Should concierge care be regulated?

Those in charge are fearing the effect of doctors opting out of Medicare and health insurance.

As the practice environment for generalist doctors deteriorates, many are declining to accept Medicare and other health insurances.

One response to the resulting primary care shortage is to mandate every physician to accept Medicare, removing the trump card of opting out and switching to a cash-only model.

Regulating cash-only practices (via Better Health) is the first step of making that happen.

And it will truly be a chilling step for the medical profession if it ever comes to fruition.

Comments

John
All this will do is accelerate the already-present exodus of doctors from that over-priced state. Maryland has some of the wealthiest counties in the nation, notably Howard and Montgomery counties in the Washington-Baltimore areas. These are also among the most costly locations in the nation to live and do business, with high living costs, high staffing wages high business taxes, high rents and malpractice premiums. Doctors leave because they correctly project that they will do much better somewhere else in the Mid-atlantic, like the Carolinas, Virginia or even Pennsylvania, compared to Maryland, or even elsewhere in the country where costs of business and living are lower and hospitals are more welcoming and helpful in promoting new practices.
Calling a concierge practice a form of insurance, when it is not–it is a private membership–is really nothing more than trying to extend the reach of government regulation beyond the controls usually applied to those who accept public insurance and, in the usual government way, exercise that control in the form of price fixing. It will come to no good. All it will do is close the door to the one option beleagured doctors have to remain in practice there. But Maryland is a small state, and unhappy doctors won’t have to move far to find something more acceptable.
Anonymous
The article only discusses concierge practices , not the broader category of cash only practices.
Regardless, if they do this and try to force Medicare participation directly or indirectly (via onerous regulations like the current opt out process), they’ll simply increase the exodus of primary care physicians to nonclinical careers or retirement.
Cash only practices, including concierge practices, offer one of the better hopes of keeping our more skilled primary care physicians working in clinical medicine while Medicare and the third party payer system continues to decline, destroying primary care in the process.
Anonymous
The government can force me to accept “Medicare for all”, but they can’t force me to stay in practice. If the day ever comes when Uncle Sam tells me I have to do that, that’s the day I’ll gladly liberate myself from a job I already can’t wait to leave.
Chuck Brooks
Primary care doctors are fighting a losing battle, regardless of whatever political promises may be inferred. The entire US medical system is under siege, not only to the tender mercies of the Pete Starks in DC, but far more effectively to comparative advantages, one very visible indication being the cars in hospital’s administrative parking lots. Medical tourism is a fast growing alternative to arbitrary and capricious pricing practices, with real and huge economic savings that are below the deductibles for the self employed and uninsured, icing on top of the physcological benefits of knowing they’ll be taken care of by some of the world’s best medical practioners. The quality is just as good, and in many cases even better, than US counterparts, with highly trained professionals and a technological infrastructure that is often better than what may be available in many US hospitals. The follow-up and remote diagnostics, along with a much more integrated holistic approach to health maintenance, are being built out, with much of the technology already in place e.g., processing US tax returns, evaluating digital x-rays, a healthy high tech design and manufacturing base that increasingly supplies domestic medical appliance requirements. Doctors may better spend their time investigating the ‘minute clinics’ potentials that they can control themselves, instead of imagining that things will get better a la Waiting For Godot.
Chuck Brooks
FutureWare SCG
David
Concierge care is not health insurance. If there is an issue, a third-party can hold the money in escrow until it is taken (quarterly) from that fund. Here we have people trying to solve a problem that doesn’t exist. Or, less charitably, who want to destroy a service they do not like.
If physicians are mandated to accept Medicare and Medicaid, then it is time for a revolt or simply to quit medicine altogether or to practice in another state. I, for one, do not wish to be a slave of the state, to be disposed of as any government goon desires. God help those patients who stay with the physicians who continue to work under such control.
Anonymous
Why are we all so quick to just blame the government for this? The health insurance industry has a tremendous interest in squelching the concierge movement.
Anonymous
“The quality is just as good, and in many cases even better, than US counterparts, with highly trained professionals and a technological infrastructure that is often better than what may be available in many US hospitals.”
Spoken like somebody with no affiliation to a medical tourism company. No, really.
