As money talks, doctors walk to greener pastures, leaving lower-income patients to find health care services in a shrinking field of primary physician services.
On the health care horizon there is a practice occurring in patient/doctor relationships that if it takes off, could create a problem for people who are on fixed incomes and rely on Medicare to help pay their medical costs. A practice known as retainer-based arrangements or informally called “concierge” or “boutique medicine” is appealing to many primary care physicians who say they are struggling to sustain a practice. In order to make ends meet with more and more patients unable to afford the increasing costs of health care in this country, some doctors say this extra fee for services reduces their urges to get out of medicine altogether.
For those who can afford it, patients pay a monthly or yearly fee ranging anywhere from $600 to $5200 annually, depending on which one of three models the doctor subscribes to. This additional fee is above and beyond what Medicare or private insurance pays for and gets you a more direct line to your doctor with more time to discuss your personal health issues. The potential for harm here to lower-income patients is that this greater access by higher income people is time that will be taken away from those who can’t afford this luxury.
The benefit to doctors other than the obvious monetary one is that they get to spend a greater amount of their time with patients, enabling them to better diagnose a patient’s problems and more accurately prescribe treatments that will remedy or cure what ails them. It is this aspect of the arrangement that some doctors are finding attractive, though, according to an AP report on this issue, “people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.”
“Medicare recipients, who account for a big share of patients in doctors’ offices, are the most vulnerable. The program’s financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.” (High-end medical option prompts Medicare worries, by Ricardo Alonso-Zaldivar, AP, 4/2/11)
Currently there are fewer than 800 concierge doctors nationally but that is five times the number it was just six years ago. In a field of about 300,000 generalists the small number who have signed on for this elite service is having no real impact on physician-patient heath care relationships. But Robert Berenson, a commissioner with MedPAC, which was created by Congress to advise lawmakers on Medicare and watches for problems with access, sees this arrangement as the “canary in the coal mine” for more doctors. He’s concerned that “the fact that excellent doctors are doing this suggests we’ve got a problem. The lesson is, if we don’t attend to what is now a relatively small phenomenon, it’s going to blow up.”
Fellow commissioner and MedPAC chairman Glenn Hackbarth agrees. “My worst fear — and I don’t know how realistic it is — is that this is a harbinger of our approaching a tipping point,” said Hackbarth, noting that ‘there’s too much money’ for doctors to pass up.”
There is of course great value to this for those who can afford it. Many of us who deal with the health care system today often feel we don’t get the attention we need and want. This is a factor of too many patients being handled by a single physician. But unless a physician or health care provider has large numbers of patients paying at often break even rates, it is hard for many providers to cover costs to sustain a practice.
Where this arrangement may run into legal problems with government assistance programs like Medicare is when it could lapse into a form of double dipping. One of the three models that presents this problem is where the arrangement exists to charge the retainer fee while still billing Medicare for some visits that the physician will claim are not covered with the retainer. Elizabeth Hargrave, whose study from the National Opinion Research Center at the University of Chicago and Georgetown University was presented to MedPAC during a Sept. 13 briefing in Washington, D.C., pointed out that “there are potential liabilities posed by billing patients for services that are already covered.” (Concierge medicine a mere blip on Medicare radar, by Chris Silva, amednews staff, 9/30/10)
Adding fuel to this potential crisis is the fact that numbers of primary care physicians in this country are dropping. “In 1949, 59 percent of doctors worked in primary care, but by 1995 that number was down to 37 percent. Over the past ten years, as many as one in five primary care providers have left the profession. There’s a broad expert consensus that we face a critical shortage of general practitioners and that the problem is only getting worse,” according to N. Thomas Connally, a retired internist who practiced his trade for thirty-three years in Washington, D.C.
The recent efforts by Democrats and the Obama administration to reform health care coverage has run into stiff opposition by the health insurance industry and many corporate health care entities, along with their conservative backers in Congress. The Patient Protection and Affordable Care Act (PPACA) will extend the life of the Medicare Trust fund to at least 2029. But House and Senate Republicans say these measures will be a burden to taxpayers, despite the plan’s ability to pay for such costs as it recoup funds lost to waste, fraud and abuse that have been rampant over the last couple of decades.
There is still uncertainty amongst many doctors too as a recent Thomson Reuters – HCPlexus National Physicians Survey found, where 65% of those questioned “fear that the quality of care will deteriorate under PPACA and that their reimbursements (pay) will go down as well.” Clearly there is much work that needs to be done to correct what is wrong with our current system. With more and more baby-boomers joining the ranks for Medicare coverage there will be a greater opportunity for many to fall through the cracks. Without addressing the need to increase the number of primary care physicians, the practice of concierge medicine will only elevate the problems if this practice continues to grow at it’s current rate
- Concierge Medicine. Is It What Healthcare Dreams Are Made Of? (medcitynews.com)