Physicians

PHYSICIANS/POLICY: Concierge Medicine-Interview with Ed Goldman MDVIP

Does primary care have a future? And is that future a version of concierge medicine? It’s very early days, but yesterday I had a great conversation with Ed Goldman, CEO of MDVIP, a franchise concierge medicine company. He has some very interesting things to say about how concierge care may not just be for the worried wealthy.

The conversation is in this podcast
.
There’ll be a transcript available in a couple of days.

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102 replies »

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  2. DR’s who do not like their Concierge Practice. There are physicians who became disappointed with changing their traditional practice and cannot go back. Why? Numbers? non-responsiveness of purveyers of the model? What can we know about those who face that predicament daily? Your thoughts please.

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  4. A concierge doctor, also known as a VIP concierge doctor or a private doctor is a primary care physician who provides enhanced care to a patient. Concierge practice is also called boutique medicine, internal medicine practice, retainer-based medicine, and innovative medical practice design. Some of the advantages of Concierge medicine include coordinated wellness programs, coordinated prescriptions, more time with the doctor, availability of the doctor via cell phone or e-mail at any time of day or night, availability of home visits and more. An example of a VIP Concierge doctor is Dr. David C. Rosenberg of Jupiter Concierge Family Practice. The address to his office is 2141 Alternate A1A South, Suite 200 Jupiter, Florida. It is located near the Calle Vija shopping center at the corner of Old Dixie Highway and East Indian Town Road in Jupiter. Visit his website at http://www.jupiterfamilypractice.com or call 561-743-0005 to get more information about concierge medicine.

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  6. Interesting comments, it stuck me that when watching the news the other day that the autoworker at 160,000 actually makes more than the doc, at 120,000.
    And given the importance of your health vs your car seems odd, but then Britney Spears makes alot more than any fireman, I suppose all this is indicative of the human condition.
    Whether MDVIP is a bad thing is same as asking if any premium service is a bad thing. There is no guarantee to health care, perhaps if we all remembered that we’d stop over eating, drinking, stop smoking, and exercise.
    The fee these docs charge is less than smoking, gambling, etc…….for me 1500 for primary access to a highly rated Doc is a better investment than any of those….so that’s where my money would go.
    But that’s a choice I make, and why I bust my butt each day to earn a good living, so I can live a good life or at least the best I can. I don’t expect anyone to be compelled or volunteer to be my doc, landscaper, waitress, teacher, etc…..I earn the prviledge of other peoples time and attention.

  7. hearing the Podcast Make the Deep impact my Psychi, Well I have a lot of experience in Medical field and seen lots of insurance facts.
    I already have a huge deductible and relatively high premiums (due to pre-existing conditions). How do the insurance companies figure into concierge medicine?
    Mens health is tottaly hesterical and i think for general Public that They should have proper guidance for the insurance plans

  8. I do appreciate the stories by the doctor’s telling us how their practice has changed and some of their motivation for their decision. I think it boils down to:
    1) An economically attractive model for the physician. And no, I don’t believe the physician gets to pocket $900,000. There are costs involved. But the financial model is part of the attraction for the physician
    2) The ability to see fewer patients and concentrate more on the ones they have.
    3) Most doctors agreeing to this model are near retirement age and would just retire if this option were not presented. In the case of my doctor, he is openly advertising to move you to one of the new PCP’s in their practice if you choose not to go with him.
    I don’t see it as a terrible thing – I see it as a choice. One I haven’t decided upon whether it’s worthwhile or not.
    However, I do have one request: doctors, please stop the “woe is me” stories. I understand doctors work very hard and are getting squeezed from many angles. However, the assertion that your average bus driver is living better than your average doctor is just asinine. Doctors make a LOT of money. And for the most part it’s well deserved. Don’t apologize for it, but don’t try to pretend it doesn’t exist.

