathons being run over the weekend.

Monday, May 30th – Royal Pains (Sleuth, 6 am – Tuesday, 6 am) | Just a month away from the show’s third season premiere (June 29 on USA Network), Sleuth offers a trip to the Hamptons-set concierge medicine series.


HSAs, HRAs, FSAs and the Medical Expense Deduction —
The Impact On Concierge Medical Care & Direct Care
Concierge Medicine Today has recently learned and confirmed from our trusted sources that The Family and Retirement Health Investment Act of 2011, sponsored by Senator Hatch and Rep. Paulsen, is going to be introduced in Congress today, May 26, 2011. This is an important and significant leap forward in the marketplace of concierge medicine and direct care.

Philadelphia-Area Dentist Partners With Local Physician to Offer Advanced Cardiovascular Disease Screening Test
By Marketwire | via MSNBCPLYMOUTH MEETING, PA — Plymouth Meeting dentist Richard Nagelberg, DDS recently announced that he will be partnering with Washington Crossing Family Practice physician Charles Whitney, MD to provide a state-of-the-art screening test for cardiovascular disease in their respective offices from June 23rd – 25th.


Should Patients Currently Taking Niacin Stop Therapy?
Dr. Steven Schnur, cardiologist and CEO of a concierge medicine group, cautions patients not to stop taking niacin without consulting a physician first. “The patient population in this study had well-controlled LDL [bad] cholesterol, but in many patients this is not the case,” he says. “Further studies need to be done and several studies are currently [in progress].”


As Interest in ACOs Wanes, It’s Time to Do the ‘Next Right Thing’
Written by Steve Ronstrom, CEO, Western Wisconsin division of Hospital Sisters Health System | May 23, 2011 | Source: Becker’s Hospital Review

Like many other hospitals, we had been seriously considering implementing an accountable care organization. It seemed like the right thing to do to meet the needs of patients. The purpose was to make healthcare more efficient by integrating hospital care with that of physicians and other outpatient providers.

But now — like many other hospitals, as well — we have dropped plans for an ACO because the proposed regulations are too complex. However, we have not given up looking at the future or pursuing “the next right thing,” which would incorporate many of the objectives of ACOs without actually becoming an ACO.


Good things come in smaller practices
BY JIM DOYLE | Posted: Sunday, May 22, 2011 12:00 am | Source:

So-called concierge medical practices, some in operation several years, still represent just a small niche among local health providers. But they appear to have found sustainable financial models, and they speak to much larger frustrations among doctors increasingly squeezed by health care cost pressures.

…Concierge doctors share the view that health care has become increasingly depersonalized, owing to a host of trends. There’s a national shortage of primary care physicians. Medical students are drawn to lucrative specialties to help pay off their enormous student loans. Primary care practices usually serve thousands of patients, and their waiting rooms are teeming with sick people.

Reform could create more ’boutique’ doctors
Some physicians may be turning to retainer-based medicine, but it is not a model that most practitioners have adopted, says Michelle McOmber, CEO of the Utah Medical Association. “Most Americans utilize health insurance or are covered by a government plan if they qualify for it. Within the typical insurance model, a care provider gives care to a patient and a third party pays for most or all of it,” she says. “Within the retainer-based model, the provider and patient make arrangements without the insurance company in between.”

Dr. David N. Sundwall, who served as executive director of the Utah State Department of Health from 2005 to 2010 and is currently a professor of public health at the University of Utah School of Medicine, views retainer-based medicine as a legitimate, if somewhat elitist, attempt on the part of some doctors and providers to streamline the current process and provide more personal care to patients who are willing—and able—to pay for it.

From a public policy perspective, Sundwall has mixed feelings about retainer-based healthcare. While it does have benefits for patients and physicians alike, “My frustration is that these concierge systems only see those people with means and do not participate in care for the poor,” he says.


Reform could create more ’boutique’ doctors
Dr. Kevin Logan worked for several years in the St. Vincent Physician Network until he decided to head in a radically new direction. He not only left the support network of St. Vincent when he set up his one-man practice in 2003, but he also decided to no longer accept insurance payments from the likes of Anthem, UnitedHealthcare, Medicare or Medicaid. Instead, he charges $395 for one-hour visits and $145 for 30-minute follow-up visits. This extra time, he says, allows him to get to the root of patients’ illnesses—rather than making a quick diagnosis and dashing off a prescription.


Concierge Healthcare Provider EliteHealth Announces New Philadelphia Location
International concierge medicine group EliteHealth welcomes Philadelphia internist Dr. Adam Sobel
to the EliteHealth team.

Philadelphia, PA (PRWEB) May 13, 2011 – Now a leading provider of concierge doctor Philadelphia medical services, EliteHealth is proudly announcing their newest provider location. By welcoming internal medicine specialist Dr. Adam Sobel and his practice Sobel Medical Associates to their team, EliteHealth is now prepared to offer premier concierge medical services to residents of the Philadelphia area.

An established practice since 1997, Philadelphia’s Sobel Medical Associates specializes in internal medicine services for a diverse group of patients. Having been selected by EliteHealth as a prime location for concierge healthcare in Philadelphia, Sobel Medical Associates can now offer both classic internal medical care programs and premier concierge health services through EliteHealth.


Concierge Health Care: Worth the Hefty Price Tag?
The dwindling number of primary care doctors is a driving force behind the idea of concierge health care. According to the concierge health care companies, doctors are currently treating 30 to 35 patients a day, spending less than eight minutes with each patient and overworked and underpaid. Many times, a nurse or physician assistant will meet with a patient instead of the doctor.

With concierge health care, patients don’t have to wait weeks to schedule an appointment or endure long waits and get to spend more time with their actual doctor (some plans block off a minimum of 30 minutes) as well as 24-hour hour access to their doctor via telephone and e-mail. Patients also get advance screenings to prevent things like heart failure or diabetes. Standard doctor visits – if you have the flu or need a checkup – are billed to your insurance provider.


California: Quick MD offers ‘quik’ treatment at low cost
Dr. Lawrence (Larry) Ramalho of Quik MD, attempts to see patients either the same day or the next, referring patients to specialists if necessary, for more complicated medical needs. His hours vary according to patients’ needs, but he sees many of his patients on weekends or towards the end of the week when other doctors may not be available. He does not take insurance, but provides the patient with receipts for submitting reimbursements themselves.

Quik MD Care keeps the fees low, according to Ramalho. “After the initial visit when I set up the patient’s chart for $100, most office visits are around $50, with the cost discussed and estimated immediately,” he said. “This is one-stop care as well. Routine medication is dispensed in the office at a low cost.”


BUSINESS NEWS | OREGEON | Published Tuesday, May 10, 2011, 11:21 AM
At OHSU’s Center for Women’s Health, a ‘concierge’ medicine practice suddenly lacks physicians
Hundreds of women received unsettling news from the Center for Women’s Health at Oregon Health & Science University last week. Three of the four internal medicine physicians and a nurse practitioner at the center are leaving to practice elsewhere, a letter to patients said. The fourth internist is taking an extended leave of absence. OHSU officials say it’s not the end of the unusual clinic, an internal medicine group nested within a larger obstetrics and gynecology clinic, and in which most patients elect to pay an annual fee for a “concierge” service called Life Choice offering longer visits with doctors and other amenities.

“It’s been a very effective part of the Center for Women’s Health,” said Dr. Charles Kilo, chief medical officer for OHSU Hospital. The center, he said, has already begun recruiting new physicians. During the transition, primary care providers from other OHSU locations will care for Life Choice and other patients of the internal medicine clinic.


See the doctor more often – but at a price
After 15 years of practicing family medicine at a frantic pace, running from one patient to the next with barely enough time to be familiar with their symptoms let alone the person, Dr. Martin Schulman decided he’d had enough. In 2005, he jumped off the traditional primary care treadmill and started Encinitas Personal Healthcare, a so-called concierge medical practice. Instead of the usual 2,500-patient load, Schulman now has just 250 patients. Hurried 10- or 15-minute appointments now stretch to one or two hours. And, patients can call, text or email him 24/7.


OPINION | APRIL 25, 2011
Top 3 Ways To Increase the Number of Concierge Physicians Across The U.S.
When a physician is free to create pricing structures that meet their local demographic demands without the intrusion from insurance and avoid providing “hamster healthcare,” which only allows doctors to spend 6 to 9 minutes with their patients, you make a happier patient, healthier family and less frustrated and fatigued doctor who is able to care for their patients more thoroughly and comprehensively.


Patients Aren’t Consumers. But They SHOULD Be.
A Response To A Recent Article Published In The NY Times.
When we think about soaring health care costs in the United States, isn’t one of the main reasons precisely because patients have NOT been treated as consumers spending their own money? In that case, I think Krugman has it backwards. If the goal is to control health care costs, that will never happen until patients are treated like consumers.

American Well Launches Online Care for Providers, Bringing Telehealth to Practices Nationwide
New offering allows care encounters with patients at home or work, using Web or phone, while supporting shift toward Accountable Care contracts. Online Care For Providers equips physician practices with new capabilities, including: Specific features that help physicians to increase revenue from patient interactions that are currently not reimbursed, such as phone calls or e-mails – or to offer entirely new services, such as specialty consults and concierge medicine.

Concierge Medicine Physician Shortage — And Where The Growth Is The Highest
Demand For Concierge Medical Care Currently Outweighs Supply of Physicians Across U.S.


Healthcare Leaders Worry That Boutique Medicine Will Exacerbate Physician Shortage

More physicians are moving into boutique practice, in which patients pay an annual fee on top of insurance in exchange for more personal care and better access to their physicians, according to a Boston Globe report. Some healthcare leaders worry that more physicians will choose boutique medicine as reimbursement drops. When one physician moves to boutique practice, hundreds of patients are left with out a physician — a problem considering the already existing shortage of providers.

More docs gravitate toward boutique practice
Concierge medicine is expanding as more doctors—and patients— tire of assembly-line primary care, opting for something more personal, and pricey. The numbers are still very small —a survey commissioned by a congressional agency last year identified 756 concierge medical doctors in the United States, up from 146 in 2005. And Florida-based MDVIP, a company that helps physicians set up these practices, said it will add six new MDVIP doctors in the Boston area this year, increasing its physicians statewide to 16. But even a tiny number of doctors leaving traditional offices for boutique practices—out of thousands of primary care physicians—is enough to make some health care industry leaders nervous. They worry that more doctors will follow as insurers and government payers cut fees and hem in providers with regulations. And when even one doctor makes the switch, there are substantial side effects, leaving hundreds of patients to scramble for a new physician.


New Health Care Act Removes Legal Justification For Most FNCS Concierge Practices
By John R. Marquis | Contributing Legal Writer | Warner Norcross & Judd LLP
85 East 8th Street, Holland, Michigan 49423 | |

The largest segment of the concierge medicine industry is now almost ten years old. The legal foundation on which it is based was laid in 2002, when Tommy Thompson, the then-secretary of Health and Human Services, formally concluded that physicians who participate in Medicare could nonetheless charge patients a special fee in exchange for services that are not covered by Medicare, even when the fee amounts to a precondition to providing Medicare-covered services to those patients.


APRIL 8, 2011
More Threats to Walk-In Medicine: Enter, MOBILE MEDICINE
By WhiteGlove House Call Health | ConvUrgentCare Report
Last month we described the growing momentum behind telemedicine and virtual visits. We also discussed how this new approach could threaten urgent care and retail clinics because patients can be cared for at home rather than driving to the nearby retail store, medical office building or standalone urgent care facility. This month we introduce another concept, called WhiteGlove House Call Health, that is the latest potential threat to walk-in medicine. It is essentially a mobile MinuteClinic and more, providing primary care and urgent care services, using nurse practitioners.


Concierge Medicine Could Create “Insurance Caste System”, Critics Say

The spread of concierge medicine, where patients pay a fixed fee to their physician in return for specialized attention and round-the-clock service, could pose a threat to Medicare by creating “tiers” of healthcare, according to a National Public Radio report. If concierge medicine becomes increasingly popular, those unable to afford $1,000-a-year retainers could be forced onto a lower tier of healthcare, with longer wait times and less face time with physicians, according to the report. Medicare patients are especially vulnerable: As reimbursements decline, physicians are starting to rethink their participation in Medicare, exacerbating an already significant shortage of primary care providers.

Read the NPR REPORT on concierge medicine

U.S. NEWS | APRIL 4, 2011
Dr. Jay Harvey leaves crushing patient load to be a personal physician again
Dr. Jay Harvey’s office in the Tampa Bay, FL area accepts private insurance. Concierge fees will range from $1,800 for families with babies to $1,200 when the youngest child reaches middle school age. In return, he is limiting the number of families he sees to 300. Patients will be able to contact Harvey directly by cell phone, e-mail or text. They also will get four secure e-mail consultations and three video conference visits per year, receive lab results via e-mail, same-day, next-day, evening or weekend appointments with little or no waiting, office visits that take as long as needed, access to an in-office pharmacy for common medicines, as well as waiting rooms that offer video games, wi-fi and Starbucks coffee. They also will get to see Harvey, not whomever happens to be on call. For additional fees, Harvey will even make house calls and accompany parents to school meetings for special needs kids. “I’m offering things no traditional practice can hope to touch,” said Harvey, who had signed up five families as of last week.


U.S. NEWS | APRIL 3, 2011
‘Concierge medicine’ stirs Medicare worries
If concierge medicine goes beyond just a thriving niche, it could lead to a kind of insurance caste system. Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services and, in return, you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention. But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul. The spread of “concierge medicine,” in which doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge between the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.


Pediatricians experiment with concierge house call practices
Most concierge practices focus on providing additional services and physician access for adults. House calls are sometimes part of the package, but most care is office-based. Dr. Kulich, who founded KidsHousecalls a few years ago, is one of a small but growing number of physicians to establish a concierge pediatric house call practice. He is available 24 hours a day, seven days a week. He has no office and accepts no insurance. Although his practice is financially viable, he has learned that working this way is not for the faint of heart. These new practices are usually marketed as a convenient choice for middle-class and wealthier families. Another selling point is that house calls are a healthier option than seeing children in a medical setting where they could be exposed to various pathogens.


BLOGS | APRIL 1, 2011
Concierge medicine. Is it what healthcare dreams are made of?
Do you long for the old days? You know ’ the ones your father used to tell you about when mom gave him a chance to get a word in. Perhaps he reminisced about walking several miles to school, how hard his father worked to make ends meet, or the doctor that made house calls when anyone in the family fell ill. People say the days of physician house calls and the tender, personalized care that accompanied them are long gone.


U.S. NEWS | MARCH 29, 2011
Associations of Concierge Doctors Spreads To Pediatrics & Home Care Physicians
The American Academy of Concierge Pediatricians – strives to provide a verified network of quality Board Certified Pediatricians that have devoted their practice to provide care that is above and beyond the level of care a traditional pediatric office practice provides. Extended visits and House Calls provide care and patient satisfaction that is unparalleled to the constraints of the traditional office practice at the mission of AACP. Prospective members are welcome to apply for membership in our network of concierge pediatricians. You must be Board Certified and operate (or be in the process of implementing) a Concierge Practice (with or without House Calls).

American Academy of Home Care Physicians – We envision a health care system in which any patient who needs it can receive comprehensive primary medical care in their own home. Since 1988, the American Academy of Home Care Physicians has served the needs of thousands of physicians and related professionals and agencies interested in improving care of patients in the home.

U.S. NEWS | MARCH 21, 2011
British websites are pushing boundaries of online medicine
In Britain, an increasing number of websites are pushing the boundaries of online medicine, with at least a dozen sites offering consultations and medication most countries only allow during in-person visits — or remote ones with the help of a webcam or telephone call. The sites are completely legal, and fall under the jurisdiction of a regulator called the Care Quality commission. Not surprisingly, the most in-demand drugs are for erectile dysfunction, sexually transmitted diseases and hair loss. The websites don’t handle serious medical problems or emergencies and don’t deal in narcotics, painkillers or other drugs people could become addicted to.


CMT Physician and Kittanning, PA Homer Schreckengost, MD Finds More Patients When Offering Weekend and Evening Appointments
Homer Schreckengost wants patients to feel at home when they visit him at his doctor’s office. Schreckengost not only works out of his East Franklin Township home basement, but offers personalized health care through a new technique called “concierge medicine.” He can perform many treatments, offers weekend and evening appointments and even makes house calls to make sure patients deserve personal attention.


U.S. NEWS | MARCH 21, 2011
Online healthcare companies: Do they help or hurt the public?
MDLiveCare, Zipnosis, Virtuwell and the like prescribe mainly antibiotics and antihistamines, and they say they can take as detailed a medical history online or over the phone as most doctors do at an office visit. With that information, company officials say, their doctors and nurse practitioners can decide whether to treat patients or refer them for a hands-on workup. Rob Webb, CEO of OptumHealth Care Solutions in Golden Valley, Minn., figures that online health care companies are following the same path to acceptance as nurse-staffed retail clinics such as MinuteClinics in CVS drugstores.


U.S. NEWS | MARCH 21, 2011
Medical practices increasingly allow online appointments
About 16% of family doctors used online scheduling in 2009, up from 6% in 2005, according to the American Academy of Family Physicians. Most do it on their own or through health systems in which they work. Several factors are driving the trend. On the doctors’ side, it’s mostly the need to add patients and reduce overhead costs. They’re also growing more comfortable with computers. About half of family doctors use electronic health records, and 44% prescribe electronically, according to the academy.


U.S. NEWS | MARCH 21, 2011
Doctors’ House Calls Making A Comeback
There are about 4,000 doctors who make house calls in the United States, a number that is expected to grow if a provision in the health care reform bill is successful. Known as the Independence at Home Act, the provision is intended to encourage more doctors to make house calls by allowing them to share in any savings if they can prove they reduced hospital use, improved quality care and left patients satisfied with their treatment.

ARIZONA | MARCH 21, 2011
For country doctor, house calls are a hike down Grand Canyon
Another day at the office…Dr. Ken Jackson, the 2010 Country Doctor of the Year, at the start of the trail that leads 8 miles down the Grand Canyon to Supai on the Havasupai Indian Reservation. When Jackson rides in, the day gets started around 5 a.m. when he feeds Molly and loads her into her trailer. Next comes a 90-minute drive from his home just outside of Kingman to Hualapai Hilltop, north of Peach Springs, where the trail to Supai begins. Helicopter flights to Supai also depart here. Nurse Leah Goldie brings the medical charts, stethoscopes, Doppler ultrasound and other supplies. She always takes the four- to five-minute helicopter ride into Supai, located eight miles down. After seeing up to a dozen patients, Goldie boards the outbound helicopter and Jackson and Molly head up the trail, a trip that can take as long as three hours.

Primary Care Gaining Popularity In Residency Matches

The number of U.S. medical school students who will enter family medicine residency positions rose 11% over 2010, the second year of increase of these positions in a row, according to the American Association of Medical Colleges. In this year’s National Resident Matching Program (NRMP), there are 2,708 family medicine residency slots and nearly half of those will be filled with U.S. medical school seniors.

Talk In Canada About Concierge Medicine Heats Up: Good & Bad
This week’s show on concierge medicine generated a strong difference of opinion from you. Provital Health & Wellness, based in Edmonton is one such clinic. Provital charges paying patients an annual membership fee of $3500. The high annual fee is usually justified on the basis that the fee pays for unlimited access to dieticians, massage therapists, psychologists and other health care workers whose services are generally not paid for by the provinces.


BLOG | | MARCH 16, 2011
BLOG POST: The Ethics of Concierge Medicine
I find myself an accidental defender of concierge practices. …But, for a moment, try to forget everything you think about concierge medicine. The fundamental ethical concern with concierge medicine is that such a system will price most people out of health care.

CBC Canada Talks Concierge Medicine on Serius Satellite Radio Program
Dr. Brian Goldman hosted an online radio interview on Friday, March 11, 2011 together with Live Right Now, Sirius Satellite Radio Channel 137 and CBC’s initiative to help Canadians live healthier. Dr. Goldman interviews one Canadian physician who is operating a successful concierge practice in Canada and has found a legal way to work and operate around The Canada Health Act.

March 14, 2011
Concierge Medicine Growing in L.A., Orange Counties
Despite the expense, concierge medicine is growing nationally and especially in Los Angeles and Orange counties. Exact numbers aren’t readily available, but national and local physicians, as well as concierge management organization officials said they see growing interest among physicians and patients in Southern California.


Lincoln, NE Doctor Transitions To Concierge Model
A frequent criticism of health care is that doctors have little time to spend on the complex underpinnings of chronic disease or to help patients stay well. Falling reimbursements and physician shortages have made pit stops out of doctor visits. Concierge medicine addresses both shortcoming.

Specialties In Concierge Medicine Not Limited To Primary Care and Family Medicine Anymore
According to Concierge Medicine Today’s recently released research which analyzed concierge medicine specialties across the country for the past 12 months, over 66% of current concierge physician practices operating today across the U.S. are primarily ‘internal medicine.’

The Endangered Berwick CMS Nomination
Without reform, a concierge doctor’s patients would be exposed to the same high rates of errors, infections and accidents that threaten all hospital patients today. As one specialist who cares for the very wealthy (and does not accept insurance), said to me not too long ago: “It doesn’t matter who you are – or how much money you have – you don’t want to be in any of Manhattan’s hospitals.”

Doctors Try New Models To Push Health Insurers Aside
Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs. Now some medical practices are sidelining health insurers entirely, instead charging patients a moderate membership fee each month. The approach gets a nod in the health-care overhaul law. But not everyone agrees it’s the right way to go.

