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August 16, 2006
PHYSICIANS/POLICY: Concierge Medicine-Interview with Ed Goldman MDVIP
Does primary care have a future? And is that future a version of concierge medicine? It's very early days, but yesterday I had a great conversation with Ed Goldman, CEO of MDVIP, a franchise concierge medicine company. He has some very interesting things to say about how concierge care may not just be for the worried wealthy.
The conversation is in this podcast . There'll be a transcript available in a couple of days.
August 16, 2006 in Concierge medicine, Physicians, Podcasts | Permalink
Comments
As a med-student interested in health policy and bored while working out I have been listening to podcasts like these to educate myself while on the bike, treadmill, etc. Its nice when you can actually kill two birds with one stone. Basically, Mr. Holt I'd love it if you could provide other podcast interviews with innovators of care if/when the opportunities arise.
Getting back to MDVIP, I remember listening to Dr. Goldman's podcast interview with Nancy Collins of the Journal of Medical Practice Management awhile ago and have enjoyed hearing about the success of the MDVIP model. I was wondering if the data mentioned in this interview about decreased patient utilization of hospital facilities(ER, Surgical, etc) is readily available on the internet. I am interested to see whether in the future(ie my years of practice) insurers will realize prevented steps like yearly screenings will save them long term money. Seeing decreased patient utilization numbers from a large enough data pool may be enough to wake them up. Until the upfront fee is provided by insurers though it will only generate a two-tier health system: those willing and able to pay and those who aren't.
As for the other major problem, getting people like me to go into primary care, I see concierge medicine as a possible lure as it will bring more patient interaction, empower the patient-physician relationship, and create a more stable economic environment. All of these will increase the happiness of the physicians in these practices and allow new physicians to pay off student loans. At private schools like USC $200K is a pretty normal level of indebtedness at graduation.
Posted by: slippingsloth | Aug 16, 2006 9:41:17 AM
Okay, I'm a bomb thrower and I hate all Republicans especially Flordia Republicans, but it wasn't hard to smell snake oil salesman here even without the glowing praise of Tommy Thompson.
1. Goldman has been discplined twice by the Florida Medical Board.
2. He poses as a physician (complete with coat and stethescope) even though by his own admission he sees no patients.
3. His former company Cybear was investigated and fined by the SEC.
Why should I believe anything he says?
Posted by: elliottg | Aug 18, 2006 1:13:39 AM
MDVIP is Goldman's company, but the point of the story has more to do with the idea of "concierge" medicine than it does with one company's method of delivering it. MDVIP sets up individual physicians in VIP-type practices, markets them, and takes a piece of the cut in return. But the actual delivery of the healthcare is by the individual physicians, not by Dr. Goldman. If I were a physician interested in joining his organization, I wouldn't care if he were a doctor or not. If I were a patient interested in seeing one of the MDVIP doctors, I wouldn't even know that Goldman exists.
As a physician, I have mixed feelings about the idea of an MDVIP-like practice. What I like is that it would allow me to see a reasonable number of patients and provide really high quality healthcare for them and still earn the same as I am now. What I do not like is that I would lose so many of my current less fortunate patients and instead become a well-paid attendant to a small group of my wealthy patients.
But I certainly have considered it!
Posted by: John Fitzpatrick | Aug 18, 2006 6:04:57 AM
"2. He poses as a physician (complete with coat and stethescope) even though by his own admission he sees no patients."
He is an MD and has earned the right to wear the long white coat whether he is currently actively seeing patients or not. This doesn't mean I fully support the goals of MDVIP though.
Additionally, were you similarly appalled in the early 1990s when Hillary was prancing across the USA in a long white doctors coat trying to promote her HillaBilly healthcare reform disaster? I think not!
A doctor pretending to be a doctor I can accept, but there is nothing worse than a lawyer masquerading as a doctor.
Posted by: pgbMD | Aug 18, 2006 8:16:53 AM
I've heard Dr. Goldman talk about his ideas several times now. And at length. I've been impressed by both his presentation and his message. If I were a physician (and I hasten to add I am not) I would be very interested in exploring this model of care delivery, and its implications for my practice. If I were a patient looking for a primary care physician, I'd want to investigate this idea pretty closely.
