Medicare Goes Concierge – Sorta
One of the great things about concierge medicine (also called direct practice) is the ability to contact your doctor at any time. Also, that your doctor will work with other caregivers and advocate on your behalf.
Yes, it costs you extra for the extra service, but that is how the doctors can reduce their case loads and free up the time to provide you with additional attention. Not everybody thinks the additional fee is worth it, but many do. Plus an argument can be made that the customized care saves money by reducing duplicative tests and hospitalization.
The New York Times now reports that Medicare will try to replicate these benefits. Come January it will pay physicians an extra $42 a month to coordinate the care of patients with two or more chronic conditions. The patients will have to sign a contract with the doctor and will pay 20% of the additional cost.
Now, of course bureaucracies have a way of turning even the best ideas sour. In this case, will the $42 be enough money to allow the physician to reduce their patient load to free up the time to perform the additional services? How was the $42 determined? Plus, it is curious that the only patients eligible are those who already have two or more chronic conditions. Perhaps the best opportunity for intervention is well before patients develop chronic conditions.
And we can expect that Medicare will be so nervous about this new benefit that physicians will end up spending as much time filling out paperwork for the bureaucrats as they do caring for the patient. The Times writes –
As part of the new service, doctors will assess patients’ medical, psychological and social needs; check whether they are taking medications as prescribed; monitor the care provided by other doctors; and make arrangements to ensure a smooth transition when patients move from a hospital to their home or to a nursing home.
You can imagine all the reports that will be required by Medicare to prove the doctor actually did all this.
So, we will see how it works out. Still, Medicare deserves an “atta boy” for recognizing and rewarding the essential role of the personal physician in patient care.
“You can imagine all the reports that will be required by Medicare to prove the doctor actually did all this.”
Good point Greg. I can imagine it will cost much more in time than the $42/month the doc receives.
Concierge medical services is a way that some doctors use to compete for patients. Merely having Medicare offer doctors additional money for intangible services is unlikely to have the desired effect.
“And we can expect that Medicare will be so nervous about this new benefit that physicians will end up spending as much time filling out paperwork for the bureaucrats as they do caring for the patient.”
This is the problem with anything proposed by the government.
“Come January [medicare] will pay physicians an extra $42 a month to coordinate the care of patients with two or more chronic conditions. The patients will have to sign a contract with the doctor and will pay 20% of the additional cost”
So it appears Medicare will pay about $34 pmpm and the patient will pay about $8 pmpm. The doc thus receives about $500 per member per year, of which the patient pays about $100.
This seems a straightforward capitation of a physician service.
If this is a good idea, why not capitate office visits, too? Hospital care? Surgery?
Yes, it is like capitation, but limited in scope. It doesn’t try to cover everything. In fact, it is sometimes called “retainer medicine.” Like paying a retainer to an attorney, you get his attention and access to services, but you are still billed for specific services. Plus it is chosen by the patient, so if it isn’t working out the patient is free to opt out. This is far different than a capitated HMO.
“This is far different than a capitated HMO.”
Yes of course but . . .
“If this is a good idea, why not capitate office visits, too? Hospital care? Surgery?”
You can’t discern any difference between primary care and surgery?
We have shown Medicare in a couple of good published studies that concierge doctors like myself can reduce readmissions by 90%, reduce initial admissions and ER visits by over 50%, cut specialty consultations by over 50% and cut the need for high cost imaging and elective surgeries over 50% for anyone enrolled in our practices. In the case of the complex elderly medicare patient this translates into tens or hundreds of thousands of dollars per patient per year in savings to Medicare. Now, to do this we have to cut our patient loads from 3,000 to 600 per doctor and spend five times as much time with each patient we still have in the practice. Thus, in my opinion, this paltry payment is pretty much a joke and will make little or no difference in the care or cost, but this is how CMS is responding to the obvious data difference. They need to multiply the payment by a factor of five and contract with the doctors to limit the size of the practice to 600 patients while promising to otherwise completely leave us alone to do our job without interference. Then it might actually work. And they would save many times what they spent. TWL MD Chair ACPP http://www.acpp.md Owner, SPFC http://www.skyparkpfc.com
“They need to multiply the payment by a factor of five and contract with the doctors to limit the size of the practice to 600 patients while promising to otherwise completely leave us alone to do our job without interference”
This will help the primary care physician shortage how?
It would make primary care a hell of a lot more attractive than it is today and get more physicians to switch from specialties to primary care.
By attracting more physicians to the field. I might even consider resuming primary care medicine under such a scenario. I imagine there are many more like me who have left family medicine for greener pastures – urgent care, hospitalists, administration, semi-retirement, etc.
Yes it would help the shortage of primary care right now. One of the concierge doctors in my call group is a consulting endocrinologist who switched to primary care concierge for a better life and a better practice. I am woking with an excellent cardiologist who is about to do the same. Here and there sub specialty internists all over the country are making this change right now. Students have all but given up pursuing primary care pathways until they hear about direct practice and are becoming interested again. This is the best and perhaps the only way to fill the pipeline with primary care doctors. TWL MD Chair ACPP http://www.acpp.md Owner SPFC http://www.skyparkpfc.com
Medicare costs about $12,000/person/year. Why not just give seniors a high-deductible private plan and an HSA? Let them be free to go anywhere they choose. And end the collusion between hospitals, doctors, and insurance companies so that those seniors can get true prices when they use their HSAs.