The Doctor Will See You Now ... For An Extra $1,500
A Florida company is at the epicenter of what's called Concierge Care
The move toward concierge care leaves the medical establishment in a quandary, however. Many agree that strict cost controls and authorization-based management by insurance companies, HMOs and Medicare have squeezed doctors and increased bureaucracy. Doctors and patients alike complain of tight office schedules, long waits and "little flexibility to accommodate patients whose problems consume more than the 15 minutes that third-party payers allot" for a primary-care appointment, says Dr. Mervin Needell, a recently retired Miami urologist who wrote about the concierge trend in The Journal of Clinical Ethics.
Needell and other ethicists acknowledge concierge doctors are fulfilling their duty to provide prompt and ample care to patients and that the doctors avoid overusing hospitals and specialists because they have time to treat their patients themselves.
At the same time, the ethicists worry that concierge medicine will widen the care gap between rich and poor. And, they ask, what happens to the patients, usually more than 1,000, who are dropped every time a doctor switches from a regular practice to a concierge practice?
"If only a few doctors do it, it will be OK," says Needell. "But if all the doctors bolt, the vast majority of the public would be left without adequate medical care."
It's not yet clear whether the concierge approach actually makes patients healthier or just makes them and their doctors more comfortable.
Data from MDVIP show its patients' hospital admissions are 65% lower than the national average for Medicare members and 26% lower than a top-ranked HMO's average. The average hospital length of stay was 17% lower for commercially insured patients and 5% lower for Medicare patients. Total hospital charges, too, were reduced: 14% for commercial patients and 13% for Medicare patients. Company executives say they achieved these results despite higher severity ratings for MDVIP-admitted patients.
But more data and peer-reviewed studies are needed to figure out whether concierge care actually produces better health, says Kenneth W. Goodman, who directs the University of Miami Bioethics Program and the Florida Bioethics Network, a group of healthcare professionals who wrestle with ethical issues in medical care and research.
Goodman has been fairly critical of concierge care. But recently, UM's medical school entered into a contract with MDVIP to open such a practice in Key Biscayne. That concierge office could provide key data that are missing in the debate, Goodman says. "We hope this experiment will demonstrate whether this type of medicine makes a difference or not," he says. "If there's no difference, then it will be hard to convince people to pay for it. If there is a difference, it means that people who have more money are getting better medical care -- and that fact is not something to brag about."