It's a little too easy to write off the concierge concept as elitist or exclusionary - which appears to be the knee jerk reaction of a lot of people, especially in the media. I think there may be a little more to it than that ...
I think a large part of the problem has to do with the way this idea is being sold to the public. If these guys are smart, they'll drop the term concierge (which personally makes me think of valet parking with stethoscopes and antibiotics), and come up with something with slightly broader appeal ..
Posted by: john irvine | Aug 18, 2006 8:36:18 AM
Goldman is a salesperson for his company first and foremost. He has a proven track record of being less than truthful of which I gave 3 examples. (If you don't see that a promotional picture of a guy who doesn't see patients in lab coat and stethescope is misleading then you lack critical judgement skills necessary to evaluate any claims.) His substantive points in his podcast are
1. That patients and doctors appreciate the concierge relationship.
I think that this is true, but a result of ignorance on the part of patients. Patients always like doctors they have a long-term relationship with and there are costs to switching. MDvip does not sign up new doctors; they convert established practices and squeeze out anywhere from 60 - 80% of the current patients. If this was such a wonderful deal then why is only that the model that works?
2. There is value added to patients in a variety of ways such as 24 hour access, same day appts., and specialized information.
Concierge service isn't necessary to accomplish this; I everything described by Goldman from the largest, most beauracratic HMO in California. Furthermore, the quality of doctors I see (schools and fellowships) exceeds that of mdvip's docs based on a quick perusal of a random sampling. In addition, I see doctors with more recent education which, I believe (don't have the cite handy), make fewer mistakes and provide better treatment than older doctors.
2. The system reduces healthcare costs.
This is a fascinating claim. I can't believe that no published papers have been produced with such wonderful numbers. My guess based on my skepticism is that the claims are subject to a variety of problems. Goldman should hire Matt to write a paper with those numbers. My guess is that they are just spin like his doctor act. (Sure, he is a doctor, but the picture is misleading. Sure the numbers are there, but not adjusted for demographics.) I think the right attitude is to be suspicious of any pronouncement by Goldman until MDvip releases its actual data.
In short, I think that Matt got spun in the same way he complains that the NYT gets spun sometimes.
Posted by: elliottg | Aug 18, 2006 10:05:43 AM
Well the SEC investigation of Cybear (which was a bit of a joke company) was around a pretty minor revenue recognition issues, and I can't find any information on the web about Goldman being disciplined by the license board.
Maybe I am being snowed, but if this approach can really show that paying the primary care doc more to look after fewer patients saves money overall, then it's very interesting--and has huge implications for the future of primary and secondary care. If it's just rich people trading up for a better class of waiting room and the doc's cell phone, then it's less so.
I assume that the data will come out on that soon.
Posted by: Matthew Holt | Aug 18, 2006 1:31:51 PM
elliott hasnt been in a hospital lately.
If he had, he would know that EVERYBODY AND THEIR BROTHER NOW WEARS WHITE COATS. Thats right. Everybody from the senior cardiothoracic surgeon to the janitor now wears the white coat.
RNs wear it, LPNs wear it, NPs wear it, CNAs wear it, MRI techs wear it, X-ray techs wear it, Nuc med techs wear it, PAs wear it.
The white coat means NOTHING in terms of status these days.
Back in the good old days up to the 1970s, only the doctors wore the white coat. Of course those were the days when doctors were considered gods. The other healthcare fields noticed this, and said to themselves "hey maybe we can be gods too if we appropriate the white coat and use it for our own purposes." So thats exactly what they did. Now that everybody who works in the hospital wears a white coat, it renders the status of the coat meaningless.
Posted by: jason d | Aug 19, 2006 3:44:29 PM
I went on the MDVIP website and was pleased to see that my husband’s dental practice fits the definition of a “concierge practice.” We have a small practice providing extensive preventive care and treatment of acute and chronic dental conditions, with a focus on individualized attention and dental planning. (see their website :) We don’t charge our patients an annual membership fee, but offer similar services. (small practice, on-time appointments, coordination of referrals, give out the cel phone, etc.)