HEALTH | MARCH 7, 2011
Gallup Survey Reveals Happiest States In U.S.
Sun and waves might be good for the soul, according to a new national survey naming Hawaii as tops in well-being among U.S. states – but the sunshine doesn’t necessarily elbow out Northern Lights and snow, as Alaska also made the top 10 happiest states list.

Questions Raised About Oversight of Concierge-Style Health Provides

Direct primary care services typically charge patients a flat monthly fee that allows them to have a physician available on retainer. The fee also ensures that patients can receive coverage for all routine medical care. Beginning in 2014, the federal health reform law will allow direct primary care practices to market their coverage alongside traditional health plans in health insurance exchanges.

Consulting Firm Offers Doctors a Prescription for Successful Transformation
to Concierge Medicine
Addressing the growing challenges facing primary care and non-procedural physicians, Dr. Kihm — who successfully transitioned his own practice to concierge medicine in 2009 — created CMD to help other physicians in their quest to focus more on patient needs and quality care.

MMRGlobal Launches Unique Concierge Medicine
Physician-Patient Electronic Point-of-Sales System
MRGlobal, Inc., today announced that it is introducing an electronic point-of-sale system for physician offices, healthcare professional and hospital systems. The system will deliver targeted messaging to physicians on the features and benefits of MMRPro, specifically the MMRPro Stimulus Program, and tips on providing Concierge Medicine.

Marco Island, FL Physician Opens A Concierge Medical Practice To Treat Alzheimer’s and
Geriartic Patients
The concept of concierge medicine is increasingly popular here and around the country. Now another doctor has begun weekly visits to Marco Island, FL seeing patients for a variety of issues, including internal medicine, Alzheimer’s and general geriatric medicine.

NEWS | FEBRUARY 10, 2011
Value Menu Medicine: Price Transparency Finally Reaches The Doctor’s Office
The more doctors (not office managers, staff or nurses), communicate with patients face-to-face and provide other value-driven options, the more those patients will come back again and again. Up until recently, primary care and health care practices were one of the only segments in the U.S. that rarely listed how much their fees were for their time, services and products.

The Boston University School of Medicine Forms Partnership With Concierge Medicine Today & It’s Research Arm, The Collective
Assists With Pilot Study and information gathering on Concierge, Boutique, Direct Care and Retainer-Based Medical Practices Across The U.S. & Abroad.

Rx Compliance Improves Among Concierge Medicine Patients
Atlanta, GA – In many cases, concierge physicians can reduce the total amount of medication their patients intake by 50-95%, this according to surveys obtained from concierge/direct care physicians operating in the concierge medical movement across the U.S. [November 1, 2010 to February 1, 2011 – Internal Data © 2011].

Medicare advocates call for Health Canada investigation into Copeman Healthcare Centre’s
member-only “concierge medicine” model
Numerous complaints from members of the public who have been denied insured medical services because they are unable to pay the thousands of dollars
in additional fees.

Concierge Medicine: The Cure For Bad Moods
Today there really are visioneering physicians that accept cash and many times, will tell you how much their service costs before you buy anything. Simple, right? Up until just the past few years, the health care marketplace was the only industry in America where consumers of service (ie patients) had no idea how much things cost.

NEWS | JANUARY 31, 2011
Concierge Medical Care With a Smaller Price Tag
One Medical Group doctors see at most 16 patients a day; the nationwide average for primary-care physicians is 25. They welcome e-mail communication with patients, for no extra charge. Same-day appointments are routine. And unlike most concierge practices, One Medical accepts a variety of insurance plans, including Medicare.


Is Concierge health care worth the money?
What gets to you the most about medical visits: waiting days or weeks to see your doctor, the hour-or-more delay when you’re there — or the feeling that, once you finally met with the doctor, you got only 10 or 15 minutes of his time? There is an alternative, if you can afford it: concierge health care.

USA Network’s Royal Pains Actor Acknowledges In Recent Interview That ‘Concierge’ Medical Care Caters To Larger Demographic of People Than Hit Drama Portrays On Small Screen
Hollywood, CA – “I talked to concierge doctors about who their clients are,” says Mark Feuerstein who plays Dr. Hank Lawson of HankMed on USANetwork’s Royal Pains. “I think they’re generally slightly older and slightly less attractive than the ones you see on Royal Pains, but I got a sense for what niche this concierge medicine thing has filled in our marketplace…”

Don’t Look to “Concierge Medicine” to Save the Healthcare System
Ultimately, neither the concierge model nor the patient-centered medical home will save primary care. What’s needed is a completely different approach that puts primary-care doctors in charge of the healthcare system and gives them financial incentives to control costs. When that happens – perhaps as part of the new ACO’s – doctors will flock into primary care again.

Concierge Medicine – The New Social Medicine Culture
Concierge medicine is a re-write to a doctrine older than anyone reading this. This concept is allowing medicine to return to the personal relationships. We all claim to have ‘great’ relationships with our doctors and most of us do. But what ever happened to house visits?

Concierge Medicine, a disruptive force for good in healthcare
I’m captivated with the idea of concierge medicine right now…private pay, family medicine, and especially in combination with major medical insurance. It solves a lot of problems in the healthcare space right now.

Concierge Medicine: Reality or Mirage
Up to this point, I have been skeptical that concierge practices would ever have more than a marginal impact…To me, the $1000 to $2000 yearly fees for direct access to doctors were a powerful deterrent. So were the financial risks of converting to a concierge practice without third party contracts, and the psychological difficulties of abandoning existing patients and downsizing from a panel of 2000 or so patients to 500 to 600 patients…But certain developments, tangible and intangible, are making me take a second look.

The “Top Docs” of 2010 – Released By Concierge Medicine Today
Concierge Medicine Today (CMT) is pleased to announce that after careful review, the Editors at CMT have released their list of the “Top Docs”of concierge, boutique, direct primary care, retainer-based medical practices across America.

Part 1 of 3 Medical Home Series.
Where Everyone Is Invited. Is Included. Is Important.
In the new world of medicine, medical homes and concierge medicine are delivering some big results. These health care providers and the businesses they operate are successful in today’s difficult marketplace because of timing, technology, relationship and the listening ear you receive from every physician you meet inside these practices.

Town & Country Magazine and Concierge Medicine Today Talk About “Top Docs,”
Royal Pains TV Show, Cost & More!
CMT EXCLUSIVE! The Editor of CMT Talks With Town & Country Magazine About Trends, Business Models Used By Physicians, Benefits To Patients, Cost, Services and More! Programs Available For People of All Ages, Backgrounds and Salaries.

What Every Patient Should Know About ObamaCare
Guest Columnist, Martha Boone, MD took nine hours to read the healthcare bill and this is the letter she sent to her patients…

Over 32% of U.S. Members of Congress Pay Annual Fee For “Access” To A PCP
For $503.00 per year, House and Senate members can designate the official congressional physician to be their primary care doctor — meaning they never have to leave Capitol Hill, deal with crowded doctor’s offices or be subject to the same type of care from a doctor as the rest of us.

4 Mistakes to Avoid When Selecting Your Next PCP
Is Eight Minutes Really Enough Time For Your Doctor To Collect 25 Years of Family History?

Who’s Choosing the Concierge Doc?
It’s Sure Not Executives.
Executives account for less than 4% of patients searching for this type of care.

Services Typically Offered by the Concierge MD
Membership fees typically cover basic services that include preventive care, routine physicals, longer appointments, next-day appointments, 24-hour-a-day phone access and e-mail, house calls, coordination of care when you travel, and a CD with your medical records. If you have health insurance, your concierge doctor may submit claims for treatments that are not covered under your membership.

Healthcare Reform and The Concierge Physician
Expanding coverage is a good thing — But the underlying cost of health care must be directly tackled
over the coming years.

Concierge Medicine: Deal or No Deal?
Cost of Concierge Medicine, Direct Care & Retainer-Based Programs Across The U.S.

Concierge Medicine: Shedding (Not Shifting) Costs
According to recent polls among concierge medical physicians from across the U.S., these polls have revealed that more than 50% of current
concierge medicine fees cost less than $135 per month and on average, $1,500 per year…

UPDATE! MDVIP Hospitalization Rates
MDVIP is eliminating over 9,000 hospitalizations per year, saving roughly $79 million in total health care expenditures.

FSAs, HSAs Will Be Less Flexible In 2011
New rules governing the amount of pre-tax money you can put in flexible spending accounts (FSAs), health savings accounts (HSAs) or health
reimbursement accounts (HRAs) will go into effect in 2011.

The ‘Royal Rip-Off’
Darth Vader (Hayden Christensen) sues USA Network over ‘stolen’ TV Series, Royal Pains.

Hybrid Concierge Medical Practices Gaining Traction Among Geriatricians and MDs with Large Senior Populations
A growing number of geriatricians and physicians with large senior populations are turning to alternative practice models, including direct pay,
full-model and hybrid concierge programs.

Direct Primary Care and Concierge Medicine.
What’s the Difference?
Direct primary care practices, similar in philosophy to their concierge medicine lineage – bypass insurance and go for a more ‘direct’ financial relationship with patients and also provide comprehensive primary care and preventive care services for a very affordable fee. However, direct primary care is only one branch in the family tree of concierge medicine.

Concierge Medical Care and the 13 Trillion U.S. National Debt
Concierge medical care is so affordable that 928,571,429 people could be provided this care for 10 years.

Concierge Medicine A Mere Blip On Medicare’s Radar
The number of doctors charging patients a retainer fee for extra services has grown, but it’s difficult to measure the impact on Medicare beneficiaries…

New Research Center Opens In Atlanta, GA & Takes The Temperature of Concierge
Medicine In America
The Concierge Medicine Research Collective’s data will contribute to the educational information available in the marketplace today. The Collective will
share this information with its members as well as those businesses, HR Departments, lobbyists, physicians and patients who wish to know more
about concierge medicine and its future.

Concierge Medicine Succeeds In Recession
Nearly sixty percent (59.0%) of all current concierge physicians are doing ‘Better’ financially than one-year ago.

Patients Prove Price (ie “Savings”) Is Why They Choose Concierge Medicine
Results of Summer 2010 Patient Survey Conclude That Cost Savings Is Why They Choose A Concierge Medicial Physician For Their Individual and Family Care.

Bad year for concierge medicine

Updated December 29, 2010 | By John R. Marquis | | EMAIL JOHN >>

It has not been a particularly good year for “fee for non-covered services” concierge medical practices. The uncertainties created by the Patient Protection and Affordable Care Act signed into law in March (CMS has now nicknamed this new Act simply the “ACA”), especially the injection of the annual Personalized Prevention Plan Services (“3P Services”) into the mix, has been profound. CMS has now issued its Final Rules (published in the Federal Register the last few days of November) (the preliminary Rules were published in June), and there is no change that would affect or benefit FNCS practices.

The Final Rules are almost 700 pages long, and, of course, they deal with a good deal more than the 3P Services I have been concerned about. Spokespersons for CMS have been imprecise in referring to these 3P Service over the last several months, going so far as to call them an “annual checkup.” This led many to confuse these annual services with the “initial Medicare physical” (the “Welcome to Medicare” physical) and to conclude that the “initial” physical was now an annual one and covered by Medicare. The Final Rules are clear that the “initial” physical has NOT been disturbed or changed by the ACA or the Rules and that the 3P Services (which CMS has now nicknamed “AWV” (standing for “annual wellness visit”)) are new, separate services.

So, where are we? Here is a summary of my concerns:

  • Many concierge physicians provide an annual “wellness plan” in conjunction with the patient’s annual physical exam. I think the AWV services, set forth in the ACA and the Final Rules, by definition will overlap in some ways any “wellness plan” that a concierge physician is going to develop for a patient. Therefore, any physician who charges an annual fee for coming up with a “wellness plan” for the patient is likely charging for something that is now covered (as of 1-1-11) by Medicare.
  • I think the physician can continue to include an annual physical in the annual payment (since the “physical” is something different from the AWV services), although some caution is still warranted – the Final Rules acknowledge that there are some similarities and overlaps between the AWV services and an annual physical.

At the very least, in my view, a FNCS physician should eliminate from his or her contract any reference to the provision of an annual wellness plan. Just take it out and don’t develop one for patients unless he or she is charging for it outside of the annual fee. And the contract should, just to be safe, have the patient acknowledge that the annual fee does NOT cover the AWV.

Some might even consider eliminating the physical altogether and simply providing enhanced access services (“amenities”) in exchange for the annual fee. There does not appear to be any real question that such services are not covered by Medicare.

I am sorry that I cannot be more specific or definitive about all this, but we have been thrust into a gray and murky landscape with these new rules and regulations. I suspect that things may become clearer as we go along, but, frankly, I don’t hold out much hope for the short term.


Although not a great year for Concierge design practices (FNCS in Marquis language), it may have been a banner year for Direct practices. The ACA opened the door for a marriage of Direct practices with wraparound insurance designs so that our patients will no longer have to buy their primary care twice. In a more subtle sense, this line in the ACA may even have clarified for the first time that the monthly fee IS for health care and that it should be viewed as a legitimate health care expense whether or not reimbursed by insurance.

Qliance will likely have some very positive announcements in the next few months. As the medical economy as we know it speeds toward the economic cliff, there will be an opportunity for less expensive, more humane, more effective health care to show what it can do – to defy the laws of medical economics. Qliance is producing data that is hard for even us to believe: like 62% reductions in ER use, 50% reductions in advanced imaging and specialist care, and 25% fewer hospital days in our patients – combined with extremely high levels of patient satisfaction. This is not bad news for monthly fee practice, but may provide a bar for us to all strive for.

I hope that some of the Concierge practices are watching and considering what health care could be like if they cast off the shackles of FFS reimbursement and really started working for their patients exclusively.


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Health Care With Personal Service
Doctors, patients jumping on trend of concierge practices.

By Kim Underwood | Email the author | December 27, 2010

Some Reston-area residents are taking part in an increasing health care trend: primary care physicians who are changing their practices to “concierge” practices.

Concierge medical practices charge a membership fee to join – which critics say makes them “too exclusive” for the average patient. However, in return, concierge doctors conduct more extensive annual physicals and testing, offer “assured appointments,” detailed lab results, health risk analysis, and assessment of long-term wellness goals.

One Reston physician who has made the switch is Dr. Kevin Kelleher. Kelleher, with business partner Dr. Mark Vasiliadis, founded Executive Healthcare Services in 2004, leaving their traditional practice, Generations Family Practice, located next door.

Kelleher and Vasiliadis still own and operate Generations, but see only patients at Executive Healthcare.

Vasiliadis first heard about concierge medicine in 2001 from MD², the first concierge practice in the US, started in Seattle in 1996.

Vasiliadis’ and Kelleher’s family practice, Generations, had been growing very well, but they “were very busy, hurried, seeing 25 to 30 patients a day,” Kelleher says.

The doctors said they were stretching to see patients earlier in the morning and later in the evening.

“We weren’t able to implement fully the primary care aspects of medicine that we wanted to,” Kelleher said.

They concluded that concierge medicine was a better model for family care. They could be stronger advocates for patients as their personal physicians.

“I know the people in my care,” Dr. Kelleher said. “I have the time to implement the health improvement steps we have outlined, and early detection is better.”

Kelleher’s patients get 24-hour access to their physicians through e-mail, cell phones, pagers, and they always have a doctor on call. The doctors also make house calls, if requested. There are small perks, too, like snacks in the waiting room. An Executive Physical can take two-hours, and is more comprehensive than most physicals, says Kelleher.

Kelleher says the practice has established a relationship with specialists, offering them “the complete picture of a patient’s health,” and all related laboratory work and data.

Still, Kelleher acknowledges not everyone can afford concierge care.

The fees at Executive Healthcare, which are in addition to any monthly health insurance costs, start with the Initiation (and first month’s) fee of $1500 (for individuals or families). Individuals then pay $250 monthly, while the first adult of a family pays $250/month; the spouse, $200/month; and any children, $50/month. Families with college-age students (18 to 25 years) can pay $150/month for their coverage.

Corporate members, meanwhile, pay $3100 annually, which includes their Executive Physical.

For any patient, office or in-house testing visits are extra, starting at $60/visit. For insurance, the practice is considered an out-of-network provider. Most of their patients do keep their health insurance and get reimbursed for some of the office visit costs.

Executive Healthcare limits the practice to about 300 patients per doctor to be able to focus on those patients. At a traditional practice, it is about 1,000 patients per doctor.

Kelleher says he has a 98 percent patient retention rate. “Patients rarely leave our practice,” he said, “and if they do, they come back.”

Tom and Marion Rametta, who lived in Reston for 30 years before moving to Dumfries a few years ago, have been under Dr. Kelleher’s care for 25 years and said they easily made the switch to the concierge practice.

“It is fabulous,” Mrs. Rametta said. “We feel very specially cared for. It makes medicine so different.” They rarely see other patients in the waiting room, and they don’t wait long to see Dr. Kelleher.”

Meanwhile, Inova recently began a concierge medical program.

Dr. Craig Cheifetz, medical director of the Inova VIP 360 program, thinks it is “the ideal practice – it is what every patient wants.”

Cheifetz also emphasized the low patient-to-doctor ratio. He says their program has about 200 patients per doctor, while the average internal medical doctor has 3,000 to 4,000 patients.

He echoed Kelleher’s assessment that concierge medicine allows doctors to effectively care for and teach their patients, given more time for office visits. “We see outstanding results and they know how to implement the health plans we have developed together,” he noted.

At the Inova VIP 360 program, there is reserved parking, on-site lab work and a fitness consultations. The annual cost for Inova Fairfax’s program is $1,800 per person.

Concierge care comes at a price to non-concierge patients, said Arthur Caplan, Ph.D, Director at the University of Pennsylvania Center for Bioethics.

“I think there is a move toward concierge care, no doubt about that, but it is not going to become a tidal wave,” said Caplan. “The costs involved are not something that most Americans can carry, or even want to carry. Most people in this economic climate don’t have the money to spend three, four, five thousand dollars or more to retain a concierge physician [in addition to paying for insurance costs]. So it is an upperclass phenomenon, in my view. “

Caplan sees the trend as negative for patient care for most Americans.

“The downside of concierge medicine is that for every doctor who goes into concierge medicine, it means fewer primary care physicians for the rest of the population, and there weren’t that many to begin with,” he said.

Caplan also cautioned against assuming that concierge doctors are superior.

“There is no evidence that doctors attracted to concierge practices are better physicians,” he said. “It may mean a faster response from a doctor, less waiting time, etc., but it does not mean the best doctors are going there – that is just a marketing implication of the term concierge.”?

Physicians Rethink Traditional Practice, Consider Hospital Employment in Increasing Numbers

Written by Rachel Fields | December 13, 2010 | Becker’s Hospital Review

Only 26 percent of physicians plan to continue practicing as they have been for the next three years, and many are considering moves to other types of work or retirement, according to a 2010 Physicians Foundation survey.

The survey, completed by 2,379 family physicians, internists, pediatricians, ob/gyns, cardiologists, orthopedic surgeons, radiologists, anesthesiologists, general surgeons and hospitals this summer, found that 14 percent of respondents planned to switch to locum tenens work in the next three years. Eleven percent planned to take hospital jobs, 15 percent planned to switch to concierge medicine and 16 percent planned to retire.

When the same survey was taken in 2008, over half of responding physicians said they planned to practice medicine in the same way as they had been for the next three years.

Read the American Medical News report on the 2010 Physicians Foundation survey.

Uncertainty prompts doctors to rethink private practice, according to survey

Many physicians who responded say they are ready to seek options outside the traditional office.

By Victoria Stagg Elliott, amednews staff. Posted Dec. 13, 2010.

Robert Lauer, MD, PhD, never thought he would leave private practice to become a hospital employee. But after 28 years as a partner in a four-physician cardiology group in New Jersey, he became an attending physician — and the first-ever cardiologist — at Artesia General Hospital in New Mexico.

A recent survey shows that many doctors worried about financial pressures and the effects of health system reform are ready to switch out of private practice.

“The practice was beginning to feel the strain,” said Dr. Lauer, 64. “We were working harder to see more patients and trying to do more procedures, but I was getting older. I wasn’t sure I could do that kind of pace for 10 or 12 more years.”

Concern about how health system reform will roll out in the next few years and continuing instability in Medicare pay have an increasing number of physicians pondering changes in how they practice. Many are considering cutting back on hours, switching to concierge medicine, taking locum tenens positions or selling their practices to accept hospital jobs, according to a survey released Nov. 19 by The Physicians Foundation. The organization was formed in 2003 after health plans settled lawsuits by physicians and medical associations over payment issues.

The survey was completed by 2,379 family physicians, internists, pediatricians, obstetrician-gynecologists, cardiologists, orthopedic surgeons, radiologists, anesthesiologists, general surgeons and hospitalists in June, July and August. About 59% were part of physician-owned practices; 41% were employed by a hospital or other large entity — below the overall 52% employed physician rate reported by the Medical Group Management Assn.

Only 26% of respondents planned to continue practicing as they have been for the next three years. A total of 14% planned to switch to locum tenens work, and 11% said they will take hospital jobs. About 16% intended to switch to concierge or cash practices, and 16% planned to retire.

