I’m occasionally asked, “Do you have a Concierge practice?” My answer is, “Yes and no” because it depends on how you define “concierge”. If you define “concierge” as the type of practice that provides individualized care, great service and the attention you deserve when you see a doctor then yes, I have a concierge practice.
But most people who ask about a “concierge” practice (now often called “Direct Pay”) are probably asking about a kind of practice where patients become members by paying a fee of usually about $1,500/year.
This membership fee promises service for patients beyond what they might otherwise receive. Better service is possible because the Direct Pay doctor keeps his panel of patients very small, maybe 500, so he therefore has more time to spend with each patient. This arrangement is very good for the doctor because he has few patients and a lucrative income. It is pretty good for the patient because they get more time with the doctor and improved access if they can afford it. I don’t have this new type of “Concierge Practice”.
The main reason I don’t have this type of practice is because I don’t think paying all that money provides nearly as much value for patients as a straight fee-for-service model like what I offer at my office.
It is also often the case that people who need the most medical care do not have the resources to pay for entry to a Concierge Practice. Who is going to see them? I think my system can do it best. My prices are reasonable and a good value for everybody.
Concierge, or Direct Pay, is an interesting alternative style of practice and I’m confident it will grow. I hope the future of medicine allows good doctors to establish their own unique practices so patients can find the individualized care that suits them best.
Community Health Systems owns or operates over 200 hospitals in the United States. Almost half of their hospitals are recognized as “Top Performers in Quality Measures by the Joint Commission”. They are also participants in a Patient Safety Organization (PSO). According to Community Health Systems,
“PSOs were authorized under the Patient Safety Act of 2005 and are designed to improve the quality and safety of U.S. healthcare delivery. By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health systems can collect, aggregate and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care.”
Oops. Bloomberg that tells us that their data is not secure. The data was hacked. The article points out how
“Medical records are extraordinarily valuable for identity theft, as they contain all manner of personal information needed to take out credit and receive services in victims’ names. They’re most valuable, ironically, for the non-medical information they contain.”
Doesn’t it seem inevitable that despite the efforts of HIPAA more data will be compromised? Unfortunately, our current healthcare system is obsessed with collecting a lot of data on every patient and sending it to out to several entities like the large corporate headquarter of the hospital or to an insurance company or CMS. The data includes not only your name, birthday, social security number, address, phone number and insurance number. It may include your credit card number. It certainly includes many diagnostic and procedural codes that now define you to the payers and planners. Many of the codes are inaccurate.
The collection of this data is dangerous not only because it is inaccurate and can be compromised. It is also dangerous because it takes a lot of time and effort to collect it. Filling out the Electronic Medical Record with these codes is a high priority to your doctor and hospital and it detracts from the real work of caring for patients.
The Washington Post has an article today describing how the price for a cholesterol panel can range from $10 to $10,000 (the average was $220. I charge $30). Yes, the exact same test can cost 1,000x as much at a different hospital.
The authors have no firm conclusion about why there is such a range. One obvious conclusion is that their pricing (like the pricing in most US healthcare) is not based on the cost of providing the service or the value. Pricing is arbitrary and the number only means something when the hospitals misleadingly claim “charity” if it is not paid.
Distortions like this would not exist if healthcare was more like a free market.