August 2nd, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
No Comments »
Close your eyes and think of a doctor. Do you see a Marcus Welby type? A middle-aged, smiling and friendly gentleman who makes house calls? Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you? If that is what you envision, either you haven’t been to the doctor lately or you are in a concierge practice where you pay a large upfront fee for this type of practice. Whether you live in a big city or a rural community, small practices are dissolving as fast as Alka Selzer. Hospitals and health systems are recruiting the physicians, buying their assets (unfortunately not worth much) and running the offices.
Doctors are leaving small practices and going into the protection of larger groups and corporations because of economic changes that have made it harder and harder for small practices to survive. The need for computer systems, increasing regulations, insurance consolidation, skyrocketing overhead and salaries coupled with low reimbursement has signaled the extinction of the Marcus Welby practice. Some older doctors are finishing out their years and will shutter their offices when they retire. Young to middle age physicians are selling out to large groups and new physicians would never even consider this type of practice. They are looking for an employed model from the outset.
Every doctor I know who is currently in private practice is Read more »
*This blog post was originally published at ACP Internist*
March 19th, 2011 by BobDoherty in Health Policy, Opinion
No Comments »
A few days ago I received an email from a general internist about my posts about concierge practices. I have known this physician for over 20 years, and he has great insight into the challenges facing health care. This email was no exception; he had this to say how his group took the “middle way” of pursuing private funding for the Patient-Centered Medical Home (PCMH):
“My practice includes 3 primary care physicians and has invested heavily in IT infrastructure. We have re-engineered our workflows and have achieved benchmark levels of quality and service. We have won NCQA certification for our PCMH. Yet so far no payer has stepped up to underwrite our investment. So we have joined Privia Health in forming a ‘membership practice.’ Patients are asked to pay a small monthly membership fee. In return they receive some special attention . . . Plan sponsors and payers are invited to pay the fee on behalf of their employees. . . Patients like having same day access. They like secure email communication with their doctor. They like having a personal health record. They like having a case manager helping them navigate the system. And they like going online in the evening to make their own appointments. ACP policy supports the medical home but is silent on the question of what a medical home is to do before local payment realities catch up. I owe my patients my efforts to assure that when I retire an eager young internist will welcome the opportunity to take over my practice. Absent public or private funding for the medical home that is just not going to happen.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
February 28th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
1 Comment »
Many folks criticize pharmaceutical companies for providing physicians’ offices with free drug samples. They claim that this giveaway harms consumers because drug companies must raise their prices to cover the costs of these freebies. Of course, this is undeniable. Any business expense, such as payroll or advertising, has to be covered and is expectedly borne by the consumer. If a company chooses not to advertise, outsources manufacturing to a country with cheaper labor, offers limited benefits to its employees, then they can sell their product at a low price. In this hypothetical example, anemic sales may doom the company quickly.
Naturally, free samples are not really free. The rest of us pay for them. While this is true, I don’t think it is evil. Unlike the U.S. government, at least drug companies are covering their costs and not simply borrowing money every year to meet budget. Interesting concept.
Two of the community hospitals I work at have undergone transformations. One is owned by the dominant health care behemoth in Cleveland and has just completed a near $200 million renovation and expansion. The other smaller hospital is one of the few remaining Cleveland area hospitals that are still independent. I’d like to sneak there at night and hoist up a “Live Free or Die” flag up the flagpole, to delebrate its independent streak, but I’m sure that there are video cameras everywhere and that I would be in violation of several bylaws. The apt punishment might be that I would have to spend a cold Cleveland night chainedto the flagpole reading electronic medical record manuals out loud. Read more »
*This blog post was originally published at MD Whistleblower*
December 18th, 2010 by Elaine Schattner, M.D. in Better Health Network, Opinion
No Comments »
A perspective in [a recent] NEJM considers the Emerging Importance of Patient Amenities in Patient Care. The trend is that more hospitals lure patients with hotel-like amenities: Room service, magnificent views, massage therapy, family rooms and more. These services sound great, and by some measures can serve an institution’s bottom line more effectively than spending funds on top-notch specialists or state-of-the-art equipment.
Thinking back on the last time I visited someone at Sloan Kettering’s inpatient unit, and I meandered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their families to have a non-clinical area like this. The “extra” facility is privately-funded, although it does take up a relatively small bit of valuable New York City hospital space (what might otherwise be a research lab or a group of nice offices for physicians or, dare I say, social workers) seems wonderful.
If real healthcare isn’t an even-sum expense problem, I see no issue with this kind of hospital accoutrement. As for room service and ordering oatmeal for breakfast instead of institutional pancakes with a side of thawing orange “juice,” chicken salad sandwiches, fresh salads or broiled salmon instead of receiving glop on a tray, that’s potentially less wasteful and, depending on what you choose, healthier. As for yoga and meditation sessions, there’s rarely harm and, maybe occasionally, good (i.e. value).
But what if those resources draw funds away from necessary medicines, better software for safer CT scans and pharmacies, and hiring more doctors, nurses or aides? (I’ve never been in a hospital where the nurses weren’t short-staffed.) Read more »
*This blog post was originally published at Medical Lessons*
September 7th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion
No Comments »
A recent piece in The New York Times wondered if the few patients who can afford to pay for additional attention and access to their primary care doctors in a concierge medicine or boutique medicine practice might be ethical since the extra dollars are used to support the traditional primary care practice that the vast majority of patients currently receive.
Questions you might ask are:
- What is a concierge medicine or boutique medicine practice?
- Is it worth the money?
- Is the care better quality?
- Is it possible to get similar access and care by doctors not in a concierge or boutique medicine practice?
When you think of a concierge, you think about a fancy hotel staff person who answers questions and speaks various languages, books reservations to restaurants, events, and tours (even sold-out attractions) — right? The hotel concierge is your insider, someone who possesses intimate knowledge of the city and recommends must-see sites like a true local. You are personally cared for and pampered. Imagine, then, your physician providing the same attentive service. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
