Concierge Medicine: Having a Doctor on Demand

Should you drop $1,500 or more a year for a physician who truly pays attention to you? Here’s the lowdown on concierge medicine  

by Cathryn Jakobson Ramin
concierge nurse illustration
Photograph: Emiliano Ponzi

Some retainer-based doctors take preventive health care much further, setting out on walks with patients, teaching Tai Chi classes in the waiting room, conducting indoor Spinning sessions in a local gym or, in the case of Shari Rosenbaum, a doctor based in Boca Raton, Florida, maintaining an active and lively Facebook page where she posts health tips for her patients and their friends.

The downsides of “on Demand”

Concierge physicians are convinced that the comprehensive two-hour annual physical is a key part of their relationship with their patients. But public health experts have serious questions about whether such microscopic inspection is necessary or even prudent. The U.S. Preventive Services Task Force, an expert panel that reviews medical evidence and delivers recommendations on preventive care, has made itself clear on this matter by advising against annual ECGs for people who do not have chest pain or diagnosed heart disease and by dismissing advanced lipid profiling in favor of a no-bells-or--whistles cholesterol check. A 2009 study from Thomson Reuters Healthcare Analytics noted that the unwarranted use of medical care—-including high-cost diagnostic procedures and lab tests, unnecessary use of brand-name drugs and surgery of unproven value—-accounted for somewhere north of $250 billion in expenditures added to the national health care tab each year.

It’s not that the screenings cost a lot. The problem is what often comes after them, usually as a result of false positives that lead to unnecessary imaging (which not only is expensive but also exposes patients to radiation), biopsies and other invasive procedures. There’s a psychological drawback to this kind of testing as well: Who among us has not anxiously awaited the result of a breast biopsy or pelvic ultrasound that turned out to be perfectly normal?

I considered these questions as I embarked on a comprehensive wellness screening with Dr. Fong. In the end, I decided that for me what happened after those tests would be a good thing rather than a bad thing. In a concierge practice, the tests and screenings don’t get shoved into the back of a file cabinet, as they might in a more rushed traditional practice. Instead, the data would be considered in the context of my lifetime wellness plan, initiating and encouraging an ongoing conversation about wellness goals. So, in addition to having tests like the advanced lipid profiling, I filled out a comprehensive questionnaire about diet, anxiety, sleep and sexual dysfunction. For me, the result of the wellness exam was not a lot of unnecessary, expensive tests; it was an action plan that would help me improve my overall health in the months that followed.

Proponents of concierge medicine argue that this kind of practice can actually save the system money. Typically, wellness exams devote most of the two hours to establishing extensive baseline measurements of how your body functions when it’s healthy. Having those baselines might eventually spare you hospitalization for, say, chest pain. If you go to an ER, this kind of symptom often leads to hospitalization, which may be unnecessary, expensive and inconvenient. Having a baseline ECG on hand can help resolve the question of whether this is indeed an emergency, sparing you an overnight stay, notes Las Vegas concierge physician Candice Tung.

Keeping people out of the hospital can save money for the federal government, which picks up the tab for Medicare-patient hospitalizations. According to a 2010 study commissioned by MDVIP, the largest of the consulting companies that help concierge doctors manage their practices, Medicare patients cared for by -MDVIP physicians were hospitalized 79 percent less frequently than Medicare patients cared for by physicians in conventional practices. And -MDVIP patients under 65 who were covered by commercial insurance were in the hospital 72 percent less often than patients in conventional practices. If these figures represent concierge practices in general, they suggest that this form of personalized medicine may actually discourage overutilization of hospital services.

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Comments

Michelle 10.20.2012

Great article and great speaking to you about this. I posted it on www.facebook.com/healthcareforless where you will find more tips like this and how to save on your healthcare. A "good doctor" will be harder and harder to find if things continue to go on as they are in healthcare.....oh and watch out for those "online reviews"....doctors are now hiring bloggers to get their ratings up! So if you are going concierge, choose wisely!

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