The big change we made to allow him to do this was to drop the PPO’s and give patients a choice to either pay for their work at the time of service and have the insurance check come to the patient in the mail, or we will accept assignment but they have to leave a CC or form of payment on file with us. This allowed us to actually LOWER our cash fees because we don’t have to compensate for the insurance company hassles and write-offs, don’t have to pay staff to manage claims, don’t have to pay for billing, and don’t have to deal with sending people to collections because a balance was left after insurance paid. He is much happier and also gets to spend more time with the family!
We did the insurance game, and decided not to fight it anymore. I was curious if this would work with primary care doctors, or if there are doctors already doing this in medicine?
Thanks!
Posted by: Jill | Sep 16, 2006 8:05:07 PM
Mdvip is just the beginning when it comes to alternative or concierge or boutique or as I like to call it in my pediatric field "attentive care" New practice models are emerging that make mdvip obselete. Try a marriage of tech and personalized care in the form of Personal Pediatrics administrative support system that is actively practiced by Natalie Hodge MD. As opposed to Goldman, she has invented a new practice, or reinvented an old, model the communication system of which makes the entire office obselete. Providing care for children where they need it most when they are sick, AT HOME. Watch the story of Personal Pediatrics unfold. "Personal Pediatrics... The Pediatrician of the Past and Future...Today" www.personalpediatrics.com
Posted by: Natalie Hodge MD | Oct 6, 2006 2:20:51 AM
I recently attended a meeting (by letter invitation)held by a physician who is converting his practice to MDVIP with a 600-patient limit. There were approximately 500 in attendance. When Dr. Goldman's video started I almost expected to hear about a great condo opportunity in Florida. I just knew this was going to cost more than I had. When the $1500 annual membership fee was revealed, 1/2 the crowd left and not surprising, many were elderly. Although the general concept of preventive care is smart and the "no waiting for an appointment" certainly appeals to everyone, including me (having had acute asthma for many years), the additional expense is unappealing and probably impossible for many. Obviously, this physician wants to cut back on his workload and I can appreciate that. So now those of us who are on a limited budget will have to look a little harder and longer for the physician practicing preventive medicine, who takes time with his or her patients and who encourages a holistic approach when possible without the $1500 membership fee. The sales rep. from MDVIP could not stress enough the fact that if we did not sign up immediately we could lose the opportunity to join and we would be placed on a waiting list. I wondered if there really would be a waiting list. The physician also announced that he would not be accepting Aetna/United Health Care (an HMO). That decision alone will in all probability diminish his numbers and I'm wondering if MDVIP had a hand in that decision. HMOs are well-known for practicing without a license. Until I went to this meeting the other night, I had never heard of the "Concierge Practice." Well, now I wish I hadn't. It's just one more thing that is not in my budget.
Posted by: Jo Ann | Nov 9, 2006 8:40:27 PM
As a healthy senior, I see my doctor once or twice a year for a physical and tests. That's it! I felt joining MDVIP wasn't worth the $1500. Not for me anyway. It'a a different story for the MDVIP folks. If my doctor signed up the maximum 600 patients, he starts out with $600,000, plus continues to bill the insurers for services rendered! MDVIP had 40,000 patients on the program in 2005, that's $20,000,000 for Dr. Goldman and team. I call it GREED.....
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Posted by: protonix | Nov 27, 2006 3:24:53 PM
I converted my practice to a concierge model of care a little over a year ago. I thought I would provide some insight into the experience.
The real issue is the fact that health care is being run as a for-profit enterprise with insurance companies making billions of dollars in profit on the backs of doctors and patients alike. When the CEO of United Healthcare can accrue $1.6 billion dollars in stock options then you know there is a problem. Even Blue Cross/Blue Shield, a non-profit, consistently showers there senior executives with large 6 figure salaries and bonuses. The same HMO that consistently reduced my fees to an average of 70-75% of Medicare raised my own medical insurance premiums by as much as 100-150%! Who decided to make Medicare the standard and why should I discount me fees below that which my own government (taxes) pay me?
As a consequence, primary care medicine has become a volume driven business. In my area it is not unusual for a PCP to see 30 or more patients a day. Most of them no longer admit or follow their patients at in the hospital because it is not financially advantageous to do so. It seems HMOs would rather pay a hospitalist who does not know the patient rather than the patient's own doctor. Lets add the medical malpractice crisis and you have the recipe for a disaster
Our medical schools are not cranking out new primary care doctors at a time when America's baby boomers are entering their late 50's and 60's. Given the above environment can you blame a medical student with an average debt of over $150,000 for not going into primary care? They can make 2-3 times as much as a PCP by becoming a subspecialist or dermatologist?
