Acquiring a horse may be inexpensive or even free—then the expenses mount: vet bills, boarding, training, new equipment, not to mention all time dedicated to your new pet. Similarly, your EHR may be cheap or free, then IT fees, hosting fees, hardware, update fees and user training all have to be paid for. Now, imagine the government telling us we all need to buy a horse and keep it for life—great for the horse industry, but perhaps not for you.
Posts from 2017
(Snippets from the frontline)
You suddenly become ill. The emergency room doctor feels admission is necessary. Your physician agrees, so you are hospitalized with IVs and testing done. Treatment is given, you survive and go home.
Your insurance company denies payment and claims you should not have been admitted. Now you are responsible for all medical bills.
Denial by insurance companies after hospitalization happens more frequently each day. Occasionally, your physician can have a “Peer-to-Peer” phone discussion with the insurance doctor to mitigate the issue.
Here’s the rub: They decide on an “approximate” call time (e.g. 8-12 noon), and expect your physician to be around a computer to reference the medical chart. If this contact is not made within a certain number of days from discharge (sometimes as little as three), their denial automatically becomes irreversible.
Trying to allot “Peer-to-Peer” time is like waiting for cable TV repair. Your doctor is under the gun and gets blamed. Worse, it is time infringement on medical care rendered to other patients.
It’s a new twist in their old game.
Another reason for eliminating insurance company middlemen.
Gene Uzawa Dorio, M.D.
A Biennial Recognition, Meet The Who’s Who In Concierge Medicine Throughout The U.S. In 2017-’18 by industry trade publication, Concierge Medicine Today.
OCTOBER 10, 2017
ATLANTA, GA USA – Twenty-five (25) Physicians have been named to Concierge Medicine Today’s biennial ‘Top Doctors In Concierge Medicine’ for 2017-2018. This national trade publication’s recognition is a distinction held by less than one percent of doctors across the country every two years.
“We look for physicians who have made a significant impact on patients, their peers, their community, their state, social media, clinical research and personalized treatment, use innovative technology and more,” said Michael Tetreault, Editor-in-Chief of the industry’s medical news and information agency, Concierge Medicine Today. “Concierge Medicine physicians don’t accept the status quo. Therefore, we believe it is important to acknowledge specific physicians and certain practices every two years within the Concierge Medicine space … they reflect, demonstrate and drive innovation, communicate with exceptional professionalism, provide value and uncover the unique benefits of this at-the-ready industry.”
Over the past several years, Concierge Medicine Today found distinguished doctors opening unique practices in markets like New York, Florida, Connecticut, California, Georgia, Texas and Illinois. This year, physicians are prominently working in various medical areas of healthcare which include: Integrative and Functional Medicine; Pediatric Care; Primary Care; Cardiology; Tropical Medicine; Family Medicine; Executive Healthcare settings; mobile medical facilities; and even Holistic Menopause and Anti-Aging practices. The result is Concierge Medicine Today’s ‘2017-2018 Top Doctors In Concierge Medicine’ across America list, which includes some of the nation’s most respected specialists and outstanding primary care physicians. These are the doctors that patients, peers and other healthcare professionals recognize as the best in their fields. They do not pay a fee and are not paid to be listed. Today, as in years past, it is a list which is respected by the medical profession and patients alike as a source of quality information.
“Patient Satisfaction in Concierge Care remains exceptionally high but inside traditional medical practice environments, patients expect to wait and they expect friction with staff,” notes Tetreault. “Nowhere else in our lives except inside a healthcare facility do we ready ourselves for this kind of tension. Attitudes toward Concierge Medicine have undergone significant and positive changes since the signature of the Affordable Care Act in 2010. Patients seeking Concierge Physicians tell us they expected insurance to cover their visit. When it is was not, they expected to fight. Consumers of healthcare today say, they expect a disengaged staff and an unpleasant visit when at their doctor’s office. We can do better. Concierge Medicine Patients are Invited rather than Expected. This counter-intuitive approach exceeds expectations, thereby creating a massively loyal and engaged audience which, in turn, is producing some amazing patient outcome data as released and seen by other organizations operating in this space.”
