A few years ago, my physician retired and I had to find a new one. One seemed good until I discovered that they had this tiered pricing scheme where the more you paid in the form of an annual subscription, the more services they offered. For example, with my previous physician, if I went for my annual check up, he would order the usual tests and then later his aide would call me and tell me what the results were (if they required no further action) or he himself would call me to tell discuss with me what I should do if the matter so warranted it.
With the new doctor, they would not release to me the results of my tests that had been paid for by my insurance company. She said that I had to make a second office visit to just get the results, whatever they were. Not only was this time consuming, it meant that I would be charged by my insurance company for an extra doctor visit. However, if I paid extra for the ‘premium’ service, I would get the results mailed to me, just like my former doctor had done for free.
I felt that this was a form of extortion and quickly changed doctors.
But now I hear from reader Norm that this may be a trend, and that there is something called MDVIP that some physicians are switching to. He sent me some links that describe how this new system that comes under the heading of ‘concierge care’ or ’boutique doctors’ works. (See here and here.)
But as Scott Isaacs says:
In order to provide this level of care, your doctor has to cut his practice down from 2,000-3,000 patients to 600 patients. What is the criteria for selection? The simplest criteria there is: money. MDVIP costs $1,500 to join. No, that’s not a one-time fee to join. That is an annual fee to maintain your membership in the MDVIP program as well as stay a patient of your doctor. This comes out of your own pocket and goes on top of all your insurance payments to your doctor.
Doctors claim that they are doing this because they want to practice better, more in-depth medicine. I don’t buy it. The hefty up-front annual fee is what points me in the direction of the motivation for the doctors. They get more free time because they are dealing with 20% of the patients they used to see and they get $900,000 in dues straight away not counting any money they collect from your insurance provider. Who wouldn’t like more vacation time and a raise?
Norm’s doctor was charging an annual fee of $1,800. He explained why he declined to participate in the system, reasons that I echo.
1) I typically see my doctor only 2 or 3 times per year. That means each visit will effectively cost me $600 to $900 per visit under the new plan–on top of my normal insurance premiums. That’s a lot of money.
2) It bothers me that under this new system those who can afford it will get better healthcare than those who can’t.
3) If a doctor using MDVIP typically reduces his caseload by 75%, that’s thousands of patients who will be “put back out on the streets.” This will place an even larger burden on primary care physicians who are not switching to the MDVIP system, and who must pick up those extra patients.
One of the objections that people who already have good health insurance have to providing expanded health coverage to all was that this would enable more people to have access to doctors and that hence they would find it harder than before to see a doctor. It was a callous and selfish response and this ‘concierge care’ may be trying to target such people, and take advantage of their need to have access to better care so that they can continue to ignore the plight of others.
Here’s a video about this phenomenon.