So where do we go from here? If you are a patient then you can either take your chances with the system or decide you will invest $1500 a year on your health. Essentially, the patient is being asked to dig deeper into his pocket to make up for the fact that the insurance companies and Medicare simply do not pay doctors enough. I would be the first to switch back to a regular practice if I were paid a fair fee for my time. Another option for a doctor is to just say no to these insurance companies. Open up a cash only practice. When I switched to my concierge practice I eliminated 2 FTEs because I no longer needed them to make referrals, deal with paperwork, answer 6 phone lines, etc. With a good electronic health record a PCP can get by with 1 FTE and outsource the billing. Such a venture is a risky one. It seems patients are willing to spend money on everything but their doctors. They will pay for vitamins, acupuncture, massage therapy and other non-traditional practitioners but balk at a $10 copayment at their PCP's office. In the end, you get what you pay for and in this country we have traditionally undervalued primary care medicine.
A great deal is written about the possible ethical issues involved with concierge practices. I personally consider it more unethical to have a for-profit health care system that directly benefits shareholders and senior executives when we have over 45 million Americans without health insurance!
Posted by: RC | Jan 8, 2007 8:13:57 AM
I recently decided to become a patient of a PCP pracice recently converted to MDVIP. I'm happy with my physician and upscale concept, but the cost is $1,800/year. Until reading this blog, I didn't realize the cost for all others seems to be only $1,500.
Does anyone know of if there is a standard fee for MDVIP patients?
Also, can someone advise me what percentage or portion of the Fee goes to MDVIP?
Posted by: JL | Jan 10, 2007 12:31:35 PM
The price is regionally based. Most practices are at $1500 but in some places like LA, or New York the price (like everything else) is a bit higher. The fee is split 1/3 MDVIP and 2/3 for the doctor.
RC
Posted by: RC | Jan 10, 2007 12:40:16 PM
Hey Pat:
You make it sound like a primary care physician earning a decent living is a bad thing! You will forgive me for thinking that after 20 + years of education, an average medical school debt of $150K, an average practice loan of $50K, countless hours on call and being available to your patients 24/7 yeah, a 6 figure salary is merited!
It seems society wants it doctors to take a vow of poverty along with their Hippocratic oath. I assure you when a patient is seriously ill in an emergency room, scared that they might die, the last thing on their minds is whether or not their doctor is "greedy".
Posted by: RC | Jan 11, 2007 9:26:34 AM
Concierge Medicine is alternative form of practice, another choice for patients. It is not and should not be tauted as teh healthcare solution, as I steadfastly disagree with my SIMPD counterparts. As per the GAO report, it's not a threat ot access. By my calculations, it represents less than 0.04% of the current physicians in the country. So if the number doubles, it's still insignificant.
Choice is not bad. $100 a month is a good value, infact for my patients, it's probably the best investment with teh highest Return on Invesment than anything else that spend $100 a month on. www.myconciergedoc.com
Posted by: Concierge Doc | Jan 23, 2007 9:31:06 PM
What does the annual physical cover? Also, when I called the MDVIP in my area, the office staff said that I would occasionally see his associate. I thought one of the main reasons for this program is that you would routinely see the same dr each visit.
Posted by: Helen McMichen | Jan 31, 2007 11:03:53 AM
Thanks for all comments! JACK - http://www.chinabboss.com
Posted by: JACK | Feb 22, 2007 5:55:57 PM
Thanks for all comments, which are helpful for me. I'll pay more attention on comments here.
JACK - www.chinabboss.com
Posted by: JACK | Mar 9, 2007 11:50:07 PM
It is tiresome to read about "greedy" doctors from people who have NO understanding about healthcare economics. Here is a quick Healthcare Econ 101.
As a medical office manager for a struggling family physician, we are in the process of ending our participation in health plan "networks" and going to private pay medicine.
Here are the facts:
In 2007, physicians are working more (60 - 100hrs/wk) and earning less than they made in 2002.
In over 190 metropolitan areas of 290 studied, one health insurance plan has a market share in EXCESS of 50%. These plans DICTATE the earnings of physicians.