“It’s the tremendous uncertainty of what is going to happen in the future,” said Lou Goodman, PhD, the foundation’s president and executive vice president and CEO of the Texas Medical Assn. “And hospitals are saying, ‘Come work for us.’ “

The last time the foundation asked doctors about their plans was in 2008. In that survey of 11,950 responding physicians, including family physicians, general internists, pediatricians and obstetrician-gynecologists, just over 51% planned to continue practicing as they had been and only 11% said they would retire. Slightly more than 7% talked about changing to concierge medicine, and nearly 8% planned to switch to locum tenens.

The question about hospital employment was not asked in the 2008 survey but was added in 2010. That’s because of increased hospital interest in hiring physicians, particularly in the wake of the Patient Protection and Affordable Care Act.

The 2010 Physicians Foundation survey found significant dissatisfaction with the new health reform law. The major goal of the survey, “Health Reform and the Decline of the Private Practice,” was to assess physicians’ views of the legislation.

According to the survey, 67% felt “somewhat” or “very negative” about it when it was enacted in March. An additional 27% were “somewhat” or “very positive.” After the initial reaction subsided, 10% felt more positive but 39% were more negative.

Of the respondents, 54% believe patient volume would increase because of reform, but 69% said they did not have the time or resources to treat additional patients while maintaining quality of care. A total of 68% believe that reform would diminish the financial viability of their practice.

“There’s general anxiety about big government, and it is shared by physicians,” said Tim Norbeck, the foundation’s executive director.

This anxiety was compounded by numerous short-term Medicare pay patches in 2010.

According to the foundation’s survey, physicians place reform of the sustainable growth rate formula (36%) above health reform (34%) as the policy that could have the greatest effect on their practices. An additional 30% said they were unsure which of the two would be the bigger issue.

Although the Physicians Foundation’s survey documented a malaise among some physicians, experts cautioned about generalizing based on the results. Foundation representatives said the survey was mailed to 40,000 physicians and e-mailed to 60,000, with 2,379 completing them for a response rate of only 2.4%.

Even those conducting the surveys don’t expect that every physician who says he or she will make a change will do so. However, “a certain percent are going to make a change, and this will have a significant impact on the delivery of health care,” said Mark Smith, president of Merritt Hawkins & Associates, a physician placement firm in Irving, Texas, that conducted the survey for the foundation. “We are going to see a migration away from private practice to employment.”

For example, the foundation noted that many of the options physicians might choose would involve treating fewer patients, which could exacerbate doctor shortages.

Dr. Lauer, who hopes to retire in five years, said he has no regrets about moving 2,000 miles from central New Jersey to southeastern New Mexico to leave private practice for hospital employment.

He said he still works hard, but it’s eight to 10 hours a day rather than up to 14. He said he gets to spend more time with patients, because appointments are longer than they were at his medical group.

At first, Dr. Lauer said he wasn’t sure whether his new job would be the right fit. “But I’m now quite happily employed at this small community hospital,” he said. “The cardiology clinic keeps getting busier, and we’re doing testing that they could never do before. To me, it’s very satisfying.”

House Calls: A New Pediatric Model?

By Bonnie Rochman Monday, November 22, 2010 | Time Inc

Inevitably, kids get sick at the most inconvenient times. It’s uncanny how they manage to spike a fever minutes after the pediatrician’s office has closed, or smack in the middle of a holiday weekend. Why don’t doctors make housecalls anymore, you groan. Ah, they do. Or at least one doc does, provided you live in New York City or nearby, in New Jersey or parts of Connecticut.

The Wall Street Journal profiled Edward Kulich recently, detailing his personalized service that involves everything from routine vaccines and sniffles to sleep consultations. He’s got a fancy title, “board-certified concierge pediatrician,” but really, Kulich explains, he’s just meeting a need.

“I can deliver better care than I did in an office setting,” Kulich, who used to have a private practice in Florida, told me en route to a Manhattan house call. “I’ve never been in-and-out in less than half an hour.” Half an hour? That would be considered a super-long pediatric appointment, by anyone’s standards. Yet for Kulich, 33, it’s the equivalent of a quick follow-up.

His longest appointment lasted two hours, though that’s not the norm either. But here’s the point: each house call is open-ended and not limited to the specific reason you called in the first place. Your kid has an ear infection? No problem. But if you’re also concerned about his eating habits, there’s no need to wait for a well visit to bring that up.

“I take all the time a patient needs,” says Kulich.

But you gotta pay to play. Depending on how close you are to his Brooklyn home and when you call (inherent in the concierge definition is 24/7 availability, even on holidays), Kulich charges $300 to $500. Though he doesn’t accept insurance, he says patients whose parents file can get back up to 70% of his fee.

As for criticisms that concierge medicine is elitist, Kulich has got a ready rebuttal/analogy: it’s no different than private schools. “It’s the same kind of thing,” he says. “You pay taxes for your public school, but you can choose to send your kids to private school. I haven’t heard private school teachers being referred to as concierge teachers.”

Still, he knows his model isn’t for everyone. It’s not for most people, in fact. He doubts he could have made it work in Florida, for example, where he saw up to 50 kids a day. “If people are already paying an astronomical amount for their health insurance, they’re going to want to use it,” he says. “The majority of my calls for inquiries don’t end up in house calls. I say you have to pay up front, and that’s the end of that.”

As a result, his workload varies enormously. A busy day might have him seeing seven kids. A slow day? None. Still, Kulich estimates he’s making about the same amount as he did in private practice — though there are obvious trade-offs.

Take vacation, for example. He’s chained to his coverage area. Earlier this month, for example, his wife and 4-year-old son were on a cruise without daddy. “My son had breakfast with Diego,” says Kulich, “and I am on my way to a house call.”

What do you think about Kulich’s business model? Parents, would you pay out-of-pocket for a pediatrician to be at your beck and call?

$40 for unlimited doctor visits? Sign me up!

By Aaron Crowe | Nov 10th 2010 at 12:00PM
Source: WalletPop & AOL

At prices as low as $40 a month, some medical groups are offering something that’s cheaper than a gym membership, and just as good for your health — unlimited access to their services without having to go through an insurance company.

The plans are called Concierge Medicial Care or Direct Medical Care — and go by other names such as concierge medicine, retainer-based practices, membership medicine, boutique care, subscription-based practices, etc., — and cut out health insurance companies by having patients pay doctors directly, resulting in lower prices because doctor’s don’t have to spend as much time filling out insurance paperwork.

RELATED ARTICLE: “Branding Concierge Medicine

About one-third of a doctor’s time is spent on administrative tasks, said Eduardo Cisneros, who with Axel Lapica co-founded Symbeo, a direct medical practice in Bloomfield, N.J. Instead of filling out paperwork, doctors can spend up to 30 minutes with a patient at Symbeo. Preventative care is a primary need among its patients, but many also join so they can get immediate care when they need it, Cisneros said.

“The biggest impetus for people joining is they feel they have the need to see a doctor,” he said of the five-month-old business with 80-90% of its customers uninsured.

With 70 million Americans uninsured or under insured — with 59 million of them without health insurance for part of 2010 –it’s a big market. Dan, a 35-year-old Symbeo patient who didn’t want his last name used, told WalletPop that he joined the group in June because at the time he didn’t have health insurance. He’s self-employed and a student, and now has other health insurance. He plans on keeping his direct medical care coverage with Symbeo because it’s an inexpensive way to get a second opinion, which he says makes his $40 monthly fee “priceless.”

“I don’t have the money to pay for what each individual doctor’s appointment would cost me,” he said.

Dan has hypertension and has had to pay cash out of his pocket to see a specialist, which isn’t covered in his direct medical care plan.

“I might not be in dire need of medical help, but I want to keep up on any medical conditions,” he said.

Symbeo’s plan covers prevention, sick visits, minor stitches and chronic illnesses such as asthma and high cholesterol. It’s offices don’t have major medical equipment or specialists, although referrals are made. Supplemental insurance for emergencies, such as through Aflac, is needed.

Symbeo’s plans per person are $40 a month if paid a year in advance, or $50 a month for three months. The low prices don’t equate to low quality by doctors who got their medical degrees through an overseas correspondence course, Cisneros said.

“People have asked us flat out, ‘Are these doctors? Are these students? Are these foreigners?’ ” he said. He answers they are all real doctors.

At Qliance, a direct primary care group in Seattle, the monthly fees range from $44 to $129 depending on age and service preferences for unrestricted access to its doctors and nurse practitioners. Using Qliance with a low-premium insurance plan can reduce health care costs by 40% to 50%, according to the company.

Qliance offers 30- to 60-minute office visits, on-site X-ray, laboratory and a “first-fill” prescription drug dispensary, and no limits for preexisting conditions. Its routine care includes vaccinations, routine blood tests, women’s health services, pediatric care, broken bones and ongoing management of chronic diseases like diabetes and obesity.

With a 30-minute visit with a doctor guaranteed, joining a direct medical care plan is like a throwback to the family doctor and having a personal doctor to take care of you. And with prices starting at $40, they’re a throwback to a time when medical care wasn’t as costly.

Hospitals Likely to Consolidate in Response to Compliance Regulations Health Care

Written By: Kenneth Artz
Publication date: 11/09/2010
Publisher: The Heartland Institute

Hospital consolidations are expected to increase in the coming year, leading to fewer independent hospitals and doctors, a trend some critics fear could lead to higher health care prices and diminished quality of care.

Costs Will Drive Mergers

According to Edmund Haislmaier, a senior research fellow at the Heritage Foundation, the new health care law gives hospitals more reasons to merge with rivals because of its emphasis on integrated systems where hospitals and doctors coordinate care.

“You’re going to see more concierge medicine—for a fee, a doctor will treat you and your family. This will lower costs for physicians, and they can cut their overhead, personnel, paperwork, and compliance costs,” Haislmaier explained.

He predicts once the insurers with other areas of coverage besides personal health care realize what a hassle and expense compliance will be, they will drop out of the game.

“Physicians have to start thinking like they are in a binary world now. You’re either going to have to work with someone who deals with the risks and fills out the paperwork, or you’re going to have to drop out of this system. If you’re a physician, you can live in this environment or think about radically opting out,” said Haislmaier.

‘Power over the Doctors’

Jane Orient, M.D., the executive director of the Association of American Physicians and Surgeons, takes a similarly dim view of consolidation. She points out prices rose rapidly in some markets after hospitals consolidated.

“Politicians and bureaucrats have been trying to make consolidation inevitable and grab power to be as exclusive and charge whatever they want. Call it a ‘monopoly’ or a ‘cartel,’ but the result is always the same in multiple states, and it’s never good for the consumer,” Orient said.

Orient says an added benefit from the government’s perspective is an easier path to exercising authority over the health care system.

“Washington wants to have power over the doctors. That’s the whole idea. Even though hospitals will be privately owned, they will be heavily regulated, and a lot of physicians will be forced out due to compliance costs,” Orient said. “The public will have to take what they can get. This means exorbitant rates for what you peviously could pay a hospital to perform for a procedure 30 years ago.”

Kenneth Artz ( writes from Dallas, Texas.

NOVEMBER 8, 2010
Doctors Abandon Traditional Practice For Concierge Medicine, Hospital Employment
Source: Kaiser Health News

News outlets report on trends in physician employment.

The Palm Beach Post, on the growth of concierge medicine: “As health reform prepares to send another 32 million people into the already stressed health system, some say that concierge medicine is the future — where the wealthy see the best primary care doctors in a luxury setting, and everyone else makes do with clinics staffed by ‘physician extenders’ such as nurse practitioners. … More than 430 MDVIP [a concierge medicine company] doctors now practice in 31 states, seeing 138,000 patients. The growth, nearing 25 percent a year, persuaded Procter & Gamble to become 100 percent owner of MDVIP in December. Meanwhile, its concept has been copied, and some observers put the number of concierge doctors nationwide at 5,000” (Singer, 11/7).

Concierge Medicine Today: In 2009, an online media and news agency, Concierge Medicine Today, was created by entrepreneur and journalist, Michael Tetreault. Media outlets, like Concierge Medicine Today, are perceived to be more relevant and share more factual information when compared to web portals, blogs, independently owned physician web sites and group associations. Why? Because according to the Online Publishers Association, online news and media web sites provide more accurate, educational, informed, unbiased and comprehensive content. This relevance translates into a perception that brands (eg. Concierge medicine) found on media web sites are more informed, relevant, pre-screened and vetted than those found on generic physician directories randomly found on the Internet.

“Concierge Medicine has a story to tell…no doubt,” said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today. “That story is that these practices provide an affordable, cost effective and personal relationship with a doctor. Furthermore, I personally believe it is also a life-line to those primary care physicians across America considering alternative business structures for their practices. It [concierge medicine] is very attractive to just about any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.”

The Wall Street Journal: More physicians are choosing to work for hospitals rather than going into private practice. “The latest sign of the continued shift comes from a large Medical Group Management Association survey, which found that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier. … The trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology.” Meanwhile, “[h]ospitals are also seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations that is encouraged by the new federal health care law” (Mathews, 11/8).

This is part of Kaiser Health News’ (KHN) Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report. In addition, KHN and our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Concierge medicine companies registering more physicians
“Not for every doctor,” boutique practices
remain a niche segment of the health care system.

By Victoria Stagg Elliott, amednews staff. Posted Nov. 3, 2010.

The number of physicians signing on with concierge practice companies has increased, according to statements issued in September and October by two large organizations offering these services. Concierge practices, however, remain a small part of the health system.

“I don’t envision that it is going to be 20% to 30% of health care,” said Wayne Lipton, managing partner of Concierge Choice Physicians, based in Rockville Centre, N.Y. “A couple percent is probably more realistic. It’s not for every doctor.”

The company offers physicians a hybrid concierge program. A member practice continues to take insurance and see a significant proportion of patients in the usual way. Patients have the option of choosing to pay a monthly fee for additional services, such as 24-hour direct phone and e-mail access to their physician. About 50 to 150 patients usually do so.

A total of 172 practices signed on with Concierge Choice Physicians as of October, an increase from the 120 that enlisted at the beginning of the year.

MDVIP, which is based in Boca Raton, Fla., also reported growth. Practices that signed on with MDVIP, which was purchased by Procter & Gamble in December 2009, restrict the patient population to no more than 600. All the company’s patients pay fees for additional services such as longer appointments.

MDVIP had 430 practices as of October. A year ago, 330 were signed on. Many of these practices continue to take insurance, including Medicare, but physicians need to ensure that the additional fees are not used for any covered services.

Doctors who sign on with these companies say establishing some form of concierge practice can be an alternative for physicians in solo or small practices. The companies provide management services and resources for concierge practices.

“The doctors own and control their own practice and remain independent,” said Mark Murrison, MDVIP’s president.

Although these companies reported growth, a Sept. 13 study found that concierge or retainer practices did not become a significant part of the health system or have much of an impact on access to care. This was a significant concern when the model emerged more than a decade ago.

The impact of retainer practices on Medicare beneficiaries could not be quantified, according to the study by the National Opinion Research Center at the University of Chicago and Georgetown University in Washington, D.C. Only 756 physicians operated these kinds of practices in 2009, an increase from the 146 that the Government Accountability Office found in 2005.

Researchers noted that most retainer practices have one or two physicians and operate in large metropolitan areas. Most are in primary care, although a few specialists such as cardiologists and endocrinologists work this way.

Senate’s Two Doctors Call Obamacare ‘Bad Medicine’

Written By: Thomas Cheplick
Published In: Health Care News > November 2010
Publication date: 09/22/2010
Publisher: The Heartland Institute

The two physicians currently serving in the U.S. Senate have released a blistering comprehensive study of President Obama’s health care law, which reveals disconcerting data on the effects the law will have on the cost of health insurance and health care services in the United States.

Sen. John Barrasso, M.D. (R-WY), who commissioned the report along with fellow physician Sen. Tom Coburn, M.D. (R-OK), explained on a conference call with journalists the study, titled “Bad Medicine,” questions Obama’s promise his national health care overhaul would not result in people losing their health insurance or being forced to choose new plans.

It also highlights a new report from the Congressional Budget Office showing premiums for millions of American families in 2016 will be 10-13 percent higher than they would have been without the legislation, representing a $2100 increase in costs per family.

Can’t Keep Plans

Barrasso said the Obama administration recently released a regulation that threatens the health care plans of approximately 75 million Americans.

“This law will increase health insurance premiums, spending, and its overall cost to America is going up,” Barrasso said. “And now they issued this new regulation which effectively means about half of Americans will not be able to keep the original health care plan that they have right now—another promise that this President cannot keep.”

Coburn said the reform represents a “lost opportunity” to have taken pro-market steps to lower health care costs. He calls the new law “unsustainable.”

“Some of the most upsetting, yet not unforeseen, examples of bad policy here include the 16-plus million Americans that are forced into Medicaid, illegal immigrants continuing to get free care while costs are shifted onto Americans, uninsured Americans will be considered violators of the law, and the millions of Americans who will lose their current health plan as employers either drop coverage [and will have to] purchase more expensive, government-dictated health insurance,” said Coburn.

Many Jobs to Be Killed

Barrasso maintains the worst effects of the new law will be felt by low-wage workers because it “raises the cost per hour of hiring workers in America.”

The federal minimum wage requires low-skilled workers to produce goods and services worth $7.25 an hour in order to be worth employing, but the totality of U.S. government regulations before Obamacare pushed the cost per hour of hiring a worker to the mid-$8-range. That trend is exacerbated by the new law, according to Hudson Institute economist Diana Furchtgott-Roth.

“Obamacare moves that cost to a little over $9.00 per hour,” said Furtchgott-Roth. “In order for Americans to get hired, their labor must be worth a little over that amount—a bar that many low-skilled, low-wage Americans just cannot meet.”

Barrasso says this measure will effectively price many people out of the workforce and into unemployment.

“This health care law is especially hard on many Americans who do not have college degrees or technical school training, and that’s many Americans,” Barrasso said. “It’s also hard on those who are looking for work, which is even more Americans during this recession. It makes it harder for small businesses to hire people because of the additional expense to the business of Obamacare’s regulations.”

Small Businesses Strained

Barrasso maintains these health policy changes allegedly undertaken with the aim of lessening the burden on small businesses have actually made the situation far worse.

“Small businesses are suffering from the enormous uncertainty about the ultimate cost of Obamacare on them. There are nearly about 1,700 new rules the Secretary of Health and Human Services has to issue—which they are running behind in issuing, and missing many deadlines,” Barrasso noted. “I believe one of the reasons the unemployment rate has stayed so high, around 10 percent, is because of Obamacare’s new taxes and health care mandates on our country’s businesses and the great uncertainty it has caused.”

“Obamacare is contributing to that high level of unemployment,” Sen. Barrasso explains.

Calls for Repeal

Barrasso has called for the repeal of the health policy overhaul, replacing it with more pragmatic, pro-market solutions that do not damage the economy. He says the aim must be to lower health care costs and make health care affordable to Americans of all socioeconomic levels while fostering personal responsibility and choice.

“Putting 16 million more Americans onto Medicaid is a good example of how wrongheaded this is. You take a system that has repeatedly showed itself to not work with the number of people already in it, and put 16 million more people into it? That will not work,” Barrasso said. “I think we have to repeal and replace this health care law with sensible provisions that will actually lower costs, increase patient control, and put affordable high quality health coverage within the grasp of every American.”

Barrasso, who has read from prior Health Care News stories on the Senate floor, said he plans to keep the drumbeat for repeal and reform going over the coming months.

“While we are in session, I go every week to the Senate floor to give a ‘Doctor’s Second Opinion’ on the health care law, and I note another example highlighting how bad it is for small businesses,” Barrasso said. “I note another unintended consequence of the law, another broken promise made during the debate of this bill, of some new rule or regulation that is bad for patients and health care providers, because this law is bad for Americans.”

Thomas Cheplick ( writes from Cambridge, Massachusetts.

Politicians Try to Deny Paternity of Obamacare

Written By: By Jane M. Orient
Publication date: 10/24/2010
Publisher: The Heartland Institute

Before its passage, politicians were urged to vote for Obamacare as a smart political move. In time, supporters claimed, people would come to love the new benefits. “Good policy is good politics,” President Obama said.

Today, as people find out what’s in the bill, they are coming to hate it. In a leaked PowerPoint presentation, Families USA advises a new message: “The bill isn’t perfect, but we’ll improve it.” Forget about the extravagant claims of reducing medical costs and the federal deficit, it says: “Keep claims small and credible.” A lead Wall Street Journal editorial queries: “Who’s Obamacare’s Daddy?”

Few of the groups that pushed for passage are crowing, and even fewer electioneering politicians are bragging about their authorship of the “historic” legislation.

At our county medical society, there’s a mood of impassive resignation. The society is making a deal with a business group to help doctors survive—and to help the society slow the loss of disenchanted members. There’s no applause for the AMA’s endorsement of the bill.

No Cause to Celebrate

Small medical practices won’t be able to afford the crushing new “compliance” requirements, say the society’s leaders. They have three years to figure out what they are going to do. The alternative to closing or merging is, in this view, to outsource responsibility for studying the new rules, collecting the documentation, and filing reports. Declaring independence from the system hasn’t occurred to them yet, but it will.

Patients have no cause to celebrate either. More people will be covered, but by Medicaid—and unemployment benefits. As employers look at the cost of “minimum essential coverage” or penalties such as $3,000 per employee if any worker qualifies for subsidies, there will be fewer hires and more pink slips—especially around the thresholds of the 201st, 101st, or 51st employee, where new requirements based on “bigness” kick in.

Small businesses may have been excited about the 35 percent tax credits touted on a postcard sent at taxpayer expense. But if they did the math or used the National Federation for Independent Business internet calculator, they probably figured out they didn’t qualify.