Congratulations to the following physicians named to Concierge Medicine Today’s 2017-2018 list of ‘Top Doctors in Concierge Medicine’ who made the list (in alphabetical order):
“When healthcare is looking for innovation and ideas about care delivery, they are observing Concierge Medicine,” said Tetreault. “One of the most interesting observations inside of this years list of physicians is just how many are implementing genetic testing to help their patients understand more about their health.”
“Two notable observations we encountered throughout our entire review process was related to patient comments received prior to transition and staff issues— which seem to plague most medical offices, even those inside the four walls of a Concierge Medicine practice,” said Tetreault. “A physicians reputation in the public and online is dramatically different from the patient reviews they may receive prior to a physicians entry into Concierge Medicine vs. after the conversion. Many [physicians] go from zero to hero in the eyes of their patients in a matter of weeks or months. We have also noticed that the physicians staff and their individual attitudes towards patients still remains a sore spot among the doctor’s and patients concerns. Even post-transition, when physicians are well into managing their Concierge Medicine members … managing staff inappropriately can impact the clinic’s annual patient retention and ultimately, their bottom line. However, it is amazing what can be accomplished when Physicians walk this healthcare delivery process out and into their own communities. It is only now, that when we are able to look back and track these dramatic career moves of physicians that we see why so many patient experiences make so much sense.”
About Concierge Medicine Today
Concierge Medicine Today (CMT) is a news organization and the Concierge Medicine industry’s oldest national trade publication for the Concierge Medicine and Membership Medicine marketplaces. Its website is the online destination for businesses, consumers, physicians, legislators, researchers and other stakeholders to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drives the conversation that Concierge Medicine and free market healthcare delivery is creating on a national and international level.
Ten Reasons Why Every State Should Welcome the Graham/Cassidy/Heller/Johnson Health Reform Bill
If a state is satisfied with Obamacare, it can keep Obamacare. But here are ten ways a state can improve on the current system if its citizens desire to do so. With the state’s approval, insurers will be able to offer coverage that is:
Affordable. Currently there are close to 30 million people who are uninsured and that number isn’t expected to change much under Obamacare. The reason: millions of people have decided that the products being offered are not worth the premiums being charged. This reform allows insurers to offer a more attractive package of benefits for a lower premium. Judicious use of risk pools and reinsurance will also help – especially with high cost enrollees migrating from group to individual insurance. If a state establishes a dedicated source of funding (outside of its block grant) for this purpose, it should be able to reduce premiums in the non-group market by as much as 50%.
Universal. At least one plan could be offered with a premium that is no more than the subsidy the state provides. Since these plans would require no out-of-pocket payment by the enrollee, people could be automatically enrolled through the Food Stamp program, by H & R Block, at the DMV and in other ways. Universal coverage could be a reality rather than an empty slogan.
Tailored. Currently, low- and moderate-income families are being forced to buy coverage that is completely inappropriate for their financial circumstances and health status. Instead of insurance that has unlimited annual and lifetime limits and a $13,000 deductible, would they rather have less upper bound coverage along with a low deductible and a Health Savings Account. The latter option would give the family easy entry into the system, but would leave some very expensive cases for a safety net (which is a more appropriate way of funding them).
Equitable. One of the worse features of Obamacare is the extremely inequitable treatment of people who are offered insurance at work versus people who purchase their own coverage. Employers of low-wage workers are offering Bronze plans with very high deductibles in return for a premium that is 9.5% of their wage. If employees turn down this offer (which almost all do), neither the employees nor their dependents are eligible for highly subsidized insurance in the exchanges. Under this reform, the employer and individual mandates go away and states can equalize the subsidy offered in the group and individual markets. This will be especially important in states where the non-group market has become completely dysfunctional and group insurance is cheaper and better.
