• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

SUNDAY FORUM: Medical Professionals Weigh in on Concierge Health Care

Posted on: Tuesday, 8 November 2005, 15:00 CST

We continue to hear from readers about our Oct. 17 article, Further division in health care? about the trend toward concierge care, which lets patients receive additional benefits for a fee. Here are three from medical professionals point of view.

Eye-care fees are frozen

As a health care provider, it was with great interest that I read about Sentara allowing a medical group to charge patients a monthly fee above and beyond their health insurance premium in order to receive certain perks when seeing members of the group.

What is really astounding is that Sentara is apparently allowing the M.D.s to keep this additional monthly fee per patient in addition to the fees that the physicians are paid by Sentaras Optima major medical plan for the patient visits.

In most health care offices today, there are a minimum of one or two additional employees whose only job is to deal with obtaining authorizations for patient visits and filing claims with the insurance companies. Then the doctors are expected to see the patients at a significantly discounted fee compared to what they would be paid by a patient without insurance. Unfortunately, if a doctor wants to see any patients, he has to be a provider for these plans.

In my practice, I am paid a fee for eye health examinations for insured patients that is equal to what I charged for an examination 15 years ago. That fee has not changed for cost of living in more than three years even though insurance premiums have increased by about 20 percent per year over the past three years.

When Ive called to inquire about any chance of future fee increases, just to help me cover my increased costs of having an office and qualified staff, I have repeatedly been told that there are none. They then tell me that I have two choices to deal with this problem: I can either drop out as a provider for their plan, which is not practical if I want to see any patients, or I can just see more patients in less time.

The net effect of this in many offices is that the patients are herded through like cattle and are lucky to be seen within an hour of their appointment time, and the doctors get burned out, which can lead to substandard care.

In my office, I have managed to avoid these problems by having a great staff and utilizing the latest technology available so I can provide true quality time while I care for my patients. Unfortunately, that is getting harder and more expensive to do all the time.

To the physicians in the group who are being allowed to have the concierge patients, Im envious. To those patients who are further being priced out of the health care market, I would encourage you to protest loudly to your insurance company and ask them to provide the doctors a reasonable fee for their services so you can continue to see the doctors you have established a relationship with and trust with your health care.

Believe me, the doctors are not receiving any portion of the increased insurance premiums you and I have had to pay.

Thomas Cheezum, O.D.

Chesapeake

Tip of the iceberg

This is an addition to the discussion of concierge medicine. For 40 years, I was in the private practice of internal medicine locally. In 1958, when I opened my practice, the norm was fee for service. Blue Cross/Blue Shield covered in-hospital care only. My office fee was $6. Internists saw patients in both office and hospital. Office expenses were minimal.

Now internists practice in the office or the hospital. Those in office practice are faced with exorbitant expenses. Office rent, telephones and directory listing, personnel salaries and benefits, computerized medical records and billing, malpractice premiums, professional dues, unemployment and workers compensation, sales and business taxes, mandatory attendance at postgraduate seminars, office supplies.

Office fees are now set and paid by third-party payers. Fees take little account of quality of care or complexity of the conditions treated. The bulk of the dollars allotted to cover office care go to the administrative expenses of federally funded medicare, for- profit medical insurance and for-profit health maintenance organizations. The physician is allotted what remains.

Physicians usually do not chose medicine for its financial incentives, but they feel that enduring the long training period, the stresses and intellectual demands of their calling, and its demands that impact on quality time with family, should mandate reasonable remuneration in a setting in which patients needs can be fully met.

If the current trends continue, more physicians will opt for a return to a fee-for-service system. Concierge care is just the tip of the iceberg.

Bernard H. Miller

Virginia Beach

No positive spin

I have been reading with great interest the ongoing debate regarding local physicians opting for a concierge style of practice. The reaction to this by the local medical and lay community has been varied, from applause to condemnation.

From a personal standpoint, I understand the frustration of office-based internal medicine. I have been in practice for 23 years and have witnessed an increasing interference by insurance companies (including one owned by the parent company that employs these physicians), government and other vested interests.

Medicine itself is rewarding and exciting. Now, however, the physician has not only to keep up and be perfect but also be a benefits manager, pharmacist and psychiatric social worker. Who wouldnt want a business composed of a small number of financially independent, highly motivated clients? This is America, isnt it?

The irony in this situation, however, is not lost. These physicians nominally work for a local not for profit health care organization whose mission clearly states the usual medical corporate mantra of supplying the health care needs to the community.

Why management didnt demand some positive spin from this move is totally beyond comprehension. Something as simple as having these physicians volunteer one afternoon or evening per week at a local free clinic or at the health department pro bono would have assuaged those who condemn. What else are they going to do with all their free time sell vitamins? Play golf? Answer e-mails?

I applaud the physicians for doing what they did. They are responding to the ongoing interference in their practice lives and have made a choice to extricate themselves. I condemn their management for not expecting more from them.

Jonathan Miller, M.D.

Norfolk

Source: Virginian - Pilot

More News in this Category