Massive Cost-Shifting, New Taxes

The federal government will foot the bill for the swollen Medicaid rolls until 2016. But states will lose the premium taxes on people crowded out of private plans and onto Medicaid—taxes that now fund up to one-third of that program. They’ll also have new demands on already strained or broken budgets, such as the requirements to monitor insurance premium increases and set up insurance exchanges.

In reading the 906 pages of statutory language, one finds no “patient protections” or anything that makes care more affordable. There are only ways of shifting the increased costs to other people or taxpayers.

Most Americans will hate hate features such as the billions of new tax reporting forms, more crowded emergency rooms, decrease in available doctors, loss of medical privacy, additional marriage penalties, and lots of new taxes either because you are defined as “rich” or because you are paying the taxes that “rich” businesses such as medical device manufacturers pass along to you.

Immunization Required

There are things in the bill that some people will like: Federally funded abortions, lots of multiculturalism, national servitude for doctors, acceptance of death by dehydration or starvation, thousands of new jobs for IRS agents and bureaucrats, millions of unwilling new customers for managed-care schemes and federally certified computer systems, and grants for developers of medical cookbooks, ineffective smoking cessation aids, and politically correct “counseling” and “education” programs.

By 2014, Obamacare will suck the economy dry while displacing the professionals and institutions devoted to caring for the sick.

We need to starve it of funding, disown it, repeal it, enjoin it, and nullify it on the state and individual levels. The ideas and their purveyors have to be expelled from the halls of Congress and the palaces of the executive branch, and the society that harbored them must be immunized by this experience against future schemes for a government takeover of medicine.

Jane M. Orient, M.D. (, is executive director of the Association of American Physicians and Surgeons.


October 2010, AAPS – Source: Association of American Physicians and Surgeons, Inc. –

It is simple to opt out of Medicare – far simpler than staying in the Medicare program. Thousands of physicians have already opted out, and we not heard a single regret by any of these physicians. Medicare endangers seniors, rations care and punishes the best doctors whose only aim is to give the best care. For the sake of patients and integrity of the profession, doctors should get out of Medicare.

Once CMS unleashes its dreaded new program of “private auditors” to shake down physicians in the Medicare program, far more physicians will likely opt out – and even more will wish they had.

The AAPS has prepared this “How To” guide for your benefit. These suggestions do not constitute legal advice – please consult an attorney for any legal issues or questions.


Primary Care Training Programs Receive $17 Million
John Commins, for HealthLeaders Media , October 4, 2010

The Health Resources and Services Administration has issued $17 million in grants to bolster primary care training programs in communities across the nation.

“(The grants) target community-level health professions shortages, support workforce diversity, and provide for retooling our workforce to meet the demands of an aging population, the chronically ill, and disabled,” said HRSA Administrator Mary K. Wakefield, RN.

The 99 grants, funded under 2010 appropriations, will support 21 Area Health Education Centers, 68 Geriatric Academic Career awards, and 10 Nursing Assistant and Home Health Aide Program awards.

Awards fall under two AHEC programs that will receive a total of $10 million: Infrastructure development grants go to four universities to establish and advance state-wide or multi-county AHEC programs; and point of service maintenance and enhancement grants support 17 universities that have established partnerships with community-based AHECs.

AHECs are interdisciplinary, community-based training programs led by academic and community leaders who collaborate to improve the supply, distribution, diversity, and quality of healthcare personnel, with a special focus on primary care personnel in rural and other underserved communities.

Sixty-eight GACA grants will share $5 million to support career development for academic geriatric specialists to help address the fast-growing 65-plus population, which is expected to almost double by 2030. In recognition of the importance of comprehensive care, the Affordable Care Act modified this program to expand eligible entities to include schools of medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy or other allied health disciplines in an accredited health professions school that is approved by the HHS Secretary.

GACA grants focus on chronic disease management, geriatric ethics, palliative care, and health promotion. Award recipients also work with underserved and uninsured patients across many community settings including acute, ambulatory, and long-term care.

Ten NAHHA grants totaling $2.4 million will go to colleges or programs that provide community-based training to nursing assistants and home health aides who treat the elderly, chronically ill, and disabled. As nursing homes and home health agencies continue to have problems with recruitment and retention of qualified workers, there is growing concern over the current and projected shortages of these frontline direct care workers. Grantees project that these awards will enable them to train more than 4,000 nursing assistant and home health aide students over the 3-year project period.

Patient ‘Coaching’ Savings Tallied
Cheryl Clark, for HealthLeaders Media , September 27, 2010

As providers heatedly debate whether providing intense patient “support” saves healthcare dollars, a study of 174,120 patients concludes that it does—by about $6 per person per month.

The report suggests that two extra efforts by health coaches to make telephone contact with higher risk patients resulted in a 3.6% reduction in costs after one-year, largely due to reduced costs of hospital admission or readmission, which were 10% less. The study was conducted by David Wennberg, MD, of Health Dialog Services Corporation and colleagues, and was published in last week’s New England Journal of Medicine.

“This is the largest study done of this type,” Wennberg says. He adds that interventions included helping patients navigate the healthcare system as well as providing decision support. For example, decision support includes the coach helping the patient understand the pros and cons of having back surgery for sciatica, which carries risks that may be greater than managing the pain with medications, comes with a greater time to healing and may require repeat procedures. “The goal is to have shared decision making…with a fully informed patient.”

The researchers also initiated phone calls to larger percentages of patients with chronic and other high-risk conditions that put them at higher risk of being hospitalized or using a high number of expensive healthcare services.

The participants, who had similar medical costs and resource utilization at the start of the study, were divided into two groups. The usual support group received three outreach attempt phone calls from healthcare coaches who teach self-care at many levels, and make sure patients understood hospital discharge instructions and adhere to medication regimens. The enhanced support group received up to five outreach attempts, if the subjects had not been contacted with the first three.

The coaches included registered nurses, dieticians, respiratory therapists, and pharmacists.

The study participants included those who were at risk for hip, knee surgeries, prostatectomies, cardiac revascularization procedures and lumbar procedures. Patients classified as being in the top 40th percentile of high healthcare utilization, those with conditions such as heart disease, those at increased risk for surgical intervention and those with chronic conditions such as congestive heart failure or diabetes were included for the enhanced support. “

At some point (with patients at lower risk of needing expensive healthcare services) there is a point of no return. But we didn’t find it in this program,” Wennberg says.

After 12 months, 10.4% of the enhanced support group and 3.7% of the usual support group received the telephone intervention, the authors wrote.

The study found that after one year, costs for facility and professional services were $8.48 per person per month lower in the enhanced support group than in the usual-support group. Pharmacy costs were 52 cents per person per month higher in the enhanced support group. The program’s costs were $2 per month. “The net savings was $6 per person per month.”

The field of care management has been filled with controversy and debate, with many studies showing mixed results. One comprehensive study of 15 care-coordination demonstration projects by the Centers for Medicare and Medicaid Services found significant cost reduction benefit in only two, and the savings were so low they didn’t cover the projects’ costs.

Another meta-analysis showed that care support improves clinical outcomes, “but has mixed effects on cost or resource utilization,” Wennberg wrote.

Participants were employees with one of three types of health insurance who worked in seven geographically and occupationally diverse organizations, but the authors cautioned that the results may not be generalizable to other interventions but Health Dialog has expanded it to the general population.

Care support has been proposed as one component of the remedy for runaway health care costs,” Wennberg and colleagues wrote. “This study shows that an analytically driven, targeted, population-based program can decrease hospitalization and surgical procedures and thereby reduce total medical costs for the population as a whole.”

One important way in which the study showed that this kind of coaching saves costs was in the way coaches assisted patients with decision support, explains Wennberg, who also is a member of the Dartmouth Atlas Working Group team.

Health Dialog Services Corporation markets its coaching program to a variety of plans. The data and trial design was reviewed by an independent third party prior to publication.

DOL Releases New Guidance on Some Key Reform Provisions
Source: National Assoc. of Health Underwriters

SEPTEMBER, 24, 2010 – Tthe Departments of Labor, Health and Human Services and Treasury released new interim guidance establishing an enforcement grace period for key aspects of the new claims and appeal procedure rules under PPACA. The interim guidance, which is welcome news for health plans and self-funded plans, provides for a “good faith” enforcement standard until July 1, 2011, so that health plans have more time to implement the regulations’ very extensive requirements.

Also on Monday, the agencies issued responses to a number of FAQs concerning regulations that have been issued pursuant to PPACA, including questions relating to maintaining grandfather status, the new claims and appeals rule, coverage of dependent children to age 26, and out-of-network emergency services. Some key points from the new guidance include:

It provides relief regarding grandfathering for insured group health plans based on a decrease in the employer’s contribution rate. Specifically, an insured plan may continue to be grandfathered even if an employer decreases its contributions towards coverage by more than 5%, if the insurer obtains a representation as to the employer current contribution rate and the rate on 3/23/2010 and requires (in prominent contract language) that the employer notify it of any changes to the rate.

It extends this rule to multiemployer plans, and provides that for self-funded multiemployer plans with no employee contributions (or fixed-dollar contributions), a decrease in the employer contribution rate will not alone cause loss of grandfathered status, if the employee contribution rate does not go up and there are no changes that would otherwise cause loss of grandfathered status.

It states that guidance will be issued soon addressing circumstances where grandfathered plans may change insurers without loss of grandfathered status (a pleasant surprise).

It provides that the 24-hour urgent care rule applies ONLY to claims—not appeals, which are still under the 72-hour window. Also, a new model notice is provided, as the first one contained mistakes.

It provides that plans may limit health coverage for children until age 26 to only those children meeting the Code section 152(f)(1) definition of children, and may impose conditions for covering children not described in Code section 152(f)(1) (e.g. grandchildren and nieces/nephews) as dependents, “such as” requiring that they be dependents for income tax purposes.

With respect to out-of-network emergency services, it provides that if state law prohibits balance billing—or if a plan or insurer is contractually responsible for any amounts balanced billed by an out-of-network provider—the plan is not required to pay the minimum amount otherwise required by the IFR.

Will Patients Pay for Concierge Medicine?
Written by Rachel Fields | September 21, 2010 | Becker’s Hospital Review

In exchange for a membership fee, patients can receive round-the-clock physician access, same-day appointments, personalized health plans and longer office visits. But in a down economy, physicians considering concierge medicine must wonder if their patients are willing to pay a fee beyond their regular insurance coverage.

Recent coverage of concierge medicine indicates the answer is yes. An August editorial in The New York Times revealed the number of physicians practicing concierge medicine has increased from 200 in 2003 to around 5,000 today. A study published in The Patient: Patient-Centered Outcomes Research showed while physician-patient relations are relatively similar in concierge practice and general medicine practice, concierge medicine patients are more likely to report that their physician spends sufficient time in clinical encounters.

As the 2011 influx of newly insured patients approaches, Wayne Miller, JD, with Compliance Law Group, says, “In this economy, are people still willing to pay a fee beyond what they would be paying for insurance coverage? That’s really a big question because people can’t always afford it, so the critical issue is: what is being offered, and how much is it worth?”

Mr. Miller says patients with modest insurance coverage might be particularly drawn to concierge medicine because it offers “increased access, more education, online care and many other features that may not be paid for by insurance.” He says he has seen concierge practices align themselves with high-deductible plans. If patients take a plan that has a low premium and a high deductible, concierge physicians may be able to save the patient money be identifying problems before they require an expensive treatment. “The thought is, I can help you stay healthy so you can maintain this plan and not pay so much out of pocket,” Mr. Miller says.

Mr. Miller says concierge medicine might also attract physicians who would like to use more technology in their practice. “There are some physicians who want to use online medicine to help their practice, but to do that, they feel they need to have a different kind of patient base or a patient base that’s in tune with technology,” he says.

Physicians with a majority of patients on fixed incomes might have less to gain from concierge services, as well as physicians whose patients visit infrequently. “If you have a lot of older or HMO patients, you have to expect you will lose some of the patient population who won’t be willing to pay, whether or not it’s a great thing for the patients,” he says. Physicians may also need to terminate existing relationships with payors who won’t allow the physician to collect additional payments.

Physicians who have experienced the move to concierge medicine agree that it’s not for everyone. A 2010 article in Kansas’ Wichita Eagle interviewed Aly Gadalla, MD, an internal medicine physician who chose to convert part of his practice to concierge medicine. For $2,500 a year, he gives patients 24-hour-a-day access, his cell phone number, same-day appointments and care that isn’t dictated by third party, according to the report.

Instead of the 2,500-3,000 patients the average physician sees, however, Dr. Gadalla limits his practice to around 250. He said the switch isn’t for every physician, just a certain sector of the population.

Mr. Miller says he believes the growth will continue as some physicians feel overburdened by patient load and financial stress. “Many physicians prefer the practice of medicine that focuses on preventative care and education, and its’ not just feasible [in a general practice environment] to provide a fuller, holistic version of medical care,” he says. “And there are many physicians who don’t want to be tied down to the traditional bricks and mortar kind of arrangement.”

Friday, September 17, 2010 | Modified: Wednesday, September 22, 2010, 12:01am EDT
Concierge practices gain steam
Primary doctors charge annual fee to enroll patients in their
membership roster
Triangle Business Journal – by James Gallagher

DURHAM – When Donna Elliott had her last dizzy spell, her husband called their primary care doctor.

Within a few hours, the Elliotts were sitting in Dr. James Jacobs’ Cary office discussing what likely caused the episode. After hearing a full description of the symptoms, Jacobs said it sounded like Donna Elliott was suffering from a migraine.

It was the first time in 20 years any doctor had suggested Elliott was suffering from migraines despite her meeting with various physicians and neurologists as well as undergoing surgeries on her neck and spine.

Following treatment for her migraines, Donna Elliott says she is feeling great and no longer suffering from dizzy spells.

“The one thing that we can guarantee,” says Elliott, “is that Dr. Jacobs is going to listen to us, make sure we understand what he is saying and then use all of his ability to find an answer.”

Jacobs isn’t any ordinary primary care physician – far from it actually. He is among a number of physicians who charge annual fees to patients, and the patients in return receive more time with their doctors and are more quickly seen when issues arise.

For years, primary care physicians have been adding patients to their rosters to make ends meet. Medicare and private insurers tend to pay doctors by procedure, and primary care doctors perform relatively few procedures. To generate enough revenue, they have to see a lot of patients. It is not uncommon for a primary care physician to have as many as 2,500 patients.

With so many patients, doctors are limited in the time they spend with each patient, and physicians and patients complain that the care suffers as a result.

To counter that system, some primary care physicians have been switching to a membership model. Under such a system, patients pay an annual fee to the doctor. That fee allows doctors to reduce their patient load, meaning more time for each patient. In many cases, the physicians actually make more money with fewer patients paying the annual fee.

“Physicians were only treating illnesses. They didn’t have time to proactively manage patient care,” says Darin Englehardt, president of Boca Raton, Fla.-based MDVIP, a national organization of membership-only doctors. “What we do is create an optimal environment.”

MDVIP, which stands for Medical Doctor Value in Prevention, has signed up more than 420 doctors nationally, with about a dozen in the Triangle, including Jacobs. Patients pay $1,500 a year for membership. That fee covers a physical exam, though acute-care treatments are billed to an insurer. The company says it has set the fee to make it affordable to folks at all income levels – it equates to a pack of cigarettes a day, says Englehardt.

Don Elliott says that while the price seems steep, he believes it’s worth it.

“I would consider that fee to be the best money I ever spent,” he says. “To have a doctor’s e-mail address and cell phone and permission to call him 24 hours a day seven days a week is worth a lot.”

The trend toward membership practices is not new, says Tom Ricketts, a health policy professor at UNC-Chapel Hill’s Gillings School of Global Public Health. Large corporations have offered access to physicians for their rank-and-file employees for many years.

And the practice, sometimes referred to as concierge medicine, isn’t limited to primary care, though recent interest tends to be in that field of medicine, he says.

Dr. John Kihm, a Durham physician who has adopted the model, says he has been able to double the time he spends with each patient. That added time, he says, gives him the opportunity to go over issues with patients, to better manage chronic illnesses and to work toward better preventive care. All in all, he believes he is able to provide a greater level of care, including making house calls, visiting patients in the hospital or nursing home and providing phone consultations as needed.

“All these things that people need in real life, I’m able to provide,” he says.

And Kihm says he has actually seen his income grow since adopting the model.

Ricketts says that doctors who lean toward such models tend to be more entrepreneurial and believe the model “is a more efficient way to deliver care as well as make money.”

Jacobs, who switched to the model at the beginning of the year, says income wasn’t his motivation. In fact, his income has dropped a little. Rather he wanted to be able to spend more time with his patients and provide better care. “This really goes back to why I fell in love with primary care medicine in the first place,” he says.

September 15, 2010
Issues In Primary Care:
Medical Homes And Ethical Concierge Practices

News outlets report on trends in the primary care workforce, including medical homes and concierge medicine.

by Kaiser Health News and Concierge Medicine Today

In the second in a three-part series on primary care, NPR reports on “a nonprofit regional health care collaborative in Maine that’s trying to build medical homes in the state.” One goal of the medical home is for doctors “to be able to hand off some of the less specialized — and often time-consuming — tasks to others. The idea, says [Lisa] Letourneau [who heads the nonprofit], is to have everyone … doing what they are most trained to do. That should best serve the patients and the health professionals.” But while “doctors and patients may be happier and healthier” in medical homes, “what will really determine the success or failure of the medical home in the long run is whether it actually saves money.” Letourneau “says many of the ongoing experiments aren’t focused enough on costs” (Rovner, 8/26).

In 2009, an online media and news agency, Concierge Medicine Today, was created by entrepreneur and journalist, Michael Tetrault. Media outlets, like Concierge Medicine Today, are perceived to be more relevant and share more factual information when compared to web portals, blogs, independently owned physician web sites and group associations. Why? Because according to the Online Publishers Association, online news and media web sites provide more accurate, educational, informed, unbiased and comprehensive content. This relevance translates into a perception that brands (eg. Concierge medicine) found on media web sites are more informed, relevant, pre-screened and vetted than those found on generic physician directories randomly found on the Internet.

“Concierge Medicine has a story to tell…no doubt,” said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today. “That story is that these practices provide an affordable, cost effective and personal relationship with a doctor. Furthermore, I personally believe it is also a life-line to those primary care physicians across America considering alternative business structures for their practices. It [concierge medicine] is very attractive to just about any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.”

Recently, The New York Times, in a reported column about the ethics of concierge medicine: “[I]t’s hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns. One group of doctors in Boston believes it is possible. And in an article published this summer in the journal Academic Medicine, they argue that it can be done to the benefit of doctors and all patients, boutique or otherwise.

Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice.” Those who opt for the “retainer practice” have longer visits, 24-hour access to a physician, “comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients” (Chen, 8/26).

Clinton, OK doctor joins concierge medicine company

By April Wilkerson | Oklahoma City, OK | Posted: 07:25 PM Tuesday, September 14, 2010

CLINTON – Dr. Robert Blakeburn reached a point in his medical practice where a lack of time meant he was only treating patients for their current ailments without focusing much on their overall health. That was simply unacceptable, he said, and not what he got into medicine to do.


September 15, 2010
Who’s Choosing The Concierge Doc? It’s Sure Not Executives.
Executives account for less than 4% of patients searching for this
type of care.*

By Michael Tetreault
Concierge Medicine Today

SEPTEMBER 15, 2010 – Despite the high-powered executives using concierge medicine, executives of all ages and backgrounds are not the most popular patient demographic searching for concierge medical doctors across America today.

According to Concierge Medicine Today and its research arm, The Concierge Medicine Research Collective, an August 2010 survey of patients across America revealed that top-level executives account for less than 4% of the patients across America searching for this type of healthcare.

“I absolutely thought that the numbers would be higher,” said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today (CMT). “With the number of consultants out there saying that [concierge] doctors should gear their marketing efforts towards executives and that a significant number of practices are comprised of this clientele, any physician should come to the obvious conclusion that this audience is not necessarily their primary market.”

So, if it’s not executives who are searching for this type of care, who is looking for membership medicine services?

To find the answer to this question, we turned to the most popular concierge physician search engine on the Internet* Concierge Medicine Today’s DOC FINDER. They receive requests from hundreds of prospective and first-time patient inquiries as well as current concierge patients looking to make a change.

49% – of all concierge physician searches by patients received are for an Individual;

23% – of all concierge physician searches received are for a Couple, with no children;

21% – of all concierge physician searches received are for Families, with children;

4% – of all concierge physician searches received are for Business Owners/Top Executives;

3% – Allowable Margin of Error +/- 3%.

The information stated here provides more evidence that concierge medicine is not just for the deep-pocketed executive. In fact, we have recently learned that over 50% of concierge medicine patients make a combined household income of less than $100,000 per year.3

This data should be very encouraging to the public, as well as the practicing concierge or membership medicine physician in America. This concept, initially thought of by many as healthcare for the rich — is now accessible and very affordable for couples, seniors on Medicare, young families and individuals.

If you would like to locate a concierge physician in your area, click here. Or, to learn more about the benefits and services these physicians provide to their patients, go to our patient education and video reserouce center, This new site has videos, blogs, articles and even a search engine you can use to locate a concierge doctor near you., is an educational and informative web site and blog that allows former patients of concierge doctors, prospective patients and even current ones to watch videos and learn more about membership-based medical practices. The site includes a blog, commentary from physicians and patients, healthcare executives and more!