The median reimbursement for an average family medicine physician is $52 - assuming that the patient's check for the copay is good, their insurance premium is paid current, the insurance company doesn't cheat the doctor, the secondary insurance is paid ...
Of that $52, staff salaries and benefits have to be paid, the facility and utilities need to be paid, medications and supplies have to be paid for, malpractice and other insurance premiums need to be paid for, billing, legal, accounting, marketing expenses, and taxes are ALL paid before the doctor sees a nickle.
Adding to the pressure, the physician is expected to provide for FREE - laboratory consults, referals, prescription refills, home health/disability/family
Medical Leave forms, provide depositions, & testimony in legal cases like auto accidents... AND a physician LOSES MONEY on almost every vaccination they give - $6,000 for flu season, $ 12,000 on the new HPV vaccine ...
The "Free Medicine" crowd constantly decries the "High Cost of Health Care". The real crisis is the high cost of health insurance, their anti-consumer networks, and monopoly status in metro areas.
A $52 office visit is less than what people spend on a concert ticket or sports event, hair styling & nails, cigarettes, a cell phone bill, a dinner for two (with wine)at a moderately priced restaurant, a typical date, or a pair of new Nike's.
Amazingly enough, when Fido or Kitty is sick, no one thinks twice about paying a VET $ 150.
My "Rich", "Greedy" doctor makes between $16 and $28 an hour working 6 days a week, 12 hours per day, no vacation, no overtime, no holidays... A plumber, automechanic, registered nurse, computer programmer, or office manager makes more money per hour than my physician.
Final Facts:
20% to 25% of all primary care residencys remain UNFILLED. 30% of all primary care doctors are 55 years of age - or older. More doctors are quitting medicine or retiring early... and fewer are coming into the workforce.
When the Medicare cuts go into effect in January '08, don't be surprised when the elderly have a very difficult time being tended to. Many practices have stopped adding new Medicare patients. These cuts are expected to exceed 30% over the next 5 years.
Let's see... rising expenses for goods and services, higher tax rates... and office visits dropping to $35.
Better news, since most health insurance contracts are based on Medicare rates... those payments will drop too.
The only option for small medical practices to survive is to offer better value, better service and quit playing the insurance game with a clientele that appreciates their dedication and skill- and pays for those services at the front door.
For those who advocate "universal healthcare", here's another fact - the government likes to make promises, but doesn't want to pay for them. You want proof, look at the treatment our veterans receive at VA hospitals - if they can get in. Spend some time at the county health clinic. That's the reality of government healthcare - and the future of medicine.
This doctor is quitting the insurance game while she still can. For the physician, it is a life or death decision. For her patients, it's a choice. Be thankful they have one.
Posted by: Carl Rupe | Mar 26, 2007 11:21:54 PM
Helen,
You're right in your comments about an associate covering. It's not advertised but it's in every concierge practice's fine print. However, I encourage you to ask, how often an associate will be the one covering. If it's more than 1 or 2 per year (depending on the number of your visits), then that's too much. The problem I addressed in my blog with MDVIP is you need to know why people choose MDVIP. MDVIP only takes docs who are long standing and they take mainly from there own practice. That implies:
These are much older physicians who leave traditional care out of frustration, so regaining a life is a primary reason of switching to a concierge practice (rightly deserved by the way). So, when they are not there, someone has to cover.
Other concierge practices, smaller ones with doctors starting from scratch and are newer will provide you with more attention because their motivation is building a practice, not switching out of frustration.
So Helen, because of excellent continuity of care between concierge practices, use of EMRs so the covering doctor always knows you, and the fact that I'm sure your MDVIP will talk to you if it's absolutely necessary whiles he's away on CME of vacation makes concierge medicine still a better choice.
So Helen, you don't realistically expect him to 24/7/365 live in the office. But I'm sure it's pretty close. Just verify how often this would occur and can you reach him in emergencies.
ConciergeDoc
www.myconciergedoc.com
ps: Welcome to the better side of medicine Dr. Rupe. I have family living in that area and if there are looking for good care, I'll refer them to your office.
Posted by: ConciergeDoc | Apr 1, 2007 8:38:09 AM
I have enjoyed reading about others experiences with the concierge practice model.