  9. I was recently abandoned by my physician of 15 years because the group he is with decided to switch over to this form of elitist healthcare. In this case, the greedy third party outsider that brought this all about is MDVIP. If I wanted to continue on with my physician, I would have to sign a contract and pay MDVIP $1,500.00 per year simply to have access to my doctor. My primary insurance company would still be forced to pay for all office visits, lab tests and any in-house procedures. In retrospect, I never needed a third party outsider to get quality care from my physician and I’m not about to line the pockets of some greed driven outsider who has absolutely no interest in my well being. This concept is very unethical and patients are the real losers under this particular business model. Medicare and all insurance companies should refuse reimbursing physicians who adopt this approach to patient care.

  10. Primary care still has a function, in fact I expect a return to healing the body with those almost forgotten home visits.

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  13. I left a busy group practice in Fort Myers, Florida in 2005 to start my house-call based concierge practice. Originally I tried to deal with insurances but since none pay for house-calls, and Medicare only reimburses minimally, I couldn’t make it viable. In our area it’s not uncommon for me to drive 30-45min between visits and I typically spend 45-60min with a patient. Hence I was drawn to the concierge business model. I am still the ONLY concierge physician in South-West Florida exclusively making house-calls in Lee and Collier counties.
    No mistake, my services are a luxury item and convenience for most of my patients. I charge $2000-$6000 a year per person, depending on age, size of family, and location.
    I know it’s not the answer to our health care crisis, but I certainly love my job again! Besides I get to see my kids more.
    2 other key points for the lay-person to understand. Just because I charge above what insurance pays, doesn’t make me rich. I actually made less than our city pays buss drivers for the past 2 years, although admitedly the potential is significant. Also, even though most of my patients are the “rich and famous” of our area, doesn’t absolve me or any concierge phsycian of our responsibility to the community. In fact this is a responsibility of each of my patients as well.
    I continue to be an active office in the US Army Reserve, chair the Health Advisory Committee of the Lee County School District, volunteer as a Guardian ad Litem serving abused and neglected kids, teach Head Start program moms about child care, etc…
    No, concierge medicine isn’t for everyone, but it certainly has worked for me and my patients.
    Andrew Oakes-Lottridge, MD
    Personalized Health Care, Inc.
    (239)694-6246
    http://www.DrAndy.us

  14. I already have a huge deductible and relatively high premiums (due to pre-existing conditions). How do the insurance companies figure into concierge medicine? Am I meant to pay the same copay, deductible and premiums on top of the $1500 annual fee? Ouch.

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  17. Wayne M. Burr, MD
    239-333-DR4U (3748)
    http://www.concierge-physician.com
    9407 Cypress Lake Dr., Ste. C
    Fort Myers, FL 33919
    Make sure that when you speak to a concierge practice that you have all the information in regards to billing. Our practice puts all of this in writing in the form of a patient/physician agreement so that all charges are explained and all covered services are listed. Make sure that you get this same information from any practice that you consider becoming a member.
    Some groups that belong to a larger franchise will not only charge a “concierge” fee, but also will bill your insurance. This arangement is not allowed in most insurance contracts, so I suppose that these practices are filling “out of network”. In contrast, my practice only charges the concierge fee for all of our services-no hidden fees or other attempts to try to collect above that of the membership fee.
    Members in this type of practice can submit patent claim forms to their insurance to try to recoup some of the cost of the membership. Most practices will give you a bill of each visit to submit to your insurance company. Discuss this with your insurance and your accountant to see what may be the best way to approach handling your medical expenses. Above all — do your homework and get the facts.

  18. Can anyone tell me how insurance and HSAs are handled for MDVIP patients? The patients still pay the same premiums? Pay the same deductible? Is there a need for an HSA if you’re an MDVIP patient?
    I have been with the same PCP for about 12 years, and she is affiliating with MDVIP. I am trying to decide whether to switch over to MDVIP with my doctor or search for a new PCP. I would like to stay with my doctor, but I’m not sure I can afford to. I can certainly understand her decision to make the switch, but there are still a few issues that are unclear to me.
    I already have a huge deductible and relatively high premiums (due to pre-existing conditions). How do the insurance companies figure into concierge medicine? Am I meant to pay the same copay, deductible and premiums on top of the $1500 annual fee? Ouch.