Sited Sources Include: Concierge Medicine Today, August 2010; The Concierge Medicine Research Collective, August 2010; Alexa Internet, Inc., August 17, 2010; Elite MD, Inc., August 15, 2010

Posted on Mon, Sep. 06, 2010
Concierge model provides high-end doctor’s visit trend
growing in Kentucky

By Mary Meehan |

No tedious waiting while flipping through outdated magazines. 24/7 access to your doctor that’s just a phone call away. And, yes, even house calls.

More and more “concierge” doctors in Central Kentucky are offering these top-flight services for a price — ranging from $1,500 to $4,200 a person annually on top of insurance premiums.

Doctors leaving a traditional general practice say decreasing payments from insurance and shrinking Medicaid and Medicare reimbursements mean they have to take on more and more patients to stay afloat. That results, the physicians contend, in stressed doctors and a reduced quality of care.

So a small number are opting out of that system in favor of concierge services in which patients pay an upfront fee, and the number of patients served by a practice is capped in the hundreds rather than the 1,500 to 2,000 in a typical practice.

The trend, which has been building across the country for about 15 years, is gaining traction in Central Kentucky, with two practices opening in Lexington and one expected to open soon in Versailles. There also are two in in Louisville and at least 12 in Cincinnati.

Many of those are part of the MDVIP network, which partners with doctors to create individual concierge services based on the MDVIP model. The 10-year-old company has more than 134,000 patients and 419 physicians in 29 states, said president Darin Engelhardt. The annual fee per patient is $1,500 to $1,800. Health care reform, with its focus on choice, is likely to push those numbers higher, he said.

“I’m not saying we are the solution,” said Engelhardt, “But we are one solution.”

But what, exactly, is the problem?

Dr. Michael Karpf, executive vice president for health affairs for UKHealthCare, said there is real pressure on general practitioners. In fact, Kentucky could use about 600 more general practitioners to serve 900,000 to 1.2 million underserved patients. It makes sense that doctors can feel overwhelmed and patients can feel underserved.

Any doctor who sees fewer patients contributes to that deficit, he said. But Karpf doesn’t necessarily see concierge doctors having a long-term effect.

It’s simply a matter of supply and demand, Karpf explained. He estimates the cost of a concierge service to be $5,000 to $10,000 a year on top of whatever fee is collected. That includes insurance premiums and out-of-pocket expenses for tests and fees for specialists. If you consider that, he said, there just aren’t that many people who can afford that kind of care.

“They can’t make it work” on a large scale, he said. “It is a niche product.”

For those patients who can pay the price, he said, “it can work out very well.”

Concierge services have their roots in the tradition of executive physicals in which high-level employees go to a place like the Mayo Clinic for an extensive, and pricey, annual workup, complete with VIP treatment.

When OneMD opened in Louisville in 2002, it took that level of service and made it year-round. The practice started with two doctors, each seeing 300 patients. They have since added a third doctor. The fee is $4,200 a person, and there are 80 people on a waiting list.

Dr. Mark Wheeler, one of the founders, said the growth of the practice reflects the desire for quality care, no matter the cost. It’s about choice.

“Some people like to drive a 1992 Yugo,” Wheeler said. “I like the luxury that a Toyota Camry gives.”

He tried this non-traditional model, he said, “because I got sick of practicing medicine on roller skates.”

When he was seeing 60 to 70 patients a day, Dr. Michael Noble said, he felt less like he was practicing medicine and more like he was working on an assembly line.

There were some 18,000 charts at the Paris practice he shared with four other doctors and a physician’s assistant. With shrinking reimbursements from insurers and government programs, the practice needed more patients to make the same money.

“The whole goal,” he said, “was to see as many patients as possible.”

After just a few years of practicing medicine that way, Noble said he started to ask himself: “Is this something I want to do for the rest of my life?”

Noble, who worked a second job as an emergency room doctor to save money to make the shift, has started his own concierge service, Integrity Personal Physicians, in Lexington. His is not the typical doctor’s office. There are cotton towels in the bathroom. There is a big screen TV in the waiting area, although the goal is to make sure no one ever really has to wait. He sees seven or eight patients a day.

Noble views concierge service as a way to return to the kind of practice that once was provided by small-town doctors, including house calls.

That kind of personal attention is why Dan Moses signed up his family for the service and the $5,000 fee.

“Not having to wait” was the main attraction, said Moses, a pharmacist. “That’s my favorite thing. You can walk in and see (the doctor) instead of waiting.”

Dr. Michael Carr, who has practiced in Lexington as an internist for 22 years, is switching to the MDVIP model for many of the same reasons as Noble.

“The current medical system doesn’t allow me to spend the personal time with patients that I had in the past,” he said. “I want to develop a partnership with them,” he said. He had 1,700 active patients but will take a maximum of 600 in his new practice.

“They want this kind of personal care and they deserve this kind of personal care,” he said.

Obviously, not everyone can afford that kind of personal care. Annette Boggs said her in-laws, Ray and Betty Ann Boggs who are in their 80s, had been going to Carr for about five years. They have chronic health conditions and made frequent office visits. But they depend on Medicaid.

The couple learned via a letter that Carr was changing his practice. “You would have thought that someone had died on them,” Annette Boggs said. After weeks of searching, they found another doctor. But the whole process left Boggs feeling uneasy, she said.

“It would bother me to think that (a doctor) wasn’t in this to help people,” she said.

Boggs might feel uncomfortable about the shift, but there’s nothing in the Hippocratic Oath that says doctors can’t make a living, said Karpf. Because of residency requirements, most doctors don’t start their own practices until they are 35. They often come out of school with debt of $100,000 to $150,000, he said.

Karpf suggested that those who opt for the concierge model make sure they pick a doctor who will provide the services promised and who has a network of specialists in place to serve all their needs.

Patients, he said, need to think through their health care decisions and consider the total cost of a service beyond the fee.

“They are going to have to understand what they are doing and what it means,” he said.

September 3, 2010
Truthfully, what’s most important to patients about
the concierge doctor?

By Michael Tetreault, Editor-In-Chief of Concierge Medicine Today

Sources: The Concierge Medicine Research Collective & Elite MD, Inc.

I’ve always been of the persuasion and believe that Concierge Medicine has a story to tell. That story is that concierge [or as they are more fondly referred to by media outlets and patients alike…membership medicine] practices, provide an affordable, cost effective and personal relationship with a doctor. Furthermore, I believe it is also a life-line to those primary care physicians across America considering alternative business structures for their practices. It’s very attractive to almost any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.

But what truly goes through the minds of the public when they are choosing to use a doctor or medical practice like this? As the administrator of DOC FINDER and our educational publications, I can tell you that we talk to and receive hundreds, and now thousands of inquiries and visitors to our site from prospective patients and current patients who are telling us what exactly is most important to them about membership or ‘concierge’ medicine.

To provide our readers, the media and others with more educational and factual insight into the psyche of the concierge healthcare patient (ages 18-98) of present day, we asked our research arm, The Concierge Medicine Research Collective to assist us in surveying prospective patients and current patients of these physicians ‘What is most important to you when choosing a”concierge” physician near you?’ NOTE: This survey was conducted between April 2010 to August 2010.

The results of our survey revealed the following answers:

38% – 24/7 Access is most important;

18% – Same Day Appointments are very important;

13% – Next Day Appointments are important;

9% – It’s important that my doctor participate in Medicare;

6% – It’s important that my doctor participate in most insurance plans;

3% – Prescription and refill requests, when applicable, over the phone;

8% – Other.

Concierge Medicine Today and its research arm, The Concierge Medicine Research Collective, is happy to provide our readers with educated insight and access to our polls and surveys. The information gathered and organized above is done so by these independent agencies and they are not affiliated with any physician or physician association. Knowing this, our readers can rest assured that this survey and data does not represent a specific group, practice or person. It represents the general public and their overall perception of the concierge medicine environment in Amercia in 2010.

Furthermore, we now are providing even more evidence that concierge medicine is not just for the deep-pocketed consumer or person(s) so reliant on insurance that they will not choose this healthcare delivery model. In fact, we have learned that over 50% of concierge medicine patients make a combined household income of less than $100,000 per year.*

In conclusion, things are looking up for the public-at-large in America seeking alternatives to their personal or family healthcare. What most people initially thought was healthcare for the rich and famous is now accessible and affordable for Archie and Edith Bunker and Joe the Plumber. If you’d like to locate a concierge physician in your area or learn more about the benefits and services these physicians provide, go to They have videos, blogs, articles and even a search engine you can use to locate a doctor near you.

5 Questions to Ask When Considering Concierge Medicine

Written by Rachel Fields | September 03, 2010 | Beckers Hospital Review

As more physicians tire of declining reimbursements and growing patient loads, concierge medicine may become more popular. According to the American Academy of Private Physicians, more than 1,000 physicians already practice concierge, boutique or “members only” medicine in which patients receive special services — such as increased access and personal attention — for a regular fee. Wayne Miller, JD, of Compliance Law Group in Thousand Oaks, Calif., says the attraction makes sense for physicians who are “just too busy, have too many patients and don’t feel they can really treat patients the way they’d like to.” He suggests five questions physicians should ask themselves when considering the move to concierge medicine.

  1. Do your patients really want a concierge medicine service?
    Before you commit to starting a concierge or “boutique” practice, you need to look at your patient population to determine whether they will actually use one. “Some of the decision will be based on how committed the patients are to their doctors,” Mr. Miller says. If a large number of your patients will stick with your practice because of a long history of quality care, concierge medicine might work for you. “If the patients are on a fixed income or older,” that might mean they won’t be able to afford a regular fee,” Mr. Miller says. “You have to expect that you will lose some of your patient population who won’t be willing to pay extra for your services, and you need to consider if that’s a good thing for your practice and the patients,” he says.
  2. Will you need to terminate existing relationships with payors?
    Some payors may not allow physicians to collect additional payments from patients in addition to reimbursements. If you continue to participate in third-party payor plans, you will need to make sure your concierge practice does not conflict with payor contracts. “Payors may even penalize the physician for charging that extra fee, which means that some doctors who [pursue concierge medicine] have to become out-of-network doctors because it gives them more flexibility to set up this arrangement.” As concierge medicine becomes more popular, it is likely that CMS will increasingly review concierge care practices to make sure concierge fees charged by the practice are for “non-covered services” under Medicare.
  3. Which additional services are you going to offer?
    If you are charging patients an extra fee for your care, you need to consider which “above and beyond” services they will be paying for. “Can you live up to that obligation?” Mr. Miller says. “If it means longer visits or access all night and day, patients might take advantage of that [and over-burden you]. Can you hire new people or different people to help fulfill those obligations?” If you think your practice may be stretched too thin with patients demanding late-night visits or longer appointments, concierge medicine might not be a good idea.
  4. How much are you going to charge?
    When determining what to charge patients, you need to assess whether the fee is present to lower your patient load and give you more quality time with patients, or whether you need to charge enough to staff new employees and increase your hours. “The charge can’t be so large that the patient can’t accommodate it,” Mr. Miller says. “You also need to consider when you will collect the fee. Are you going to collect it monthly? Annually? What happens when a patient can’t pay?” Though “members only” medicine may seem attractive, you absolutely need to have backup plans in place for patients who decide to discontinue membership or can’t pay when their bill arrives.
  5. Does your state have regulatory issues prohibiting concierge medicine?
    Mr. Miller, who practices law in California, says his state has some regulatory issues that might challenge concierge practices. “Some states have very strict requirements about accepting a fee in return for arranging or providing care,” he says. “In some states, these arrangements might be seen as creating an HMO or pre-paid health plan, which would have to be licensed.” He says physicians have to be careful about which benefits they provide to patients who pay up front. “You need to avoid allegations of an unlicensed insurance plan, and that really requires some expert involvement when setting up a practice like this,” he says.

The American Medical Association has said “retainer contracts, whereby physicians offer special services and amenities (such as longer visits, guaranteed availability by phone or pager, counseling for healthier lifestyles and various other customized services) to patients who pay additional fees distinct from the cost of medical care, are consistent with pluralism in the delivery and financing of health care. However, they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.” This warning suggests concierge medicine may undergo increased scrutiny and that quality care — whether or not a patient is paying a “members only” fee — should still be a physician’s first priority.

Wichita doctor opts for memberships instead of insurance policies

By Kim Hynes | KWCH 12 Eyewitness News | 8:28 PM CDT, September 2, 2010 | (WICHITA, Kan.)

House calls, text messages and web chats are the way a Wichita doctor plans to interact with patients… and he doesn’t take insurance. It’s a new concept in Wichita called concierge or boutique medicine. Thursday Dr. Josh Umbehr opened the first practice in Wichita called Atlas MD. It’s the third concierge medicine facility in the state.

“We’re really bringing that Norman Rockwell feel back to medicine,” Umbehr said. He’s trying to change the way you think about going to the doctor. “We won’t work directly with insurance companies, rather we’ll charge a low monthly membership rate,” he said. Depending on your age, that $50, $75 or $100 monthly membership gives you unlimited access to the doctor. “By not working with insurance companies, we can cut the red tape and broaden the way we can contact our patients,” he said.

That means Umbehr isn’t tied to an exam room. He’ll chat with patients online, answer calls on his cell phone and even make house or work visits. “It’s an option that allows us to slow down, provide care to a smaller number of patients with better quality and more convenient care,” he said. Umbehr says the maximum number of patients he’ll take is 400. He says doctors on average have several thousand patients.

Concierge medicine is not a replacement for insurance, instead Umbehr calls it a supplement for insurance. You still need an insurance policy for things like specialists, hospital visits and major medical events. Umbehr says for prescriptions and lab work, he’ll charge the wholesale price which is often pennies on the dollar.

Umbehr says it’s a different concept but so far people have been open to the idea. He believes in the long run it will save patients money and they’ll have a better patient-doctor relationship. It’s a 24/7 lifestyle for Umbehr. But he says doctors already work a lot and this will be more rewarding.

“Members Only” Medicine Increases Across the United States

By Rachel Fields | September 01, 2010 | Beckers Hospital Review

Concierge medicine is on the increase across the country, meaning that those who can afford to pay a member’s fee might receive more one-on-one time with their physician, more flexible office hours and a purported higher level of care, according to various reports.

Kim Scott, an internal medicine physician practicing in Park City, Utah, is contracted with a company called MDVIP that charges members an annual fee for a higher level of care from participating physicians. Dr. Scott told Park Record she gets more satisfaction from practicing “concierge medicine” because she can spend more time with patients and provide more in-depth feedback.

And the change isn’t limited to affluent neighborhoods: Brian Stein, MD, a private practice family physician in northeast Philadelphia who serves a largely blue-collar community, recently decided to change to the concierge model because of concerns that health reform will flood his office with newly insured patients.

An editorial in the Annals of Internal Medicine this spring questioned the ethics and quality of care delivered in concierge practices. But according to a recent editorial by Pauline Chen, MD, in the New York Times, the issue for many clinicians isn’t the ethics of the practice, but rather whether concierge medicine has been successful and how a physician should best start a concierge practice.

August 26, 2010
Can Concierge Medicine for the Few Benefit the Many?

Earlier this summer a friend revealed that for the last nine years she has been a patient in a concierge, or boutique, primary care practice. For $350 each month, she is guaranteed around-the-clock access to her doctor, appointments within 24 hours of calling, longer office visits and the kind of personalized attention and care coordination she felt was missing with all her previous doctors.

“I love this doctor,” she said. “He really knows me.”

She recounted the details of a recent emergency room visit when a call from the doctor saved her from an unnecessary CT scan and admission to the hospital. “I feel like I have a doctor who’s actually thinking about me and talking to other doctors on my behalf,” she added.

But over the course of our conversation, I also discovered that her husband does not share her enthusiasm. He goes to a doctor in a more traditional primary care practice because he’s uncomfortable with the idea that those who can afford it get better care, while those who cannot pay do not. “I just don’t think it’s right,” he told me.

The two of them had agreed to disagree.

Agreeing to disagree has been what most of us, doctor and patient, have done since concierge, or retainer, practices first appeared in the mid-1990s. Developed as an alternative to the constraints of traditional practice, this new model allowed doctors to offer more personalized care that in turn increased patient and professional satisfaction. By decreasing the total number of patients seen in an office from well over 2,000 to as few as 500, doctors could offer longer visits, increased and immediate accessibility, personalized coordination of hospital care and, in some cases, even house calls and accompanied visits to specialists. In return for these services, patients would pay retainer fees, ranging from just under $2,000 to as much as $15,000 per year.

By 2003, according to a national survey, the number of doctors practicing concierge medicine numbered fewer than 200. And while critics raised ethical concerns about the “abandonment” of patients left without primary care physicians while their doctors downsized and the creation of a “two-tiered” system that exacerbated disparities in health care access, little was done to address those concerns. These boutique practices were a relatively rare curiosity, and practitioners were left alone.

But over the years and particularly in recent months, the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides. An editorial in the Annals of Internal Medicine this spring, for example, questioned not only the ethics but also the quality of care delivered in such practices. The writer went on to urge other physicians to abandon “the neutrality with which the medical community has addressed” this issue thus far.

A month later, over a hundred doctors at a national meeting eagerly attended an event billed as a debate on the ethics of retainer medicine. But they weren’t jostling for places to argue the ethics; they wanted to hear about the experiences of physicians who were already successfully practicing concierge medicine and to solicit advice.

As this issue becomes increasingly divisive, it’s hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns.

One group of doctors in Boston believes it is possible. And in an article published this summer in the journal Academic Medicine, they argue that it can be done to the benefit of doctors and all patients, boutique or otherwise.

Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice. Patients in the retainer practice have longer visits, around-the-clock access to one of five physicians, comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients.

“I feel comfortable that this practice has been set up ethically,” said Dr. David G. Fairchild, senior author of the article and chief medical officer at Tufts Medical Center, who as a primary care physician sees patients at both the retainer practice and the more traditional general medicine practice. “No matter what practice patients are from, we treat them based on their medical need. But we also recognize that there may be a place for a higher level of service.”

That higher level of service, Dr. Fairchild points out, already exists across the country. Many hospitals, for example, have long offered “V.I.P.” rooms or suites or have concierge wards for patients who are willing to pay more during their stay. In the case of the Tufts primary care retainer practice, the differences come down to “add-ons and the environment” that do not affect the quality of care. “Maybe you have a fish tank in one office and not in another,” he said.

This consistency in care across both practices was highlighted in a survey that Dr. Fairchild and his colleagues conducted last year. With responses from more than 300 patients, they found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to do with the services offered — care coordination, physician access and interactions with office staff.

“It’s like going first-class in an airplane,” Dr. Fairchild said. “The experience of people in coach is a little different, but everyone gets to the same place at the same time.”

And at least in this model, more people may be able to board that plane as a result of increased practice revenues. The retainer fees from each new patient can support the physician costs for as many as 50 patients in the traditional practice; and retainer practice patients know from the start that their fees will be used to support teaching, service and free care in the community practice. “Some patients almost feel guilty about wanting this higher level of service,” Dr. Fairchild said. “Using their retainer fees for this type of support helps them see that they are actually making a contribution to teaching and community service, which are the mission of this hospital.”

While Dr. Fairchild is confident that the Tufts retainer practice addresses the ethical concerns of critics, he also acknowledges that concierge medicine is emblematic of larger problems in the health care system.

“This is not how any of us doctors wanted care to be set up,” Dr. Fairchild said, “but the system, as it is now, is broken. Patients are asking for more, doctors are under huge pressures, and there is not enough money in primary care.”

He added, “For the time being, this is a solution that seems to be working for doctors and patients.”

Taking the Temperature: Physician Career Satisfaction
By: Lisa Price, Web Editor | Friday, August 20 2010

Are physicians in general disgruntled with their choice of career?

It is no secret that many physicians today are displeased with their careers. Recently, an MD News reporter made the misstep of asking a physician what she was most excited about in the field of medicine, and the response was terse: she was too concerned about an uncertain future to be excited about her career.

Between Medicaid, Medicare and private insurance reimbursement issues, hospital politics, forced on-call hours and long days at the office, there is a good deal to be displeased about.

In fact, it has been stated that some medical students are making specialty choices based on lifestyle considerations, and this belief is not falling on deaf ears. The Family Medicine Interest Group — an arm of the American Academy of Family Physicians that provides family medicine and medical education information to students — uses AAFP practice survey results regarding average weekly work hours and patients to entice physicians to enter the specialty.

While some physicians are being selective about their specialty, others are entering the realm of concierge medicine or leaving practice altogether to pursue executive careers. So what will this mean for the health care system and patient care? We want to know what you think. Weigh in on this and other issues by submitting your perspective to our submissions box.


Here are some perspectives on other topics that recently arrived in the inbox:

About Newt Gingrich’s Opinion of the Health Care Reform Act

“Newt Gingrich’s response to the questions asked were simplistic, shallow and not informative. The main thrust of the Healthcare Bill is insurance reform, which is 50 years overdue and is an essential reform if we are to begin to solve our healthcare problems. Newt Gingrich and the other Republicans in power have never offered and never will offer a realistic plan to insure all Americans and are just doing the biding of the Health Insurance industry, whose profits have increased over 400% in the last eight years, by refusing to meet even their legal obligations — let alone their moral and ethical obligations — to insure access to health care in this country. Over 70% of physicians in this country are in favor of the Healthcare Bill, a fact that is ignored by news media and Republicans.” — Charles Acher, M.D., Professor of Surgery, University of Wisconsin, Madison, Wisconsin

About Health Care Reform

“The problems with our current health situation are:

1) The current level of bureaucracy established by the Insurance Carriers placing enormous burden on the practice of medicine. Prior authorizations that require that somebody must be sitting for hours listening to elevator music on the phone, complying with each of the thousands of different plans, having more billing staff than health providers, and having to treat our patients with whatever medication is decided by people that haven’t finished high school.