Portable. Because states will have the power to equalize the government subsidy available at work and in the marketplace for low and moderate-income families, they will also be able to allow portable insurance for these same families. For example, a company might buy Blue Cross individual insurance for its employees, instead of Blue Cross group insurance, and the employees could take their insurance with them to the next job.
Private. Virtually every study of the matter has found that private insurance results in better health outcomes than Medicaid. Going forward, states will be able to subsidize private insurance instead of Medicaid enrollment for the poor and the near poor.
Fair. Currently, a large number of people are gaming the system by remaining uninsured while they are healthy and insuring only after they get sick. Because of a 90-day grace period, people are also dropping coverage to avoid paying premiums at year end. Of those who are enrolled in January, roughly 25% have dropped out by September and roughly half of those reenroll for the following year. Additionally, some people buy Bronze plans while they are healthy and then upgrade to Gold or Platinum after they get sick. This type of behavior unfairly shift costs onto other people. Under this reform, states will be able to require individuals to pay the full actuarial cost of any unfair gaming activity.
States will also be able to give their citizens access to:
Personalized care. At $50 per month for an adult and $10 for a child, the cost of direct pay (concierge) medicine has come down to a level that should make it accessible to almost everyone. This reform allows these fees to be paid from a Health Savings Account or by a third-party insurer.
Specialized care. Centers of excellence will be able to specialize in specific diseases – such as cancer care, heart disease and diabetes. They will be able to ask health questions and screen applicants to help get the right patient to the right plan.
A real health insurance marketplace. Obamacare’s risk adjustment is focused on plans, not patients, and there is no realistic way for a plan to know what compensation it will receive for enrolling a patient with a costly medical condition. This is one reason for the race to the bottom – as plans try to attract the healthy and avoid the sick. As an alternative, states will be able to set up a risk adjustment mechanism along the lines suggested by Cochrane, Goodman and Pauly. Risk adjustment will protect patients, not health plans, and centers of excellence will be rewarded for providing efficient, high-quality care to patients with the most serious medical problems.
“Take care of the patient,” directed my chief resident. “In the ER—he needs you.” My fifth admission for that 36 hour call cycle, and I was tired. Yet those words are as clear to me now as they were 3 decades ago in that post-call afternoon at Detroit Receiving Hospital. “Take care of the patient” is still my care-style and professional reputation, one patient at a time.
Vexingly, in this week’s version of our overseers’ mandates, they direct us, “Take care of the population.” What exactly does that mean? I think it means that once we all work for large employers, who aggregate our little-guy data, we might get paid if our data looks good enough? Big medicine pays little-guy PCPs in their little medical homes based upon “quality measures.” We should collect our “quality measures,” and are expected to change patients’ bad behaviors and habits, and become accountable for their actions and inactions. Is this what we want to do for a living?
Fortunately, in concierge medicine we work for patients (as opposed to third party payers) and can practice the right kind of medicine for each patient. From a business standpoint, insurance pocket change isn’t worth playing the population game. Realizing the folly of population-care, I sleep fine at night when a patient ignores my advice. He is responsible for his own life. My income does not derive from his decisions. If he makes bad choices and generates bad data I’ll do my best to help, but the real change needs to come from his side of the equation. At a recent EHR-sponsored happy hour, one population-incentivized PCP said it nicely, “Noncompliant patients—I just get rid of them. They (noncompliant patients) can eat what they want to eat and do what they want to do, but I want to get paid—so I get rid of them.” Concierge medicine is a better solution.
Payers have pushed physicians into the “you are responsible for your patients’ actions” trap. In today’s iteration of “best care,” doctors are expected to identify and allocate time and money to identify “at risk patients,” all to improve medical practice outcome data. Make no mistake, insurance work is a fixed-sum game, and individual doctors will ultimately pay to pay this game.