  19. dvip is just the beginning when it comes to alternative or concierge or boutique or as I like to call it in my pediatric field “attentive care” New practice models are emerging that make mdvip obsolete. Try a marriage of tech and personalized care in the form of Personal Pediatrics administrative support system that is actively practiced by Natalie Hodge MD. As opposed to Goldman, she has invented a new practice, or reinvented an old, model the communication system and treatment for Bowel problem of which makes the entire office obsolete. Providing care for children where they need it most when they are sick, AT HOME. Watch the story of Personal Pediatrics unfold. Maybe I am being snowed, but if this approach can really show that paying the primary care doc more to look after fewer patients saves money overall, then it’s very interesting–and has huge implications for the future of primary and secondary care. If it’s just rich people trading up for a better class of waiting room and the doc’s cell phone, then it’s less so.

  20. Health care will continue to evolve as costs skyrocket. Concierge medicine represents an alternate choice, and choice is the key to satisfying the patients.

  21. hi,
    i am sort of a convinced by his idea about concierge medicine. May be, for the reason because I have been in the buisness of concierge for a while now.

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  25. “For all the poorer people to get left out of good health care because they can’t afford to pay extra for it (remembering that insurance still pays the doctor), this is shameful.”
    What about all the poorer people who get left out of ANY healthcare because they can’t afford insurance?
    We already have a “quality of care” issue in this country. The insured versus the uninsured. Frankly, I think that is far more worthy of shame than doctors who want to do this.

  26. Considering that the vast majority of posts here are by doctors or people in the health care business, this blog is horribly lopsided in opinion. For all the poorer people to get left out of good health care because they can’t afford to pay extra for it (remembering that insurance still pays the doctor), this is shameful.

  27. I really admire the way you approach to tackle this matter which became a global issue . I will be observing your future works and submitting my own views and results of my personal researches.

  28. Thank you all for such informative posts. My father, who was practicing primary care medicine for over 30 years, just completely left his practice to start a Medical Spa. I just left my career as a management consultant to run his spa – in less than 1 years we are generating 4 times the daily revenue that his practice was.
    His practice was literelly a “meat market” – hundreds of patients in the waiting room pushed through his office like cattle. It was in a low income area of New York City, so the patients had medicare or some other low paying insurance.
    The trend does seem that most primary care physicians are looking for alternatives now…. be it conceirge medicine, or medical spa…….essentially a Retail Medicine model.
    I’m interested in learning more about the working/operations of a conceirge practice. I can imagine that getting your patient base can take some time, and can leave you without revenue for quite a few months. How does Dr. Burr afford to offer complimentary massage, dietician services, personal training along with the membership fees. Are physicians just giving an Insurance Superbill so that patients can get reimbursed as an out of network provider?
    Where can one go to learn more about setting up a concierge practice? I am not interested in franchising.
    Regards,
    S.J. Shah, M.S.E.
    Director of Operations
    Amari Medical Spa
    http://www.amarimedspa.com

  29. it was very nice to go through this blog. usually we cant find that much informative blogs like this. thanks.

  30. Lawrence R. Brownlee, MD has been practicing Concierge Medicine for a few years. The request to change the style of practice came from some of the patients. His office is located in Tustin, California and sees VIP’s and Executives from all over Orange County.
    Posted by: OEV
    http://www.mdelite.com

  31. Wayne M. Burr, MD, PL
    Concierge Internal Medicine
    Fort Myers, Florida
    239-333-DR4U
    I agree that physcians should utilize all tools that are available to educate the public about different practice models. Concierge medicine is relatively new in my area, and most people, including physicians, do not know how the practice works.
    Education of the public by advertising to include print and broadcast media has been succesful. My website is another good resource for the community. Once patients realize that there is an alternative to high volume healthcare, they are more informed about how to manage their own health matters.