2) Practicing a highly defensive medicine (and very expensive one), just in case we get sued by lawyers that advertise on TV to lure patients with the expectation of becoming millionaires. This would end very simply: Ask the losing lawyer to pay all the costs of the litigation. Then only meritorious cases would reach the courts. Until that happens, we will keep requesting loads and loads of expensive tests, just in case…

3) Medicare works relatively well. Why not extend it to everybody? Where will the money come from? From the savings after getting rid of the Insurance Carriers. How come Blue Cross worked well when it was a not-for-profit insurance company?

4) If our nation’s health should stay in private hands, why not consider extending privatization to other programs? Let’s say, the Armed Forces could be a private company independent of the State. Or for that [matter], the whole government could be privatized. It would respond to its stockholders, and we would save a lot of money by doing away with elections. Only then we would have a true free market society.” — Francisco Tausk, M.D., Professor, University of Rochester School of Medicine & Dentistry, Rochester, NY

August 10, 2010
A primary care direct pay model that works

by Brian Forrest, MD | Source: KevinMD

When I started a cash-only, direct-pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life.

I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose a productivity bonus.

Nine years later, my practice Access Health Care in Apex, North Carolina is living proof that primary care physicians can provide better care to more patients more economically while making significantly more income if we start answering to our patients instead of answering to insurance companies or government bureaucrats.

Our model attracts a lot of interest:

Interested in low cost? How about a patient reducing her expenses managing her diabetes from $5,000 per year to less than $500?

Interested in improved outcomes? How about 91% of patients achieving their target blood pressure within 6 months? How about being named one of only four Cardiovascular Centers of Excellence in our state?

Interested in quality of life? How about only scheduling eight patients per day, leaving ample time for walk-ins and same day appointments, and never seeing more than 16 patients per day?

Interested in reducing professional liability? How about your malpractice premium being cut in half, and having zero risk of Medicare recovery audits?

As word about my practice began to spread, I began answering questions from other physicians looking to start or transition their own practices following our Direct Pay model. Over the past five years, those questions evolved into a consulting practice helping over 75 physicians across the country, in specialties ranging from family medicine to ophthalmology.

In the wake of health care reform, and with physicians facing financial stress from reduced reimbursements and increasing Medicare recovery audits, interest in alternative practice models is surging.

It is time to get off the treadmill of factory medicine, and return medicine to doctors and patients.

Brian Forrest is a family physician and is the founder of Forrest Direct Pay.

Last Updated: August 6, 2010
‘Royal rip-off’
Hayden Christensen sues USA Network over ‘stolen’ TV series

By BRUCE GOLDING | Posted: 2:25 AM, July 7, 2010 | Source: New York Post

The Force apparently wasn’t with “Star Wars” actor Hayden Christensen when he pitched an idea for a new TV series to the USA Network.

The Canadian-born star and his older brother yesterday filed suit in Manhattan federal court against the cable outfit, charging that it stole their idea for a comedic drama about a “concierge” doctor who makes house calls to the rich and famous.

The brothers claim that USA’s “Royal Pains” — which is in its second season — is a shameless rip-off of “Housecall,” which they offered to the NBC subsidiary in 2005.

The Christensens claim a USA exec told them “that, prior to learning about ‘Housecall,’ he was unaware of concierge doctors and that he thought it was a fascinating idea.”

A USA spokeswoman declined to comment.

Posted August 4, 2010, at 3:03 PM ET
Rich Doc, Poor Doc
Do cheaper doctors provide inferior care?

By Brian Palmer | SLATE

Many health insurance companies have responded to health care reform by pushing cheaper plans with a smaller selection of doctors, reports the New York Times. Do these cheaper doctors provide inferior care?

No one really knows. There are mountains of studies on the relationship between systemic health care costs and quality of care. (Most suggest that we’re not getting a very good deal in the United States.) But those reports typically focus on unnecessary procedures and prolonged hospital stays. Few researchers, if any, examine whether highly paid doctors provide better care than their bargain-basement colleagues. In any case, you shouldn’t assume that pricier doctors will be better for your health.

The rates a physician can squeeze out of an insurance company have more to do with market power than quality of care. Some hospitals, with their vast network of affiliated doctors, now dominate particular markets so thoroughly that they practically dictate their own fees. The company that manages the Massachusetts General and Brigham and Women’s hospitals in Boston, for example, has been accused of establishing a monopoly over Beantown medicine. While those hospitals are among the finest in the country, the 4,000 individual doctors in their system earned their high reimbursement rates by joining the right network, not necessarily by providing better care than their Boston-based colleagues.

In addition, a doctor’s ability to build a large client base—and gain leverage for negotiating with insurers—might have little to do with patient outcomes. Studies have shown that patients’ hospital preferences are more responsive to improvements in amenities like wireless Internet and on-demand video than the likelihood that the hospital will help them get well.

If you’re bargain-hunting, you might consider a large university hospital, where some of the world’s finest physicians accept the cheapest insurance plans. Many doctors at the Johns Hopkins Hospital, for example, accept Medicaid’s pitifully low reimbursement rates.

The lack of data on this topic isn’t surprising. It’s not always easy to figure out how much a doctor gets for an appointment or procedure. Large insurance companies typically offer take-it-or-leave-it prices to smaller offices, but hospitals and large physicians’ practices haggle over the reimbursement rate for everything from a primary-care visit to freezing a wart. The negotiated price usually isn’t made public, since neither party wants to undermine its negotiating position with third parties, making analysis of an individual doctor’s compensation somewhat difficult.

It’s also tough to measure the performance of individual physicians. The most common way to assess health care is to measure big-picture statistics like life expectancy or infant mortality rates, or how likely it is that someone will survive after having a heart attack. It’s impossible to assign responsibility for any of these statistics to an individual doctor, because they depend on the performance of a large number of health care workers. Your likelihood of surviving a heart attack, for example, might depend on how fast the ambulance gets you to the hospital, how accurately the cardiologist assesses the state of your arteries, whether the anesthetist effectively monitors your vitals during a bypass operation, and how skillfully your surgeon repairs the damage, not to mention the work of countless nurses and pharmacists. Even the janitor who scrubs your room clean of bacteria plays a role. Outcome data speak to how well the system is working as a whole, but they can’t say much about one doctor or another.

None of this means that you should automatically select the low-premium, small-network health insurance option. Sure, the doctors in the plan might be every bit as thorough as the concierge physicians down the street. The problem is that you might never get to see them. Many patients complain that none of the doctors in their limited network will accept new patients.

July 23, 2010
Suggested Modifications To FFNCS Concierge Practice(s) As
A Result of Healthcare Act

By John R. Marquis (

Proud Sponsor of Concierge Medicine Today

Warner Norcross & Judd LLP

After the publication of my recent article about the new Patient Protection and Affordable Care Act (the “Act”), some concierge physician clients have discussed with me how best to handle the new annual Personalized Prevention Planning Services (“3P Services”) created by the Act. I suggested in that article one method (which I will explain in more detail here) to accommodate these new wellness/preventive services within the normal structure of a “fee-for-non-covered-services” (“FNCS”)ii practice, but it would require a fundamental change in the financial structure of these practices.iii

From a legal standpoint, FNCS practices are based on the principle that a physician may bill Medicare only the approved rate for a given service and cannot charge the patient anything for the service other than an applicable co-pay and deductible. Of course, this rule applies only to
services that are actually covered by Medicare; it does not apply to services that are not covered.

The concluding element of this legal syllogism is that if the service for which a fee is paid is not covered by Medicare, the physician is not restrained by the Medicare laws as to what she can charge the patient.

Most FNCS practices today are built around an annual wellness physical (that is, one prompted not by any injury or malady but one simply scheduled on a periodic basis) and a personalized wellness plan. The following is language used in typical agreements:


June 25, 2010, CMS issued proposed rules relating
to the new Health Care Act and the new
3P Services for Medicare patients.

Click HERE for the rules.

June 8, 2010
Concierge Medical Care & The 13 Trillion U.S. National Debt

Source: Concierge Medicine Today

Utilizing a blended rate based upon national averages for current fees charged for concierge medical care, an estimated 9,285,714,286 people could be provided concierge medical care with the 13 trillion dollar debt. Carrying this out 928,571,429 people could be provided this care for 10 years. These figures are based upon information obtained through average pricing surveys conducted Concierge Medicine Today.

June 1, 2010
U.S. Preventive Medicine®, Greenbrier Clinic Sign Agreement
to Deliver Preventive Medicine Services

Greenbrier Clinic Joins The Global Prevention Network™

Dallas/W. Va. (Vocus/PRWEB ) — U.S. Preventive Medicine®, the leader in disease prevention services, has announced that Greenbrier Clinic has signed a participation agreement with the company to become a worldwide referral partner for members of The Prevention Plan™ seeking executive health, preventive medicine interventions and specialty follow-up care.

Under the agreement, Greenbrier Clinic will become a participant in The Global Prevention Network™, a select group of preeminent health care institutions with recognized research, preventive services and executive health programs in the U.S. and internationally. Affiliates in The Global Prevention Network enable U.S. Preventive Medicine to provide both national and global prevention solutions for individuals, employers, and government entities, and serve as educational partners in U.S. Preventive Medicine’s international outreach efforts.

Located in the West Virginia wing of the renowned Greenbrier Resort and Conference Center, the Greenbrier Clinic was formed in 1948 by progressive business leaders who understood that healthy executives are the cornerstones of healthy corporations. The clinic combines a relaxing environment with unparalleled diagnostic evaluation and care.

“U.S. Preventive Medicine is committed to providing our members with access to the most respected health care institutions around the globe. With a rich history that began in 1778 with its White Sulphur Springs, the Greenbrier has embodied the concept of wellness for over 230 years. Today, the Clinic offers the most advanced diagnostic equipment and expertise available. The Greenbrier Clinic will be a strong addition to our growing network of distinguished preventive and specialized care affiliates,” said Christopher Fey, Chairman and CEO of U.S. Preventive Medicine.

“The Greenbrier Clinic, this country’s pioneer of preventive medicine, is very excited to affiliate with U.S Preventive Medicine. Since inception in 1948 our medical staff has always advocated the importance of preventive medicine and impact this has on longevity. Many major corporations, government dignitaries, professional sports figures and celebrities have frequented the clinic over the past 62 years,” said H. Ed Jones, Administrator of Greenbrier Clinic. “Historically, most of our established patients return every year for their annual evaluation. Our oldest patient has never missed his annual health evaluation in 55 years,” said H. Ed Jones.

The Global Prevention Network provides The Prevention Plan members concierge service directly to the finest health systems in the world for executive health, early disease detection assessments through advanced diagnostic technology, and specialized follow up care. Other network affiliates include the Cleveland Clinic FL, Mayo Clinic FL, Mt. Sinai Medical Center, Massachusetts General Hospital, Cedars-Sinai Medical Center, Scripps Health, American Hospital in Paris and Parkway Health in Singapore.

U.S. Preventive Medicine pioneered The Prevention Plan™ product suite to address the growing health care needs nationwide and internationally. From wellness and chronic care management to The Prevention Plan Prime for seniors, The Prevention Plan offers a comprehensive suite of tools across the entire preventive health care continuum.

Other proprietary innovations include the: 1) Prevention Score™, a tool that tracks an individual’s prevention efforts and key health indicators throughout the year; 2) ROI Calculator that integrates comprehensive national data analytics with a company’s specific information to predict how much the organization can save over time with The Prevention Plan products; and 3) ROI Guarantee to offer clients a reassurance agreement that defined goals will be realized.

About U.S. Preventive Medicine

U.S. Preventive Medicine® is leading a global preventive health movement focused on saving lives and money by keeping people healthy and better managing chronic conditions before they progress. The company provides an integrated continuum of prevention programs—primary, secondary and tertiary—that are based on the clinical science of preventive medicine. The Prevention Plan™, the world’s first preventive health benefit, moves beyond traditional wellness to identify each individual’s top health risks and design a customized plan of action supported 24/7 by nurse coaches. The company is accredited in wellness and health promotion by NCQA and disease management by URAC.

About Greenbrier Clinic

The Greenbrier Clinic’s state-of-the-art diagnostic equipment assures maximum comfort and safety to patients as well as accurate, early diagnosis of medical issues. The medical staff fosters a personal relationship with patients, which builds trust and enhances patients’ understanding of their health. The Clinic’s emphasis on preventive health counseling encourages healthy people to safeguard their most valuable asset, which benefits both the individual and his or her employer. Visitors can enjoy all of the resort’s luxurious amenities, including three championship golf courses, tennis facilities, the Greenbrier Spa, and the superb Greenbrier cuisine.

May 21, 2010
Poll Finding:
Patient Retention Among Concierge Doctors Two Years
Longer Than Traditional Docs

By Michael Tetreault
Executive Director |
The Collective

ATLANTA, GA – In May 2010, The Concierge Medicine Research Collective polled concierge physicians from across the U.S. Preliminary findings indicate that 60% of concierge physicians retain their member patients for 7 to 9 years and longer. They also found that the national patient retention average for a traditional physician (i.e primary care, family practice, internist, etc.) participating with multiple insurance companies, managed care, etc., retained their patients for about 5 to 7 years. Figuratively, this longer-lasting patient retention information further solidifies concierge medicine’s rightful place in the healthcare market. Concierge doctors emphasize that what’s important to patients is relationship with their doctor and true cost savings. These are key and critical factors in the renewals of concierge or membership medicine plans that are now keeping the patient coming back year after year.


Patient Interest In Locating A Concierge Physician Up
Nearly 300% In 2010

Concierge Medicine Today receives requests every single day from people who are wanting to locate a concierge doctor in their area. Since January of 2010, our DOC FINDER Program has become one the hottest and most popular search engines for people looking for either another concierge physician or wanting to explore the benefits and cost-effective services these physicians provide.

Find A Concierge Doctor

May 20, 2010
Morning Read:
Concierge medicine multiplies

By Brandon Glenn | MedCity News

Concierge medicine multiplies: The number of doctors who practice concierge medicine, which involves foregoing insurance and charging higher prices to patients for better service, is small but likely to continue growing. Only about 1,000 doctors in the U.S. have joined the movement, but many physicians who’ve made the switch report that the grass is greener, in terms of both their personal and financial fulfillment. But many complain that concierge medicine creates a “two-tiered” health system of haves and have-nots. “The majority of us think it’s an unethical and ultimately selfish way to practice medicine,” said one internist.

May 19, 2010
Insurers hindering physicians. Docs say insurance protocols are barriers to patient care
By Shantee Woodards | Staff Writer | Source: The Capital | Annapolis, MD

Many Maryland physicians feel that health insurance regulations negatively impact their ability to treat patients, according to a survey released yesterday.

MedChi, the Maryland State Medical Society, conducted the survey in April after ongoing complaints from members about health insurance practices.

Officials asked a sampling of 132 members in different specialties how insurers’ rules – such as preapprovals for tests and medications – affected their services.

The 15-question survey found that doctors feel they are burdened by the demands of insurance companies and have considered leaving the state because of it.

“It’s even worse than we thought. The protocols are really harming patients because they are true barriers to them receiving care, and it transfers the costs from the insurance companies to the patient,” said Gene Ransom III, MedChi executive director. “These measures are really harming the patients’ access to care. It’s a real barrier and it’s a real problem.”

The survey comes as state officials are developing ways to prepare for federal health care legislation. The newly formed Maryland Health Care Reform Coordinating Council has been established to identify how health care reform would impact the state. The group is expected to issue a report in July.

As a result of the survey, MedChi officials are urging the council to identify ways to eliminate or streamline these insurance protocols. They are also petitioning the Maryland Insurance Administration to do a comprehensive review of the preapproval process as well as develop patient protection standards.

Officials from CareFirst BlueCross BlueShield – the largest insurer in the Mid-Atlantic region – declined to comment on the survey’s results.

Last month, the physicians were surveyed to determine how health plan requirements are impacting patient care. A majority of those surveyed have been in practice for more than 20 years and most came from family medicine or the internal medicine field.

Among the survey’s findings were:

Nearly 63 percent felt that requirements for preapproval for services have a very negative effect on their ability to treat patients.

Nearly 60 percent said insurers frequently delay or deny prescription medications or diagnostic testing.

Nearly 50 percent said that it takes two to five hours a day for the staff to meet insurance requirements.

Roughly 77 percent said they considered moving their practice to another state, retiring early, leaving the profession or establishing a fee-for-service arrangement to avoid health insurance requirements.

Dr. Ronald C. Sroka, a primary care physician in Crofton, was among the doctors who participated in the survey.

He said it’s not unusual for his staff to get bogged down trying to get preapprovals from insurance companies, in addition to handling calls from patients and fulfilling other needs.

Many times, the insurer has ordered prescriptions or tests just because they are cheaper, not because they are more effective, he said.

“What we have is an insurance company playing doctor based on the cheapest test that we can do, or the cheapest medication we can prescribe,” said Sroka, past president of MedChi.

That becomes a bigger problem for physicians because they are going to be the ones held legally responsible if the correct tests aren’t performed, he said.

“The doctor is the one held legally responsible. The insurance company is off the hook because they did not say, ‘You can’t do the test.’ They merely said, ‘We won’t pay for it.’ “

Sroka said he’s been trying to retire for the past eight years, but has been unable to do so because he can’t find a replacement willing to practice in the state.

He has considered offering concierge medicine – charging patients a flat fee of $1,500 a year for services – but decided against it because some of his patients wouldn’t be able to afford it.

“When you take care of people you’ve known all of your life, you can’t do that sort of thing,” Sroka said. “I’m very frustrated and I’m very demoralized and I want to quit medicine. But I promised my patients I would find someone who is very good before I leave.”

To see the full survey, visit

May 19, 2010 — 1:23pm ET
Concierge practices multiply as more docs drop Medicare

By Debra Beaulieu | FieceHealthcare

As growing numbers of physicians tire of keeping up with the increasingly frantic treadmill of traditional practice with the near-constant threat of doing it for less and less pay, it’s possible concierge medicine may become less boutique and more mainstream.

The American Academy of Private Physicians, the trade group representing the concierge care movement, says more than 1,000 doctors have gone this route, slashing their patient loads to offer VIP service to those who pay a fee, reports the Fiscal Times. According to an American Academy of Family Physicians survey, 1.2 percent of respondents say they practice concierge, boutique or retainer medicine.

The numbers may still be small, but many physicians who’ve made the switch report that the grass is greener, in terms of both their personal and financial fulfillment. While most of the nation’s primary-care physicians await month-to-month news of a looming pay cut, nearly 60 percent of all current concierge physicians are doing “better” financially than a year ago, while 29 percent indicated no change and 13 percent said they fared worse, according a February survey by the Concierge Medicine Research Collective, an Atlanta-based independent healthcare research center, a recent HealthLeaders Media article reports.

Some areas may be particularly ripe for a revolution–or perhaps mutiny–as physicians face millions of newly insured patients with which to keep up, suggests a piece on Dallas news outlet In Texas, physicians are currently abandoning all involvement with Medicare at a rate of 100 to 200 per year, according to the Houston Chronicle.

But while concierge care may be good for doctors and the mostly middle-class patients who are willing to pay for it, some say it creates an unfair two-tiered health system of the haves and have nots, the Fiscal Times points out. “The majority of us think it’s an unethical and ultimately selfish way to practice medicine,” Dr. Micheal Stillman, an internist at Boston Medical Center, told the website.

Posted on May 18, 2010 at 10:31 PM
Updated Wednesday, May 19 at 12:08 AM
Health care reform laws prompt surge in ‘concierge medicine’

By Janet St. James | WFAA

SOUTHLAKE — Few physicians can dedicate the time and attention to patients that Marcus Welby MD famously did in that 1970s television series.

Dr. Robin Hall in Southlake does.

She’s part of a booming health trend called concierge care.

In soothing spa-like surroundings, Dr. Hall provides medical care 24-7, house calls, same-day appointments at the patient’s convenience, and more.

“If I diagnose someone with cancer, and they want me to, I will go with them to the oncologist office to ask questions on their behalf that they may not think to ask because that’s a very emotional diagnosis,” she said.

For this VIP care, Dr. Hall limits her practice to fewer than 200 patients. Each pays an annual membership fee, starting at $2,000 cash.

She does not take Medicare, Medicaid or private insurance. Patients, however, can use those health plans to fill prescriptions or see a specialist.

Despite that out-of-pocket expense, concierge care is in high demand because of health care reform.

“I do think that as more and more people are insured and there’s less and less time for people to be seen, more and more people will seek this out,” says Dr. Hall of “Because more people are going to be insured, it’s going to be even harder to access care in a timely manner. If individuals already think they have to wait to see a doctor — not only just for the appointment, but in the waiting room, too — that may increase.”

In fact, ten potential patients have scheduled a tour of her upscale Colleyville office this week, which has most of the same medical amenities as a traditional family practice.

Most of her incoming patients are not the affluent elite, but from the middle class, who want to select a personal physician before health care reform limits choices for them.

There are now about 5,000 boutique medical practices in the country. More than 1,000 opened within the last year, according to the Society for Innovative Medical Practice Design. Many more are expected in coming years, as health care reform laws take effect.

Under the law, Americans will be required to carry insurance, but physicians won’t be required to accept it.

