Concierge Medicine Blog: Housecalls & cell phones.

Starting a concierge medical practice? So's Conciergedoc.

Of course he's less than thrilled with the thought of doing laser hair removal as this post attests:

Removing hair from unmentionable parts of ladies in Westchester County is how my friend Jerry spends a good part of his week. Not that there's anything wrong with that, except Jerry (not his real name) is a cardiologist, trained at one of the finest medical programs in the country. Trained to save lives. His expertise is the complex and delicate management of congestive heart failure, but he gets paid a lot more to do a laser Brazilian...

At least I can say I'm practicing what I wanted to my entire life, what I trained for my entire life. I wonder how the "ethics" talking heads would answer this question?

Concierge Medicine: Prepaid Emergency Care.

Via Medical Economics: Concierge Emergency Care?

These days, the soft-spoken, but formidable family physician is mixing it up in the role of healthcare reformer. Three years ago, Wood began advertising that his clinic would provide unlimited primary and urgent care for a monthly fee of $83 for an individual, $125 for a family. Wood immediately ran afoul of the state insurance commissioner, who warned him that he was operating as an illegal insurer, a felony punishable by up to five years in prison. For the next three years, Wood pushed for legislation—and got pushed back by the insurance-industry lobby—that would legalize his experiment. Now instead of prosecuting Wood, West Virginia is replicating his bargain-basement version of concierge medicine in a pilot program. The goal—to make healthcare more affordable in one of the poorest states in the nation.

Concierge Medicine: Another physician gives insurance companies the finger.

Is concierge medicine the way to get out from under insurance companies?

Remove $300,000 in overhead every year?

At his old practice, he estimated his overhead at $350,000, and he believes that most of it went toward meeting the needs of health insurers. He needed experts to read his charts and plug the right insurance codes into his bills. He needed staff to secure prior permissions for prescriptions and procedures. He had one employee who worked 40 hours a week just arranging patient transfers to specialists.

He also calculated that he needed to see 25 patients a day just to cover his overhead. In order to make his salary, he often saw 35 or 40. And he never could spend as much time as he'd like with them. According to his wife, Gena, practice employees had developed a ruse to keep Stein from talking to patients for too long. When a patient visit ran over, someone would knock on the door and tell him that another doctor was on the phone.

"You can't take care of 25 or 30 patients a day," Stein said. "That's not possible. What you're doing is running a cattle drive."

His new practice, he said, has an annual overhead of $50,000, and that number includes the flat screen television and leather couches in the waiting room, the Starbucks coffee brewing behind the reception desk, the electronic record software and the high-tech diagnostic equipment that Stein bought when he opened his doors...

...The key to his financial model, he said, is that he doesn't sign contracts with insurance companies, which means he's not bound by their reimbursement rates and not subject to their rules. He can decide what tests to perform or drugs to prescribe without having to make phone calls or fill out forms. He also doesn't have to worry about laws governing health insurance or Medicare fraud. Since he doesn't bill the companies, he doesn't have to follow their rules.

Via Kevin MD

Boutique & Concierge Medicine: Doctors on retainer.

Marketwatch: Botique & Concierge Medicine

Boutique Medicine: Patients pay a flat annual fee to a primary-care doctor who caters to a smaller group of patients.

There has been a lot of media attention on the supposed rush into concierge medicine by unhappy docs. I haven't seen much of a rush. There are a few doctors I know that have discussed or investigated this as a possibility but I can't think of any that I know personally that have tried this.

From the article: Dr. William Plested, president of the American Medical Association and a thoracic and cardiovascular surgeon in Santa Monica, Calif., said doctors making the transition to a retainer practice are obligated to ensure the patients who don't join find a reasonable alternative. "The idea is certainly not to leave a patient in the lurch. The idea is to improve the type of service you're providing -- improve it for yourself and for your patients."

He and Caplan agree that boutique medicine is likely to stay a niche practice.

"It's a tiny drop in a huge ocean," Plested said. "The economic reality and demographic reality is there aren't that many areas that will support this type of practice."

Still, retainer practices point to an uncomfortable truth, Caplan said. "It undermines one of our favorite myths, which is same quality of health care for all. That's never been true, but this rubs our nose in it as a society."

Any one have experience with or thoughts on this? 

Retail Medicine: Why do doctors want to open medical spas?

No end to physician problems:

-- The top five factors contributing to low morale were identified by the survey respondents as: low reimbursement, loss of autonomy, bureaucratic red tape, patient overload and loss of respect.

"I think that it is safe to say that no physician is optimistic about the future of medicine at this point," one participant wrote. Others seemed downright hopeless: "One thing that rarely gets mentioned is that, unlike other industries that are cyclical, the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future."

The free-market is forcing doctors to extend office hours

Extended office hours are now the norm.

"Suddenly, faced with less compliant patients and unexpected competition, more and more doctors are doing the unthinkable: changing their hours to accommodate potential customers."