  32. I’m sort of a convinced by his idea about concierge medicine. May be, for the reason because I have been in the buisness of concierge for a while now.

  33. The first thing we physicians have to do is become more cohesive. Strength is in numbers, a lesson taught to us from our attorney friends, who to my knowledge, have not had too many cuts in reimbursements. Hypothetically, if all physicians in the country were to drop a major low-paying insurance carrier, people (and insurance companies) would probably listen.
    The second thing we need to do in the meantime is become a bit more creative with our medical business sense. We ARE allowed to be businessmen (or businesswomen), we ARE allowed to advertise and market our services, and we ARE allowed to be entrepreneurs. In the age of lower reimbursements, rising malpractice premiums, lack of Medicare support, and high-dollar lawsuits, no one feels sorry for us but us. In the past year, we have started three practices: a concierge practice where I have opted out of Medicare and all insurance companies (a solely cash-pay model); a second that charges a small, flat fee for all uninsured patients and takes care of “insured patients” as a bonus; and a resorts house calls practice that is fee-for-service and caters to the tourist population in central California. If we could do it without a cent from any bank, and straight out of residency, so can other doctors. It just takes a bit of personal sacrifice, ingenuity, and a thorough wish to succeed independently.

  34. I just read through this entire blog and I’m curious why and how so few of us (physicians, and patients) seem to know or pay much attention to the fact that the healthcare insurance industry is making a killing every year with increasing premiums, and decreasing payments… I believe the quote was somewhere in the billions of dollars!!! I wonder why we as physicians, or physician groups such as the AMA, and the all powerful media haven’t addressed or begun to uncover such an atrocity. I don’t think its difficult to see how even small improvements in premiums and payments to physicians could dramatically impact the entire system. Anyone have any ideas about how to get the public eye focused on this?

  35. Two of the recent comments have prompted me to write again.
    First of all, the comment comparing the concierge model to an HMO presents as a clear contrast. The first item that comes to mind is the choice issue for your primary care physician. You as the patient have the choice of in whom you place your trust. Granted any insurance plans have limitations in regards to many aspect of your healtcare, but at least with you having the choice of your primary care physician who will guide your medical care, the choice of your insurance plan to cover other aspects of healthcare should be a little less daunting. As with any other decision in your healthcare, carefully review you coverage options. I have seen some patients who have changed their insurace coverage to cover more hospitalization and high end radiological procedures to reduce their monthly premium. In the end, some patients end up saving money on their healthcare with the concierge model by paying the concierge fee with lower monthly premiums to cover more “catatrophic” events.
    This also replies to the other comment about types of coverage such as catastrophic care. The choice of higher deductibles could be one option to lower the monthly cost of insurance. There are lots of choices. You just have to look.
    Wayne M. Burr, MD

  36. I attended a MDVIP kick-off last night. It was an older doctor (my wife’s) who falls into the category of “frustrated over having too many patients, wants a life.” A lot of his patients seemed to be older and probably have the money. Nobody walked out, and it was pretty well received.
    Our pediatrician had booted the insurance companies before my kids became patients. Luckily, my family has been healthy. There have been a few emergency room visits over the years and one daughter went through a battery of allergy/asthma evaluations. While the cost of annual doctor’s visits has added up over the years, it was the testing, specialist, and emergency room visits that were by far the biggest hits. Insurance was applicable to those services.
    The pediatrician seems to have been successful with his approach. His staff is small and he’s accessible, as well as being a good guy.
    I don’t know how different it would have been if there would have been many more office visits and/or office treatments from him. If this were a more readily available option, would insurance plans possibly become available that would be applicable only to the expensive diagnostic and hospital related costs? Maybe that’s similar to the catastrophic coverage?