Debbie Wessel has insurance, but was sick of being treated like a number in a large family practice.

“We never had the one-on-one relationship with the doctor,” Wessel said. “We never saw the same doctor twice in a row, and they just were not familiar with our charts.”

It’s a situation she suspects will become worse as millions more suddenly-insured patients crowd waiting rooms.

Critics say boutique medicine will only exaggerate the health insurance crisis. Many doctors may leave traditional family practices — widening the gap between the affluent and the poor.

Dr. Hall cut her practice to about one-fifth of what it once was so she could provide better all-around care.

She may not be Marcus Welby, but she believes health care is headed back to the future.

Posted May 18, 2010 at 9:21 p.m.
Texas doctors dropping Medicare patients

By Emily Peters / 325-676-6776

Hundreds of doctors in Texas are dropping out of the federal health care program for senior citizens as physician reimbursements for Medicare decline, but Abilene’s elderly report they haven’t felt the impact quite yet.

More than 300 Texas doctors have stopped serving patients with Medicare in the last two years, including 50 in the first three months of 2010, according to the Houston Chronicle, which compiled the data for a report published Tuesday.

The drop-offs follow years of declining Medicare reimbursement from the federal government. Doctors are now facing another potential 21 percent cut in 2010 in the amount of money they will receive for treating each Medicare patient. Congress has voted three times to postpone the cut, which is now set to begin June 1.

Big Country doctors haven’t started a trend of dropping Medicare service, but many have started restricting the number of new Medicare patients they take, said Dr. Maureen Trotter, a private pathologist and president of the Taylor-Jones-Haskell County Medical Society.

“Some physicians are saying they have to wait for one Medicare patient to move to a different city or a different world before they can accept another,” Trotter said. “Right now, they’re not making any money off them with their office costs and overhead.”

Abilene’s Dr. Austin King allows his office to only accept three new Medicare patients each week. Fortunately, patients don’t wait longer than two or three weeks so far, he said.

“We started this in the past year when it looked like the government was possibly going to reduce reimbursements 21 percent,” Austin said. “If you get too many Medicare patients, you can’t make it financially.”

Instead of dropping or limiting Medicare coverage, some Abilene clinics are making cuts elsewhere in attempts to continue offering the program.

The Abilene Diagnostic Clinic laid off seven workers in early April, partially because office costs rise as Medicare reimbursements dwindle, said Lisa Blackwell, the clinic’s human resources director. She added that the office has also has adjusted supply orders.

“Our doctors are not going to stop seeing Medicare patients,” Blackwell said. “That’s why you have to get creative with other things.”

The increase in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified the state’s Medicare carrier they would no longer participate, up from seven in 2006. The numbers grew to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 doctors to drop out in 2010.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

U.S. Sen. John Cornyn said the inability of Congress to reform Medicare is leaving “seniors without access and breaking the promise we made to them.”

“The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn.

Despite the Texas trend, a group playing poker at the Rose Park Senior Citizen Center Tuesday said they have not yet encountered problems finding Abilene doctors to take their Medicare coverage, but they would face tough times if they couldn’t rely on their government benefit.

Carol Parrott found a specialist in the last year to give her monthly shots to help macular degeneration in her eyes, and she’s not sure what would happen if Medicare didn’t cover it.

“I’d have to take it out of my savings until it was gone,” she said.

Mary Steed said in recent years, she has been a patient of multiple doctors who retired. She doesn’t want to be searching for a new doctor in an era when many are reluctant to sign up new Medicare patients.

“When I started going to the doctor I see now, I made sure to ask him if he was going to be around a while,” she explained. “He said yes.”

Trotter said Big Country patients are at an advantage because many have built long-term relationships with their physicians, who are unlikely to cut them off.

However, she said she expects many doctors won’t have a choice if Congress allows the 21 percent cut.

She said an uproar would be imminent.

“I think the Tea Party would pale in comparison to disgruntled senior citizens because they make up a large group that votes,” Trotter said. “I don’t think they throw bottles on the street like Greek youth, but they vote and they write letters to their congressmen, and those congressmen would get some letters.”

This article contains information from the Associated Press.

May 17, 2010, 11:02PM
Texas doctors opting out of Medicare at alarming rate

By Todd Ackerman | Houston Chronicle

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions.

The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.”

The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.
Not cost-effective

The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.”

“You do Medicare for God and country because you lose money on it,” said Culpepper, a graduate of the University of Texas Medical School at Houston. “The only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.”

Ending Medicare participation is just one consequence of the system’s funding problems. In a new Texas Medical Association survey, opting out was one of the least common options doctors have taken or are planning as a result of declining Medicare funding — behind increasing fees, reducing staff wages and benefits, reducing charity care and not accepting new Medicare patients.

In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent.

The impact on doctors has not been lost on their patients. Kathy Sweeney, a Houston retiree, twice has been turned away by specialists because they weren’t accepting new Medicare patients. She worries her doctors might have to drop her if Medicare cuts go through and they can’t afford to continue in the program.

“I’ve talked to them about the possibility,” said Sweeney, who sent her legislators a letter calling on them to fix Medicare. “They’re hanging in there as long as there’s not a severe cut, but just thinking I couldn’t continue doctor-patient relationships I built up over years is disturbing. Seniors should be able to see the doctors they want.”

The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large.

Congress would overturn the cuts, but their short-term fixes didn’t keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they’ll net $290. If the scheduled 21.2 percent cut goes through, they’d net $72, effectively an 83 percent cut since 2001.

The issue caused the Texas Medical Association to break ranks with the American Medical Association and oppose health care reform efforts throughout 2009. Then TMA President Dr. William Fleming said “reform is doomed to failure” without Medicare reform and called Congress’ failure to devise a rational payment plan “an insult to seniors, people with disabilities and military families.”
No surprise to senator

U.S. Sen. John Cornyn, R-Texas, said he isn’t surprised by the new opt-out numbers, allowing that Congress’ inability to reform Medicare is leaving “seniors without access and breaking the promise we made to them.”

“The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the Senate for not passing a House bill that would have provided a longer-term Medicare fix. “There hasn’t been the political will, but we really have no choice but to fix it.”

Cornyn acknowledged the task is daunting. The Congressional Budget Office recently estimated that eliminating scheduled Medicare payment cuts through 2020 would cost $276 billion.

The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state’s Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out.

Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move.

“I’ve been in practice 24 years, and a lot of my patients got old right along with me,” Culpepper said. “It’s stressful to tell them you’re leaving Medicare and they’re responsible for payments if they want to stay with you. You feel like you’re abandoning them.”

May 18, 2010
Two Tiered Medical Care for Haves and Have Nots
As doctors leave the system, patients scramble to find care


Not long after Cynthia Thek gave birth, her gynecologist opened a new practice in Englewood, N.J. Gone was the traditional waiting room, replaced by a reception area with spa-like ambience. Instead of a hospital gown, patients got a plush bathrobe. “It’s a beautiful space. The staff is superfriendly. You don’t feel rushed by the doctor or even the staff,” Thek, 32, explained recently. “However, [the doctor] also stopped accepting any insurance.”

Thek stuck with her doctor, Jennifer Ashton, for one post-delivery visit, paying $250, about half of which her insurance reimbursed. But when she learned that care for her next pregnancy would run $8,000 to $10,000, much of it not reimbursable, she decided to look for a new OB-GYN.

A small but growing number of physicians are pursuing Dr. Ashton’s approach: abandoning traditional insurance-based practice to offer VIP treatment, including more time with patients, in return for upfront fees. In one common setup, often called concierge or retainer-based medicine, a primary care doctor charges an annual fee ranging from $1,000 to $20,000 just to get in the door. When doctors shift to this model they can cull their patient loads, selecting only those who can foot the bill. The services they provide often include a deluxe annual physical, 24-hour direct cell phone access to a doctor and escorts on visits to specialists. Some doctors still accept insurance and Medicare and bill normally for routine care. Others, like Dr. Ashton, opt out of that system in order to charge what the market will bear. Ashton did not respond to requests for comment .

The Haves, the Have-Nots

Doctors say the concierge system makes life much easier for them and assures better care to their remaining patients. “At the end of the day, you can look yourself in the mirror and you know that you did a good job with the patients you saw,” said Dr. Steve Reznick, a Boca Raton, Fla., physician who cut his roster of patients from 3,500 to fewer than 400 five years ago. “You couldn’t do that seeing 40 or 45 senior citizens a day in the past.” While that may be true for the doctor and remaining patients, it’s not always easy for the thousands who didn’t or couldn’t pay, and who had to find a new doctor. Some health care experts view this as an ominous trend that could exacerbate socioeconomic disparity in the health care system in light of a looming doctor shortage. They say this development could be especially troublesome once the new health care law adds millions of Americans to the health insurance rolls and sends them looking for doctors. “Doctors love it. But in fact, from a societal point of view it’s a tragedy,” said Dr. Richard Cooper, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

The health care legislation recently signed by President Obama is aimed at lowering costs and adding insurance coverage for more than 30 million people by 2014, including 16 million new Medicaid members. But it does not account for the projected shortfall of 35,000 to 44,000 new primary care doctors, nurses practitioners and physician assistants that are choosing alternate disciplines because of increasing workloads, low reimbursements, a paperwork burden and a huge gap in pay compared with medical specialists.

The Doctor is Out

A 2009 survey of general practitioners by the American Academy of Family Physicians showed that 42 percent were not accepting new Medicaid patients. 65 million Americans are already living in areas the government has deemed short of primary care practitioners. And they’re not the only ones dropping out of the system. Recently, Walgreens and two other pharmacies in Seattle, Wash., decided to deny coverage to new Medicaid patients because of low reimbursements. And in a shocking move by one of the most revered hospitals in the country, The Mayo Clinic shuttered its Medicaid facility in Phoenix, Ariz., because it was losing too much money.

Dr. Marc Siegel fired a warning shot about the doctor dearth in an op-ed in the Wall Street Journal last April. “With more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have,” he said. He cited a 2008 report by the Medicare Payment Advisory Commission stating that 28 percent of Medicare beneficiaries had trouble finding a primary care physician; another survey that year by the Texas Medical Association found that only 38 percent of primary care doctors in Texas took new Medicare patients. Texas is not alone, as more and more physicians try to find acceptable ways to practice medicine without feeling like they’re being exploited.

Top-of-the-Line Care for Top-of-the-Market Fees

Concierge-style medicine is one way that overloaded doctors have chosen to respond. The American Academy of Private Physicians, the trade group representing the concierge care movement, says more than 1,000 doctors have gone this route. By another measure, 1.2 percent of respondents to AAFP’s survey say they practice concierge, boutique or retainer medicine.

While fee-for-service, or “private,” doctors have long existed, primary care doctors began converting to the concierge model about 15 years ago. Companies came along to help doctors set up these practices and handle the administration. The largest, MDVIP, has more than 380 doctors. Reznick says all the physicians in Boca Raton have adopted this model, meaning that most patients face a payment just to get in a doctor’s door. (This rise of high-cost medical services was accompanied by low-cost fee-for-service programs aimed at the poor or uninsured.)

In 2002, MDVIP attracted the attention of several Democratic members of Congress, who questioned whether concierge physicians were essentially charging seniors for services that Medicare already provided at established rates. That would be illegal. In a letter and subsequent documents, Health and Human Services secretary Tommy Thompson said that this model was fine so long as the fee was for services that were not covered by Medicare. With the exception of one case in 2004, in which a concierge-style doctor in Minnesota paid more than $50,000 to settle a claim that he violated his agreement with Medicare, HHS has left these doctors alone.

But many doctors say that while the current system is not sustainable, drastic cuts in patient load are ultimately misguided. “It’s a short-term solution to say, ‘I’m going to cherry pick some people who can pay me a concierge fee,’” said Dr. Michael Stillman, an internist at Boston Medical Center. “The majority of us think it’s an unethical and ultimately selfish way to practice medicine.”

Dr. John Goldberg, an internist in the Kansas City area, said he could hardly ask a patient who can barely pay for medication to pay a fee for his care. Juggling many sick patients is just part of a day’s work, he said. “I worked in three or four people [Monday] that didn’t have an appointment Friday when we closed the office,” Goldberg said. “They’re not paying a premium; that’s just the right thing to do.”

The American Medical Association says there’s nothing inherently wrong with concierge-type of arrangements. However, its ethics manual cautions that they “not be promoted as a promise for more or better diagnostic and therapeutic services.” That puts concierge doctors, particularly those who offer traditional service as well, in the awkward position of trying to promise patients that they’re getting something for the extra money while telling the rest they’re not giving up any medical services.

Of course some concierge doctors do say they provide services, not necessarily better care. “What I sell my patients is a better day,” said Dr. Marcy Zwelling, head of AAPP and a concierge doctor near Long Beach, Calif., who shed most of her 3,000 patients. “Do I think that sitting in a waiting room is bad care? No, but it’s probably a waste of time. I don’t think people die because they don’t have what we do. But do I think my patients live longer? I know they do.” There are no peer-reviewed studies of the health benefits of this approach. MDVIP cites its own study showing lower hospitalization rates for Medicare patients who are in concierge practices compared with those who are not. One study from 2005 suggests that the pool of concierge subscribers is less black and Hispanic, and has fewer chronic illnesses, like diabetes, than the general patient population.

Changing by Default, Not Design?

Doctors who have adopted this approach say the current system has forced them into it. To break even with reimbursements from Medicare and private insurance, Dr. Susan Wilder said she used to be able to spend no more than 8 minutes with each patient. “You’re forced into a situation of seeing more and more patients in less and less time, and the patients are more and more complex, and the administrative costs go higher and higher,” said Wilder, who converted her suburban Phoenix practice to a hybrid in which some patients pay a concierge fee while others do not. Wilder said her longstanding patients know that they get quality care no matter what. “I don’t think they needed any reassurance. I’m not going to dumb myself down to take care of my routine patients,” she said.

Reznick, the Boca Raton doctor, said he tried everything to keep his practice afloat. But he couldn’t manage. He now charges an annual fee of $1,800 as well as small payments for office visits.

Like all the concierge doctors interviewed for this story, Reznick found other doctors to take the patients who did not join his program, and kept very ill patients as well as some who could not pay.

Groups that support concierge physicians say the cost – about $4 per day in most cases – is not prohibitive, and that it comes down to a question of choice in the marketplace. “People go to McDonald’s; people go to Burger King, you know,” said Zwelling. “It’s a choice.” Darin Engelhardt, the president of MDVIP, said that most physicians who convert are on the verge of leaving medicine altogether, so it’s not accurate to say that every conversion means one less doctor in the market. To the contrary, the success of MDVIP’s financial model will lure doctors back to general practice, he said.

“On the experienced physician side, we extend the careers of primary care physicians,” he said. “And as far as younger physicians go, we’ve created a model that can prove … that primary care can in fact be viable again.”

But for Thek, who quickly found a new OB-GYN who does accept her insurance, it was not worth the price. “I feel like I get the same level of care at the new practice,” she said, “minus the spa-like office and the plush bathrobe.”

May 17, 2010
Blog Post From Kevin, MD

By Kevin, M.D.

Much has been made about how primary care is dying in this country. Will its fate be perpetuated with health reform, with over 30 million newly insured patients straining the system?

In a guest post, concierge physician Steven Knope predicts a boon for his practice: “As a concierge physician, people often ask me how this move toward a government-run healthcare system will affect me professionally. Speaking honestly, I tell them that it will help my practice, but I do not think this is good news for the country … As someone who practices full-service internal medicine, the demand for my services will continue to increase.”

It’s true that as internal medicine splinters into hospitalists and clinic-only physicians, the demand for the traditional model of internal medicine may increase.

Dr. Knope bemoans the fate for many of his colleagues, saying “their hospital skills have atrophied. They will never practice comprehensive medicine again. For them, the game is already over.”

And internal medicine’s downfall continues.


May 04, 2010
The Practice Of Medicine:
Changes Are Evident — From Med School Training And
Technology To Concierge Medicine

News outlets report on issues affecting physician practices:

Kaiser Health News, in partnership with The New York Times, explores what medical students are taught about health care costs: “Doctors in training have traditionally been insulated from information about the cost of the tests and treatments they order for patients — in fact, for decades, the subject was virtually taboo when professors and trainees discussed treatment decisions during hospital rounds. … Until recently, most schools included little information on financial factors, like how the insurance system works and how treatment costs affect patients’ behavior. As a result, most physicians enter practice with little sense of how to make the most cost-effective choices for patients, or how their own decisions affect the patient’s — and the nation’s — medical bills. … But escalating costs and the national debate over the health care overhaul are forcing medical schools and residency programs to grapple with teaching about the financial side of their profession. Accrediting organizations now require such teaching, and students and residents recognize that they need to understand finances as well as blood tests” (Okie, 5/3).

KHN/The New York Times, in a related story: “Health policy experts hope that technology will become a tool for educating doctors about the cost of care. More widespread use of electronic medical records, they say, will help keep costs in check by providing doctors with precise information on the price of tests and drugs even as they are deciding what to order” (Okie, 5/3).

The Washington Post, on how the new health law might change physician practices: “Fifty years from now, it is likely that almost all doctors will be members of teams that include case managers, social workers, dietitians, telephone counselors, data crunchers, guideline instructors, performance evaluators and external reviewers. They will be parts of organizations (which either employ them or contract with them) that are responsible for patients in and out of the hospital, in sickness and in health, over decades.” Records will be electronic. “Software will gently remind them what to consider as they treat, and try to prevent, diseases. How the patients fare will be measured and publicized, and used in part to judge practitioners’ performance.” In addition, the health care law will likely shift the focus of medicine to primary care, and physicians will be better coordinated, and readmissions could be reduced (Brown, 5/4)., on the physician shortage and the new health law: “After Massachusetts started rolling out its 2006 law to ensure that nearly every one of its residents had health insurance, the sudden influx of newly insured patients created long waits to see primary care doctors. Now, physicians worry the entire country could see the same thing happen when the recently passed health care law takes full effect in 2014” (Vock, 5/3).

The St. Petersburg Times, on concierge medical practices: The concept is “expanding to a middle class market, as more patients worry about access to health care and doctors look for alternatives to the bureaucratic hassles of private practice. Some concierge doctors accept only cash. Others accept insurance, but charge patients a membership fee. That allows them to limit the number of patients they see at a time when primary care doctors routinely have thousands of patients on their books in order to make ends meet. The American Academy of Private Physicians estimates that 3,500 U.S. doctors practice some form of concierge medicine” (Stein, 5/4).

Meanwhile, dentists “are warning they may become unintended targets of legislation designed to overhaul Wall Street,” The Hill reports. “Lawmakers and lobbyists have clashed for more than a year over whether a new consumer financial protection office would cover industries and companies that had nothing to do with the financial crisis of 2008. … Dentists could fall under the Senate financial bill because they often allow patients to pay in installments, [Michael] Graham [managing director of government affairs at the American Dental Association] said. According to a 2009 ADA survey, roughly half of dentists offer this type of billing for three or four months” (Brush, 5/3).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.


April 30, 2010
The Impact of Personalized Medicine Today
HealthLeaders Media

Download the latest HealthLeaders Media Breakthroughs report “The Impact of Personalized Medicine Today,” (This PDF will require 2-3 minutes to download) for a look at how progressive health systems, medical researchers, and physicians are working together to bring the practical benefits of personalized medicine to the frontlines of healthcare delivery.

Personalized medicine is where genetic testing, health IT, and patient-centered care intersect—and where high-value healthcare will live in the foreseeable future. Beth Israel Deaconess Medical Center, The Ohio State University Medical Center, Partners HealthCare, and Vanderbilt University Medical Center share insights and the lessons learned that will help you explore the current and near-term impact of personalized medicine, determine whether your healthcare information technology foundation is ready for the opportunity, and see where lab research and clinical practice are overlapping.

Right now in progressive health systems medical researchers and physicians are laboring jointly to bring the practical benefits of personalized medicine to the frontlines of healthcare delivery. Personalized medicine is where genetic testing, health IT, and patient-centered care intersect—and where high-value healthcare will live in the foreseeable future.

In this HealthLeaders Media Breakthroughs report, leading hospital systems—Beth Israel Deaconess Medical Center, The Ohio State University Medical Center, Partners HealthCare, and Vanderbilt University Medical Center—share insights and the lessons learned that will help you:

* Explore the current and near-term impact of personalized medicine from leading health systems
* Determine whether your healthcare information technology foundation is ready for the opportunity
* See where lab research and clinical practice are overlapping

This PDF will require 2-3 minutes to download.

April 29, 2010
Are Concierge Medical Services on the Upswing?

Joe Cantlupe, for HealthLeaders Media | RELATED ARTICLES >>

A longtime pediatrician, Natalie Hodge, MD, was living the life of primary care despair.

For years she rushed from patient to patient in her office, giving them a few minutes here and there, doing a ton of insurance paperwork, and then decided enough was enough. Like many physicians, she felt drained and lost.

“People calling, people answering phones, people scheduling, people verifying eligibility, people checking on insurance, people . . .” she says. You get the picture.

It wasn’t her style to sit still. Eventually, she founded Personal Medicine, essentially a concierge medical service, which avoids third party payers as much as possible, and adds its own unique touches, like specialization in house calls, and thriving on “virtual” communication. As she sees it, the mix is the bedrock for a “new reality for the future of primary care medicine,” built around “emergent technologies.” Curtailing insurance has cut costs about 80%, she says.

There are growing numbers in the medical arena interested in what she has to say. She was interviewed by the Associated Press, made a presentation to the Mayo Clinic, and in a few weeks she’s preparing a speech about her practice before primary care physicians at the University of Kentucky on May 9. She tells me times are good.

