Tuesday, January 25, 2011

Concierge Medicine: Reality or Mirage

In my blog of yesterday, "Health Reform Victims, " I quoted John Goodman, a conservative economist who founded the National Center for Policy Analysis. Goodman predicted “a large flourishing market for concierge services.” He said concierge practice expansions would likely drain primary care physicians from the pool of doctors available to treat Medicare and Medicaid patients.

Up to this point, I have been skeptical that concierge practices would ever have more than a marginal impact. To me, the $1000 to $2000 yearly fees for direct access to doctors were a powerful deterrent. So were the financial risks of converting to a concierge practice without third party contracts, and the psychological difficulties of abandoning existing patients and downsizing from a panel of 2000 or so patients to 500 to 600 patients.

But certain developments, tangible and intangible, are making me take a second look.

• The growing physician shortage, particularly of primary care physicians, which shows no signs of abating.

• The rapid migration of baby boomers into the Medicare market, which commenced January 1, 2011 and which will progress at the rate of about 12,000 a day for the next 18 years.

• The fears and uncertainties induced by the health reform law, viz, being able to find a personal physician once the dust settles after the 3R (reform, repeal, replace) debate.

• The entry of venture capitalists into the field, bearing capital to support emerging concierge companies.

• The unexpectedly rapid growth of concierge practices, which now number about 5000 and according to Concierge Practice Today, may grow to 17,000 in 2012.

• Modifications of the concierge model, i.e., charging a monthly rather than a yearly fee, and coupling it with a high deductible plan with a catastrophic lid and a health savings account.

I would like to bring your attention to the Qliance Medical Group in Seattle. Here is their approach, as explained at their website,

“We're using a monthly membership approach to health care, cutting out insurance and going directly to our patients to provide the most comprehensive, high quality primary care out there. The Qliance membership approach means you can see your doctor whenever you need to - even after work and on weekends. By eliminating the hassles of insurance, we are able to put our patients first and return control of your health care to you and to your doctor. “

In their latest white paper, “Health Reform and the Decline of Physician Private Practice, “the Physicians Foundation, devotes 5 pages to a case study of the Qliance model. Qliance is a practice of 9 doctors and three nurse practitioners and takes care of 4000 patients at three locations in Seattle and works with 80 employers who offer the service to their employees. Qliance plans to recruit more physicians and to open two more locations in 2011.

At Qliance, doctors see 10 to 12 patients a day, with the average visit lasting 30 to 60 minutes. At Qliance a family pays a $99 registration fee and then a monthly fee for each member of the family, based on age, not health status. Monthly fees vary from $54 for a teen, to $69 to $99 a month for a 45 year old, depending on the level of service. Fees for imaging ($17) and generic drugs (less than $10) are extra. Patients can drop the monthly service at any time.

Qliance recommends its patients also enroll in a high deductible plan or a health savings account plan, or both, to pay for hospitalizations or other costly events. In answer to critics who say concierge practices are only for the healthy and the wealthy, the director of Qliance, Garrison Bliss, MD, notes that most of their patients come from the middle class and that two-thirds of his panel are Medicare patients, who have more health concerns than younger individuals.

Bliss says the Qliance approach is affordable to 80% to 90% of Americans. In addition to Qliance, Dr. Bliss has co-founded the Direct Primary Care Coalition, whose web site lists more than 60 Direct Primary Care Medical Home Practices in 21 states.

Qliance is working on an EMR with the help of venture capital from Amazon founder Jeff Bezos and Dell Computer’s Michael Dell. Says Bliss, ”we’re taking advantage of being a venture capital-driven organizations. I have no idea how a regular primary care practice is going to do this.”

Tweet: At Medinnovation blog< Dr. Reece cites reasons why concierge practices are growing faster than anticipated. #PPACA Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com, 1- 860-395-1501


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