In Concierge Medicine we take care of the patient. In my practice, many of those were cast-off by population-treating doctors and their staff. Once in my practice, do the noncompliant suddenly comply? Usually not, but they appreciate the respect they receive, improve their life’s quality, while receiving much better, individualized care. Some smoke too much, drink too much, and-or eat too much. I don’t take on their life’s burdens and expect their numbers to improve. I do my best for them. In my concierge internal medicine practice, if the outliers’ numbers don’t improve, I will still be paid just as much, as I should. It is a lesson in futility for PCP’s to assume their patients’ risk. Collecting data, checking boxes, and groveling for a better performance bonus—who needs it?
Individual doctors cannot generate a generalizable data set. The n-size is simply too small. Bonus payments based upon doctors generating individual data that betters aggregated data will encourage doctors to lie about the data, cherry-pick patients (an insurance company favorite), and to throw out the outliers, AKA get rid of “bad patients.” As I learned in my research fellowship, “garbage in, garbage out.” Population data can only be as good as its weakest link—and there are plenty weak links! If population data looks valid, it won’t be.
The population health story is yet another Emperor’s New Clothes fable (1). The population idea has gained traction such that we all are expected to believe this idea; Like the emperor’s clothes, we should see how wonderful the nonexistent clothes/worthless ideas are—or we are fools! The concepts and PCP busy-work looks pretty to leadership, just as the emperor’s clothes looked pretty to his admirers and to him. In truth, there really isn’t anything to see. It will take decades for payers to realize individual patients generally cause their own poor outcomes, and that micromanaging doctors will not change patient behavior in the long run. PCP burnout and PCP shortages will be the collateral damage for our leaders’ misguidance.
In Concierge Medicine we take care of each patient, in times of sickness and health, and in times of good data and bad data. In Concierge, we guide our patients, and we let them make their own decisions. We respect our patients for who they are, along with their strengths and weaknesses. At days’ end, we take care of real people, not data sets. Keep up the good work!
1. Andersen, Hans Christian; Tatar, Maria (Ed. and transl.); Allen, Julie K. (Transl.) (2008). The Annotated Hans Christian Andersen. New York and London: W. W. Norton & Company, Inc. ISBN 978-0-393-06081-2.
There is a lesson to learn somewhere in the debate last month about the unfortunate circumstance of British baby Charlie Gard. Charlie was born with an inherited (yet) incurable disease that left him on a ventilator, blind and deaf. The government wanted to dictate his care in spite of the fact that his parents raised money to pay for his care with cash. The lesson: This is what will happen if the GOP allows the ACA to deteriorate into a single-payer system and choice evaporates from the American lexicon. In the meantime, the Senate debate did not show much promise as a “fix” to the ACA and it doesn’t look like the government is getting out of the way any time soon.
2017 Concierge Medicine Forum in Atlanta to Showcase “Precision Medicine” Use, Utility and Innovation Among Other Educational Topics
ATLANTA, GA — Concierge Medicine Today, in partnership with The Direct Primary Care Journal (The DPC Journal), are hosting a 2-day innovative healthcare delivery and precision medicine Forum in Atlanta, GA on Friday, October 27 and Saturday, October 28, 2017 entitled CMT’s 2017 Concierge Medicine Forum. (www.ConciergeMedicineFORUM.com)
Concierge Medicine Forum 2017: The Journey to Personalized, Precision Medicine | Concierge Medicine :: Direct Primary Care | ATLANTA, GA
AAPP Board of Directors Votes to Suspend Operations and to evaluate AAPP’s value proposition for 2018 and beyond.
We desperately need deregulation in medicine. It is hard to disagree with anything Dr. Hahn in the link below says about our regulatory nightmare, the need for reform and the chaos harmful state and federal regulations, insurance rules and the EMR mess create for all of us, doctors and patients alike. Deregulation is in part what some of us hoped the new Trump administration would do quickly, and it is in part what HHS Secretary Dr. Tom Price is trying to do by himself. His authority is limited however until and unless Congress acts. We should thank and encourage our friend Tom Price in his efforts and hope the Congress gets busy, perhaps in a bipartisan way.
Ps. Singapore has a functional system that could be adapted here to American values.