If anything, these are certainly interesting times for concierge medicine, though whether it is the wave of the future remains to be seen. It’s not an easy sell for everybody, either patients or physicians, who number about 5,000 in concierge practices. The medical establishment, too, has viewed concierge medicine skeptically though there are many out there who see it as worthwhile because physicians are continuing to work, and patients will be treated. That’s OK, no?

Docs want to make money, and in concierge, they are making some headway. In a February survey by the Concierge Medicine Research Collective, an independent healthcare research center based in Atlanta, nearly 60 % of all current concierge physicians are doing “better” financially than a year ago. Still, 29% indicated there was no change; and 13 % fared worse, according to the poll.

An attorney, John R. Marquis, has written a paper recently stating that the new Patient Protection and Affordable Care Act “is going to cause serious problems for (concierge) practices and will require them to restructure in order to accommodate it.” Fiscal restraints imposed by the law will impact physicians who remain in Medicare and charge a periodic fee as well as those who opt out of Medicare and then charge the patient a fee for providing all the medical care the patient needs, he said. Marquis discusses the health reform impact on concierge medicine physician practices, particularly related to Medicare, in his paper, “New Health Care Act Deals Serious Blows to Concierge Medicine.”

Hodge said she had been unaware of the paper, but expressed little concern after reviewing it. “We are a network of physicians that create direct patient financial relationships,” she says. “We do not have any interest, nor contractual relationship with Medicare or Medicaid. So this has nothing to do with our business. Lawyers also like to create a lot of mystery and fear around Medicare. PM has a contract with patients. PM has a contract with physicians, that’s it.”

She doesn’t like the term concierge for what she does, preferring to call it direct medical practice.

“We are entering a whole new ballgame for healthcare strategic planning—the post reform era,” she says. “The service line strategy moving forward must be integrating cash revenue stream opportunities and (personal medicine) is a way organizations may implement this as the third party payer pie continues to shrink.”

While running her pediatric practice years ago in St. Louis, MO, she was seeing up to 35 patients a day for about 10 minutes each. “Once I realized how much time my staff was spending on third party payrolls, and then I added that cost up for the year and over the years, it was so sickening,” she says.

That’s when she decided to launch her personal practice, with a “six or seven house call day,” she says. She is moving her business office to San Francisco, and hired a CEO to run the company, which includes about 10 physicians scattered throughout the country, as well as the Dominican Republic and Peru. There is one physician based in Chicago who’s targeting executive healthcare, another in Iowa focusing on elderly care, she says.

“You have a completely paperless loop, between patient and physician,” she says. “You have high level communications. Patients supplant their records from Google PHR or Microsoft or whatever. Patients pay membership fees like they do for their cell phones or other Web-based services.” The average acceptable price for consumers is about $125 a month, she says.

“Patients of course still need some kind of health insurance, but they don’t have to be exorbitant,” she says. “They need a high deductible plan to cover them for cancer or being hit by a bus or being in the ICU for two months. Remember insurers don’t provide services. I provide services. The physician.”

My former physician, a terrific guy, told me a few years ago he was getting out of his practice, tired of the insurance hassles, and was opting for the concierge route. When he finally left, he invited me to join his other patients as part of his concierge business.

After our private conversation, he sent a letter. It was going to be a lot of money, the fixed amount, each month. In return, I would get his personal care, and lengthy individual appointments. I evaluated it. After some thought, I didn’t think it was worth it. The last time I left his office, I thought, “Oh well, I’ll be looking for another doctor.”

I have a feeling Natalie Hodge wouldn’t accept that, and would keep working to get potential patients like me on board.

Qliance Nails $6M From Bezos, Dell, Drew Carey for
Primary Care That Avoids Insurance
Luke Timmerman | 4/27/10 | Source:

Qliance Medical Management isn’t the richest startup in Seattle, but it may have the most star power behind it. The company, which deals directly with patients and doesn’t accept health insurance for primary care medical services, has nailed down another $6 million in venture capital from a group led by Amazon founder Jeff Bezos, and which included Dell Computer pioneer Michael Dell and actor Drew Carey.

Besides those three famous names, Qliance attracted more cash from its existing investors Second Avenue Partners, New Atlantic Ventures, and Clear Fir Partners. The company got started in 2006 with a $3.5 million venture round, followed by another $4 million last July, bringing the company’s total to $13.5 million since inception. Rich Barton, the founder of Expedia and co-founder of Zillow, is another one of the big names that have put money to work at Qliance.

The big idea at the company, which we first profiled in December 2008, is a simple and disruptive one to the current U.S. healthcare system. Qliance runs what it calls a “direct practice” in downtown Seattle, which doesn’t accept any health insurance and deals directly with patients. The patient hands over a credit card, and agrees to pay a $44 to $84 monthly membership fee to Qliance for unrestricted access to its primary care medical services. The model allows Qliance to avoid spending its time doing things to get insurers to pay for primary care, which frees up the doctors to spend more time with individual patients.

Routine primary care—things like women’s health exams, flu shots, X-rays—make up almost 90 percent of the medical issues that prompt people to see a doctor, Qliance says. Going through an insurer to get these routine things done is sort of like asking your car insurance provider to reimburse you for an oil change; insurance is really needed when you’ve been in a serious accident, Qliance CEO Norm Wu said last month at an Xconomy event. Once people use “direct primary care” that avoids insurance, Qliance says consumers can get a catastrophic health insurance policy to cover them in case of a serious accident, or a cancer diagnosis, that is beyond the scope of what a primary care doc can treat.

By combining the monthly fee of primary care with the secondary insurance, Qliance contends employers and patients can save as much as 50 percent on their overall health spending, and improve overall health by making it easier for people to see a primary care doc who can help them focus on prevention and wellness.

“It’s not often you come across a business model that is truly transformational and disruptive in a sector ripe for reform, but that’s how we view Qliance in health care,” said Melinda Lewison of Bezos Expeditions, in a company statement. “We see significant long-term opportunity in Qliance as it’s easily scalable to other communities and health care reform has added wind to its back with the ability to compete in the insurance exchanges.”

The Amazon connection is a pretty clear one. Nick Hanauer of Second Avenue Partners, an early and enthusiastic backer of Qliance, was one of the early investors in Amazon.

Encouraging as the financing is, Qliance has had to clear a number of legal hurdles to get to where it is now. The company had to lobby hard in the Washington state legislature in 2007 to make sure lawmakers understood the business model avoids insurance, and therefore shouldn’t be covered by state insurance regulations. Last year, the legislature made it possible for employers and self-insured health plans to pay direct primary health care providers as part of an employee health benefit program, as is commonly done with traditional health insurance. That has enabled Qliance to sign up more than 70 employers to its monthly primary care service, which allows their employees access to primary care clinics in downtown Seattle, Kent, and Mercer Island.

The new round of financing will help Qliance take this vision of “direct primary care” beyond Washington state. Wu personally spent a lot of time in the past year paying close attention to the national healthcare reform debate, and enlisting allies like Sen. Maria Cantwell, the Washington state Democrat, to make sure that the new law wouldn’t create any barriers to Qliance’s model (regardless of whether insurance companies might like to stop it).

The new law that President Obama signed last month, the Patient Protection and Affordable Care Act, allows states to begin operating insurance exchanges in 2014, which makes it easier for small businesses and individuals to buy health care. What few people realize is that Wu’s advocacy apparently paid off, because “direct primary care” models like Qliance will be able to compete in those state insurance exchanges.

You can bet the full $6 million that just went into Qliance that not a dollar would have materialized if the new health reform law had created new obstacles to Qliance’s plan to expand nationally. That’s still a long way off since the company is still in its early days. But the market potential, as Wu noted in our original profile in December 2008, is about as big as it gets. Capturing a meaningful slice of the market—in which 250 million people in the U.S. need primary care services at an average price of about $50 a month—is the hard part.

“Our growth will not be limited by market potential, but by our ability to execute,” Wu said in the original story.

Efforts in education, collaboration, and technology are
improving care coordination.

Care coordination and improving patient care are lofty goals for health leaders today. With better technology and greater health stakeholder interaction, better care can be achieved. The HealthLeaders Media online news team has examined how facilities are working to improve patient care and safety through technology, education programs, and staff interaction. Here are excerpts of articles written by Ben Cole and Julie McCoy.

MassGeneral Program Brings Remote Doctor to
the Bedside 24/7

A “home-to-hospital” program in use at MassGeneral Hospital for…


To Reduce Spending, American College of Physicians Will Advise Doctors What’s Too Costly and Useless

By: Cheryl Clark, for HealthLeaders Media, April 27, 2010

This summer, the organization representing 130,000 internists will publish of a series of papers that will tell America’s doctors what they should and should not order in diagnostic tests and therapies, a guideline that strives to lower cost while it eliminates unnecessary care. While the organization will be looking at diagnostics as well as therapies, its first target will be the former.

More Analysis »

Annals of Internal Medicine Publishes
Concierge Medicine: A “Regular” Physician’s Perspective

March 16, 2010 | READ MORE

Patients Need Concierge Medicine/Direct Care Doctors

Michael Tetrault, Editor-In-Chief | March 15, 2010 | VISIT WEB SITE

Patient Procurement Agency Works With Concierge Medicine/Direct Care Doctors

Michael Tetrault, Editor-In-Chief | March 1, 2010 | VISIT WEB SITE

Making the Family Caregiver a Part of the Healthcare Team

Janice Simmons, for HealthLeaders Media, January 14, 2010 | READ FULL STORY

Today, more than 30 million family caregivers play major roles in overseeing and promoting the health and quality of life of individuals with acute and chronic illnesses.

Some patients willing to pay for ’boutique’ primary care doctors

By Tom Murphy, The Associated Press | January 13 2010 |

Dr. Stephen Glasser talks with his secretary Joann Peach before seeing a patient at his Baltimore office Jan. 12. Glasser used to care for about 3,500 patients, seeing between 25 and 30 a day. He pared the total down to between 600 and 700 when he converted to a concierge practice six years ago.

2009 Headlines & Earlier


December 30, 2009 – News from American Private Physicians Association | READ MORE

Medicareless, distrust funds and more
Monday, December 21, 2009 | READ MORE

More and more physicians are giving up their current practices and going to “concierge medicine,” in which they limit their practice to a lower number of patients who pay a substantial annual retainer fee. It is extremely difficult to find a physician or group of physicians who will accept Medicare patients. Some physicians will not accept Medicare patients or process medical insurance forms. Our current overall health care system is a house of cards that will collapse if pushed much further.

Small Practices Face Big Challenges
Elyas Bakhtiari, for HealthLeaders Media | December 10, 2009 | ShareThis

In a recent piece in The New Yorker, a physician-author compares the current pilot-project approach to reforming healthcare with efforts in the early 1900s to improve agricultural production. Farmers at the time were struggling with analogous problems—spiraling costs, a lack of “comparative effectiveness research,” poor quality rating mechanisms, and industry fragmentation—and only began to see improvements after government-initiated pilot programs spurred innovation….


Health Care Reform Irony: Thousands Could Be Denied Low-Cost Coverage

By Dr. Garrison Bliss | Posted: December 2, 2009 04:12 PM

If offered the choice, how many of you would sign up for access to a primary care physician 24/7 for a flat monthly fee of $49-$79 per month? Imagine — no more lengthy waits for a doctor to see you and no more dealing with insurance companies for routine, preventive care. That sounds pretty good, doesn’t it?


‘Boutique’ patients pay for better access to doctors

Washington Times | Nov. 25, ’09 | By Karen Goldberg Goff

Instead of leaving medicine, Dr. Sheff made the transition to a retainer practice. Often called a “boutique practice” or said to provide “concierge medicine …

Give Me a Public Option or Give Me Death?
How concierge medicine works: Doctors charge anywhere from $1500 per person per year up to $25000 or more for a family. This fee acts as a retainer …

Source: CBS News| November 23-24, 2009 7:55 AM


If you don’t choose to pay extra to sign up for “concierge” or “boutique” medical care, should you still get the same access to your doctor’s time and attention?


  • 57.2% Access to your doctor is a right, not a perk;
  • 37.2% As with all things, you get what you pay for;
  • 5.5%-Not sure;

Source: Poll | VOTE | READ MORE

New York, NY – Clinic with two doors, a symbol of two-tier care
One side is for patients with insurance, the other for those who pay up front

“…we’re biting into the quality of care if you’re not paying a premium…That’s unethical. It’s immoral. It’s just flat-out wrong.”

By Bill Dedman | Investigative reporter
Source: | FULL STORY

‘Concierge’ care is just another word for bribe
Opinion: Getting a doc’s time and attention shouldn’t require a premium fee


READ COMMENTARY | By Arthur Caplan, Ph.D.

Family physician cuts out the middlemen insurance
companies and large clinics


For an upfront fee, these doctors are at your service anytime


Medical start-up puts faith in primary, preventive care

Posted: Nov. 14, 2009 | FULL STORY

Connecting the medical-care dots: New Ellis, NY facility aims to make navigating system less confusing


November 13, 2009 | KUOW News
Labor Group Tests New Health Care Service


Participatory medicine – where MDs, hcps & pts work online
to help evolve best evidence…Understanding the best medical options for you

Posted November 13, ’09 at 1a.m | READ FULL STORY

Dr. Direct:
A physician cuts out the middle man: Family physician Dr. Sam Willis delivers primary medical care that’s more personal and less costly by cutting out the middlemen – insurance companies and large clinics.


Welcare Center in Spring House, PA is area’s latest concierge practice
by John George Staff Writer

Wednesday, November 11, 2009, 6:20am EST |

New primary care practice provides 24-hour access to doctors

November 9, 2009 | READ FULL STORY

PinnacleCare complements the work of the concierge physicians serving our members by…

October 21, 2009 | READ FULL STORY

R.I. health care model interests Maine doctors


Eliminating all health insurance could make primary care more cost-effective

Oct. 13, 2009 | Los Angeles, CA | PRESS RELEASE

Another National Association of Concierge Physicians Organizes
The Direct Primary Care Coalition

October 19, 2009 | FULL STORY

How to tell if going concierge is right for your practice.

September 18, 2009 | FULL STORY

Ten Symptoms Too Dangerous To Ignore –
… of providers who offer a so-called concierge style of medicine in which individuals pay an annual fee of $15000 for unlimited access to a physician. …

September 16, 2009 | FULL STORY

‘Medical Home Model’ saves money, boosts quality, study finds cutting patient loads and making visits longer were also found to ease burnout rates for physicians.

September 14, 2009 | FULL STORY

New York, NY – Concierge doctor offers his patients a personal touch

September 10, 2009 | FULL STORY

More hospitals looking to merge, buy physician groups

September 7, 2009 | READ FULL STORY

AMA evolves to help the youngest members of our profession enjoy long and successful careers.

September 7, 2009 | READ FULL STORY

Concierge Medicine and the States
Can concierge doctors save primary care medicine? That’s up to the states.
…So far, states aren’t mediating this overarching debate over concierge medicine. Instead, they’ve focused on a narrower question…A few years from now, states are likely to have clearer guidance for doctors as to what they can and cannot do. It’s possible by then we’ll even have come to a consensus as to what to call these doctors.

September 4, 2009 | FULL STORY

Steven Knope, MD Overcomes Objections To Critical Statement Made About Concierge Doctors

August 27, 2009 | LISTEN TO AUDIO

Concierge doctors: Real deal behind hit drama ‘Royal Pains’

August 21, 2009 | READ MORE – Intelligent Investing, Expand Primary Health Care:

…If we only do one thing to improve the American health care system, we should expand primary care.

August 5, 2009 | FULL STORY

Economic Report: Inbound Medical Tourism in the United States

August 5, 2009 | FULL STORY

Study focuses on helping seniors avoid rehospitalization

July 31, 2009 | FULL STORY

USA Network has renewed its breakout freshman hit “Royal Pains.”

July 28, 2009 | FULL STORY

Compromising the Doctor-Patient Relationship:
The Impact of the House Health Care Bill

July 24, 2009 | FULL STORY

Doctors still mystified by what patients owe

July 21, 2009 | FULL STORY

Physician and Advocate, Dr. Marcy Zwelling Speaks At National Press Club Conference

July 2009 | FULL STORY

Survey reveals many providers, billers unsure of charges to follow predetermined co-pays.

July 21, 2009 | FULL STORY

Individual Insurance Market Falls Short for Families

July 21, 2009 :: FULL STORY

USA Network Invents Concierge Doctor Game

July 21, 2009 :: FULL STORY

AMA Health System Reform (HSR) News


UnitedHealth Group, Cisco launch telehealth network

July 19, 2009 :: FULL STORY

Senate Republicans blast bill
…why don’t ALL these bozo’s give up their concierge health care plans and have to function in the REAL world like the rest of America…

July 15, 2009 :: FULL STORY

At Least Nine Doctors Who Treated Michael Jackson Under Investigation

July 15, 2009 :: FULL STORY

Concierge Models Provide Physicians with Options

July 14, 2009 :: FULL STORY partners with Qliance, Anchor Medical Clinic and Guardian Family Care in continued effort to make health care more accessible.


Southlake, TX (PRWEB) – Concierge Medicine Takes Front Seat with Health Care
Reform Uncertainty

July 8, 2009 :: FULL STORY

Hybrid Concierge Medical Practice Provides More Value, Options to Growing Number of Physicians Nationwide

July 8, 2009 :: FULL STORY

Healthcare bills scare even wealthy patients

July 6, 2009 :: FULL STORY

Michael Jackson’s death puts ‘concierge doctors’ in the spotlight

July 5, 2009 :: FULL STORY

Obama Disses Doctors

July 3, 2009 :: READ MORE

Dr. Conrad Murray was Michael Jackson’s personal physician, a concierge doctor

July 1, 2009 :: FULL STORY

Leadership Day Launches New Legislation For Primary Care

July/August 2009 :: ACP Internist :: FULL STORY

Leadership Day Launches Push For Primary Care

June 2009 :: June ACP Internist :: READ FULL STORY

White Coat or White Glove: Concierge Medicine 101

June 28, 2009 :: FULL STORY

SIMPD invited to go to Washington, DC and work with the Alliance for Patient Access

June 24, 2009 :: FULL STORY

MDVIP Launches Preventive Medicine Pilot Program For Uninsured In Northern Virginia

June 23, 2009 :: FULL STORY

USA Network Defines Concierge Doctors

May 30, 2009 :: FULL STORY

Royal Pains Premiers on USA Network – Concierge Medicine Gets the Hollywood Treatment

May 29, 2009 :: FULL STORY

Consumerism Doesn’t Simply Mean Shifting Costs to Members

April 29, 2009 :: FULL STORY

Families USA releases uninsured numbers in each state

April 8, 2009 :: FULL STORY

Bye-Bye Benefits

April 1, 2009 :: FULL STORY

Insurers offer to stop charging sick people more

March 24, 2009 :: FULL STORY

The controversy of concierge medicine: Some states have been considering whether to regulate fee-for-service physicians who practice what is sometimes referred to as “concierge” medicine.

January 22, 2009 :: LISTEN TO PODCAST

USA Network films pilot on the Hamptons

Sept. 8, 2008 :: FULL STORY

Does Concierge Medicine Transcend Radiology Education Issues in Developing Countries?

June 23, 2008 :: READ MORE

Boutique Medicine: For Your Well-Being? Or the Doctor’s?

April 18, 2008 :: FULL STORY

Dr. Steve Knope Releases BOOK:
Concierge Medicine: A New System to Get the Best Healthcare

April 2008 :: FULL STORY

The Ultimate Housecall Is To The White House


Doctors Without Orders

March 21, 2008 :: READ MORE

Is Concierge Medicine for You?

September 21, 2007 :: READ MORE

CNN – Atlanta, GA – Boutique Medicine: When Wealth Buys Health

October 20, 2006 :: FULL STORY

NAPLES, FL – Care by the Hour

August 30, 2006 :: FULL STORY


April 23, 2006 :: FULL STORY

BOCA RATON, FL – For a Retainer, Lavish Care by ‘Boutique Doctors’

October 30, 2005 :: FULL STORY

“Retainer-based” clinics…are typically primary-care practices that provide high-end care to a limited number of patients for an annual fee. Concierge doctors see fewer patients and can devote more time to each. Many also take on the role of patient advocate and help identify specialists and treatments when necessary. – Wall Street Journal, February 9, 2005


February 7, 2005 :: FULL STORY

Concierge medicine has emerged as a reaction to, if not a revolt against, the managed care medical system that has physicians handling 25 to 35 patients daily, and often spending a mere ten or fifteen minutes on the average visit. Doctors have set up concierge practices in order to dedicate more time to individual patients. – Departures, Nov/Dec. 2004 – READ FULL STORY

Concierge medicine first made headlines in 1996 with the launch of a practice by a former team doctor for the NBA’s Seattle Supersonics, who was convinced that people would pay for the kind of extraordinary care usually reserved for professional athletes. – Fortune, July 18, 2004

NEWSWEEK – February 7, 2005
House Calls; Goodbye to long waits, inattentive physicians and all that. Special treatment can be yours–at a price. READ FULL STORY

The average primary-care physician now sees a patient every ten minutes, according to the American Academy of Family Practice…Last year the Journal of Family Practice reported that more than a quarter of the primary-care physicians it surveyed expected to quit within the next two years.
– Fortune, July 18, 2004 – READ MORE

Should you consider concierge medicine?

February 17, 2004 :: FULL STORY

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