Sunday, November 6, 2011

Concierge Medicine, Less is More

In The School of innovation, Less Is Often More.

Title of article in Sunday New York Times, November 6, 2011

November 7, 2011 – Today’s New York Times ran a story on Addison L. Lawrence, a scientist at the Texas AgriLife Research Mariculture Laboratory.

Lawrence had a simple revolutionary idea about raising shrimp. Shrimp are usually raised in 3 to 5 feet deep tanks of water. But the tanks are so heavy, it takes a huge building to house them – an expensive proposition.

Why not, asked Dr. Lawrence, reduce the depth of the water to 6 to 8 inches and stack seven tanks on top of each other?

Voila! Raising shrimp became commercially viable. “And all I did ,” said Dr. Lawrence, “was reduce the water depth,” chuckling. “Now is that complicated?”

No, it isn’t.

Patients and doctors are not shrimp, but I asked myself, “ Is there anything comparable in medicine to this shrimp story?

Concierge medicine popped into my head. No one knows exactly. But there may as many as 5000 of these new-fangled practices in medicine. The idea is to charge each patient a fee of $1000 to $2000, treat them like kings and queens, be at their beck and call 24 hours a day, and offer your services without the usual billing charges.

Or as Wikipedia explains,

Concierge medicine (also known as direct care) is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care.

Whatever you want to call these practices - boutique medicine, retainer-based medicine, personalized medicine, innovative medical practice design, membership medicine, direct-care medicine, cash-only medicine – and whatever you call companies who organize them – MDVIP, Concierge Medical Associates, PartnerMD, EliteCare – the concept is the same: less is more.

These practices reduce the number of patients in their panels to 500 from 2000, and make more money. According to Wikipedia, 59.0% of concierge doctors say they are better off financially than before the switched from traditional practices. Most doctors claim they can now spend more time with patients, and 90% or more of patients are satisfied and renew their concierge contracts.

Concierge medicine is truly an innovative approach to medical practice. But it is controversial. Some say that concierge practice reflects physician greed, others that it introduces “two-tier” medicine into an egalitarian system, still others that too many concierge practices would threat access to new Medicare patients, who are entering the system at the rate of 1200 a day. In other words, more concierge practices mean less doctors for seniors.

Less is more, more is less. That more or less, is a question to ponder.

Tweet: Concierge practices, in which patients pay retainer fees to see the doctor, are growing. Whether this is good or bad, is controversial.


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