Good luck catching a plane back to India when your hip replacement gets infected and no orthopedic surgeon here will touch it since they’d be the only ones who could be sued for malpractice.
Steven D. Knope, M.D.
The idea that doctors who offer fee-for-service medical care on a retainer basis are somehow “operating insurance companies without a license” is a ruse. Even if the insurance commissioner plays this political card in Maryland, there will be other ways to structure direct relationships between doctors and patients. Laws regarding payment for concierge doctors vary from state-to-state, but nowhere is it outlawed.
This is a scare tactic meant to control doctors. It is purely political. The day that the U.S. government attempts to force doctors to work for Medicare or Medicaid will be step one on the path to a Supreme Court battle that cannot be won by Uncle Sam.
Steven D. Knope, M.D.
Author, Concierge Medicine; A New System to Get the Best Heatlhcare.
(Greenwood/Praeger, 2008)
stevenknope@msn.com
http://www.conciergemedicinemd.com
secretwave101
Concierge medicine may or may not be actually sustainable.
The thought that government would mandate how I practice medicine is creepy.
It’s beyond Gestapo.
Rogue Medic
Hmm. Doctors are leaving the Medicare system, because of the many problems specific to Medicare. The solution is to force them to participate, rather than fix the problems?
The people, who recognize the problems, are not the problems.
The people, who come up with alternatives, are not the problems
Anonymous
I will not be a slave. For over 2000 years, physicians have been free to chose whom they serve. In that time republics, kingdoms, and empires have risen and fell and that right remained intact. No tyranny has violated it until modern times.
That we even consider it here, that it is a fact in some “liberal democracies” is a testament to the ultimate triumph of the fundamental ideas of fascism, even without the truncheons and jackboots.
The Supreme Court has proven itself no gurantee against unconstitutional tyranny. It’s members take the same oath to uphold the constitution as those in the other branches of government, and have proven themselves no more reliable in keeping it.
The American people have proven themselves unworthy of liberty, eager to trade it for imagined security at every turn. Without support from the people, the limited government and liberty of our forefathers was lost long ago.
My only path is to chose where in the fabric of this society I will live and I am commited to living as free within it as I can. If I can not live free as a doctor but can as a circus geek, then a circus geek I will be.
jb
They WILL find a way to regulate concierge/retainer practices out of business. “They” being the unholy alliance of government bureaucrats and insurance companies who can not and will not tolerate any type of profitable medical transaction without their rent-seeking participation.
Aside to Mr Brooks: Thanks for the comic relief. Next time you get a chance, take a walk down the halls of any acute care hospital in the USA. Probable 10-15% of the customers there could physically tolerate a trip overseas to manage whatever they are hospitalized for; and half of that number are indigents and will need to borrow cab fare for the ride home. Your company will likely make a profit on the 2-3% of the patients that fit your business model, so don’t be discouraged, but your post is marketing for your company, not a contribution to solving this problem.
Anonymous
Agreed JB, Brooks is a salesman for a small percentage of elective surgical patients. He will make money by cherry picking. As an aside. I find it curious kevin that you allow this sales pitch yet censor out posts you don’t agree with. Your website site has definitely decreased in quality as evidenced by fewer post replies.
Anonymous
Society grants physicians the privilege to practice medicine. Through the licensing and credentialling process, it can certainly place requirements such as participation in a national insurance program. Mandatory participation exists and has survived court challenges in Canada. It was part of the program proposed by Hillary Clinton in 1994. It will certainly be part of the reform that we are about to see. The American people don’t care what rights you believe will be violated by this. They want what you have, and they’ll take it for as little as possible. The government is now telling them that they can have it for nothing. Who are you to stand in their way? And can you wait for the years it might take for a court challenge?
John
Anon. 6:12:
I think you are right. I think the public, through their representatives, will try to get whatever can be had on terms as close to expropriation as possible. They won’t be pioneers. Europe had sixty years of that sad experiment. But don’t worry, good quality of care will still be available. On the black market.
Bring a couple of kilos of coffee and some sausages at your next office visit. I’ll see what we can do to move your appointment up a couple of weeks.
David
Another option may simply be providing poor care. While I pride myself on doing an excellent job, if extortion is the game being played, I may decide to give as little as possible. Two minutes for a follow up visit? – no problem – its a Medicare patient. I think I would mentally suffer doing this – eliminating my pride in my work – but ethically it is not a problem. Again, see what you get when you try forcing physicians to think and act according to your dictates.

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