I have converted my practice to the concierge model, and as part of that model I am including other services such as personal fitness training and dietitian. We will also have massage therapy available as well. These services will be on site and if the patient desires at their home/office.
It is time that we place the decision making for healthcare into the hands of those we treat - the patient. This also allows us as physicians to treat the patient and not constantly have to navigate the land mines of insurance and third party billers.
I have had positive feedback from patients in the Fort Myers, FL area when discussing my practice. It has been well received.
Wayne M. Burr, MD
www.concierge-physician.com
Posted by: Wayne M. Burr, MD | Apr 3, 2007 1:36:30 PM
Dr. Burr, I agree with your thoughts and believe strongly that this is the basis for creating 'retainer based' medical practices. The belief that insurers need to be taken out of the mix. Currently they control everything.
My partner and I have founded Walden Centers for Personal Health which partners with physicians who are interested in practicing medicine in a innovative way. Innovative practice management can mean concierge or simply not accepting insurance payments. In our situation we set up and manage a retainer based practice for the physician, guarantee a competitive salary and the opportunity for profit sharing. As additional services we also offer exercise physiology, nutrition consulting, psycho-social evaluations and a comprehensive educational component all as integral components of the overall medical care for the patient.
We both believe concierge or innovative medicine has a place in today's healthcare industry however the concept needs to mature.
Posted by: Bonny Rollender | Apr 19, 2007 10:06:11 AM
This sounds like an HMO with a retainer fee! What's the difference?
Posted by: Robert Hauser | Apr 29, 2007 3:06:46 PM
I attended a MDVIP kick-off last night. It was an older doctor (my wife's) who falls into the category of "frustrated over having too many patients, wants a life." A lot of his patients seemed to be older and probably have the money. Nobody walked out, and it was pretty well received.
Our pediatrician had booted the insurance companies before my kids became patients. Luckily, my family has been healthy. There have been a few emergency room visits over the years and one daughter went through a battery of allergy/asthma evaluations. While the cost of annual doctor's visits has added up over the years, it was the testing, specialist, and emergency room visits that were by far the biggest hits. Insurance was applicable to those services.
The pediatrician seems to have been successful with his approach. His staff is small and he's accessible, as well as being a good guy.
I don't know how different it would have been if there would have been many more office visits and/or office treatments from him. If this were a more readily available option, would insurance plans possibly become available that would be applicable only to the expensive diagnostic and hospital related costs? Maybe that's similar to the catastrophic coverage?
Posted by: PMH | May 2, 2007 1:02:42 PM
Two of the recent comments have prompted me to write again.
First of all, the comment comparing the concierge model to an HMO presents as a clear contrast. The first item that comes to mind is the choice issue for your primary care physician. You as the patient have the choice of in whom you place your trust. Granted any insurance plans have limitations in regards to many aspect of your healtcare, but at least with you having the choice of your primary care physician who will guide your medical care, the choice of your insurance plan to cover other aspects of healthcare should be a little less daunting. As with any other decision in your healthcare, carefully review you coverage options. I have seen some patients who have changed their insurace coverage to cover more hospitalization and high end radiological procedures to reduce their monthly premium. In the end, some patients end up saving money on their healthcare with the concierge model by paying the concierge fee with lower monthly premiums to cover more "catatrophic" events.
This also replies to the other comment about types of coverage such as catastrophic care. The choice of higher deductibles could be one option to lower the monthly cost of insurance. There are lots of choices. You just have to look.
Wayne M. Burr, MD
Posted by: Wayne M. Burr, MD | May 3, 2007 5:53:35 PM
I just read through this entire blog and I'm curious why and how so few of us (physicians, and patients) seem to know or pay much attention to the fact that the healthcare insurance industry is making a killing every year with increasing premiums, and decreasing payments... I believe the quote was somewhere in the billions of dollars!!! I wonder why we as physicians, or physician groups such as the AMA, and the all powerful media haven't addressed or begun to uncover such an atrocity. I don't think its difficult to see how even small improvements in premiums and payments to physicians could dramatically impact the entire system. Anyone have any ideas about how to get the public eye focused on this?
Posted by: DrBrad | May 9, 2007 12:34:01 PM
The first thing we physicians have to do is become more cohesive. Strength is in numbers, a lesson taught to us from our attorney friends, who to my knowledge, have not had too many cuts in reimbursements. Hypothetically, if all physicians in the country were to drop a major low-paying insurance carrier, people (and insurance companies) would probably listen.
The second thing we need to do in the meantime is become a bit more creative with our medical business sense. We ARE allowed to be businessmen (or businesswomen), we ARE allowed to advertise and market our services, and we ARE allowed to be entrepreneurs. In the age of lower reimbursements, rising malpractice premiums, lack of Medicare support, and high-dollar lawsuits, no one feels sorry for us but us. In the past year, we have started three practices: a concierge practice where I have opted out of Medicare and all insurance companies (a solely cash-pay model); a second that charges a small, flat fee for all uninsured patients and takes care of "insured patients" as a bonus; and a resorts house calls practice that is fee-for-service and caters to the tourist population in central California. If we could do it without a cent from any bank, and straight out of residency, so can other doctors. It just takes a bit of personal sacrifice, ingenuity, and a thorough wish to succeed independently.
Posted by: Dr. Qamar | May 18, 2007 7:13:46 PM
I'm sort of a convinced by his idea about concierge medicine. May be, for the reason because I have been in the buisness of concierge for a while now.
Posted by: Mcgill | Jun 20, 2007 10:55:26 PM
thanks for this article i visit the site mdvip its useful and recommended to other to visit this site
Posted by: Jakee | Jun 21, 2007 4:41:26 PM
amazing article i also visit mdvip site you want to change wording in some topics
Posted by: tony | Jun 30, 2007 5:18:49 AM
Wayne M. Burr, MD, PL
Concierge Internal Medicine
Fort Myers, Florida
239-333-DR4U
I agree that physcians should utilize all tools that are available to educate the public about different practice models. Concierge medicine is relatively new in my area, and most people, including physicians, do not know how the practice works.
Education of the public by advertising to include print and broadcast media has been succesful. My website is another good resource for the community. Once patients realize that there is an alternative to high volume healthcare, they are more informed about how to manage their own health matters.
Posted by: Wayne M. Burr, MD | Jul 24, 2007 12:47:24 PM
Lawrence R. Brownlee, MD has been practicing Concierge Medicine for a few years. The request to change the style of practice came from some of the patients. His office is located in Tustin, California and sees VIP's and Executives from all over Orange County.
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Posted by: john | Oct 12, 2007 1:11:41 PM
Thank you all for such informative posts. My father, who was practicing primary care medicine for over 30 years, just completely left his practice to start a Medical Spa. I just left my career as a management consultant to run his spa - in less than 1 years we are generating 4 times the daily revenue that his practice was.
His practice was literelly a "meat market" - hundreds of patients in the waiting room pushed through his office like cattle. It was in a low income area of New York City, so the patients had medicare or some other low paying insurance.
The trend does seem that most primary care physicians are looking for alternatives now.... be it conceirge medicine, or medical spa.......essentially a Retail Medicine model.
I'm interested in learning more about the working/operations of a conceirge practice. I can imagine that getting your patient base can take some time, and can leave you without revenue for quite a few months. How does Dr. Burr afford to offer complimentary massage, dietician services, personal training along with the membership fees. Are physicians just giving an Insurance Superbill so that patients can get reimbursed as an out of network provider?
Where can one go to learn more about setting up a concierge practice? I am not interested in franchising.
Regards,
S.J. Shah, M.S.E.
Director of Operations
Amari Medical Spa
http://www.amarimedspa.com
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Posted by: nakliyat | Oct 26, 2007 10:18:49 AM
Considering that the vast majority of posts here are by doctors or people in the health care business, this blog is horribly lopsided in opinion. For all the poorer people to get left out of good health care because they can't afford to pay extra for it (remembering that insurance still pays the doctor), this is shameful.
Posted by: etfon911 | Oct 29, 2007 11:55:22 AM
"For all the poorer people to get left out of good health care because they can't afford to pay extra for it (remembering that insurance still pays the doctor), this is shameful."
What about all the poorer people who get left out of ANY healthcare because they can't afford insurance?
We already have a "quality of care" issue in this country. The insured versus the uninsured. Frankly, I think that is far more worthy of shame than doctors who want to do this.
Posted by: Mcampbell | Oct 30, 2007 12:56:43 PM
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