  37. Dr. Burr, I agree with your thoughts and believe strongly that this is the basis for creating ‘retainer based’ medical practices. The belief that insurers need to be taken out of the mix. Currently they control everything.
    My partner and I have founded Walden Centers for Personal Health which partners with physicians who are interested in practicing medicine in a innovative way. Innovative practice management can mean concierge or simply not accepting insurance payments. In our situation we set up and manage a retainer based practice for the physician, guarantee a competitive salary and the opportunity for profit sharing. As additional services we also offer exercise physiology, nutrition consulting, psycho-social evaluations and a comprehensive educational component all as integral components of the overall medical care for the patient.
    We both believe concierge or innovative medicine has a place in today’s healthcare industry however the concept needs to mature.

  38. I have enjoyed reading about others experiences with the concierge practice model.
    I have converted my practice to the concierge model, and as part of that model I am including other services such as personal fitness training and dietitian. We will also have massage therapy available as well. These services will be on site and if the patient desires at their home/office.
    It is time that we place the decision making for healthcare into the hands of those we treat – the patient. This also allows us as physicians to treat the patient and not constantly have to navigate the land mines of insurance and third party billers.
    I have had positive feedback from patients in the Fort Myers, FL area when discussing my practice. It has been well received.
    Wayne M. Burr, MD
    http://www.concierge-physician.com

  39. Helen,
    You’re right in your comments about an associate covering. It’s not advertised but it’s in every concierge practice’s fine print. However, I encourage you to ask, how often an associate will be the one covering. If it’s more than 1 or 2 per year (depending on the number of your visits), then that’s too much. The problem I addressed in my blog with MDVIP is you need to know why people choose MDVIP. MDVIP only takes docs who are long standing and they take mainly from there own practice. That implies:
    These are much older physicians who leave traditional care out of frustration, so regaining a life is a primary reason of switching to a concierge practice (rightly deserved by the way). So, when they are not there, someone has to cover.
    Other concierge practices, smaller ones with doctors starting from scratch and are newer will provide you with more attention because their motivation is building a practice, not switching out of frustration.
    So Helen, because of excellent continuity of care between concierge practices, use of EMRs so the covering doctor always knows you, and the fact that I’m sure your MDVIP will talk to you if it’s absolutely necessary whiles he’s away on CME of vacation makes concierge medicine still a better choice.
    So Helen, you don’t realistically expect him to 24/7/365 live in the office. But I’m sure it’s pretty close. Just verify how often this would occur and can you reach him in emergencies.
    ConciergeDoc
    http://www.myconciergedoc.com
    ps: Welcome to the better side of medicine Dr. Rupe. I have family living in that area and if there are looking for good care, I’ll refer them to your office.

  40. It is tiresome to read about “greedy” doctors from people who have NO understanding about healthcare economics. Here is a quick Healthcare Econ 101.
    As a medical office manager for a struggling family physician, we are in the process of ending our participation in health plan “networks” and going to private pay medicine.
    Here are the facts:
    In 2007, physicians are working more (60 – 100hrs/wk) and earning less than they made in 2002.
    In over 190 metropolitan areas of 290 studied, one health insurance plan has a market share in EXCESS of 50%. These plans DICTATE the earnings of physicians.
    The median reimbursement for an average family medicine physician is $52 – assuming that the patient’s check for the copay is good, their insurance premium is paid current, the insurance company doesn’t cheat the doctor, the secondary insurance is paid …
    Of that $52, staff salaries and benefits have to be paid, the facility and utilities need to be paid, medications and supplies have to be paid for, malpractice and other insurance premiums need to be paid for, billing, legal, accounting, marketing expenses, and taxes are ALL paid before the doctor sees a nickle.
    Adding to the pressure, the physician is expected to provide for FREE – laboratory consults, referals, prescription refills, home health/disability/family
    Medical Leave forms, provide depositions, & testimony in legal cases like auto accidents… AND a physician LOSES MONEY on almost every vaccination they give – $6,000 for flu season, $ 12,000 on the new HPV vaccine …
    The “Free Medicine” crowd constantly decries the “High Cost of Health Care”. The real crisis is the high cost of health insurance, their anti-consumer networks, and monopoly status in metro areas.
    A $52 office visit is less than what people spend on a concert ticket or sports event, hair styling & nails, cigarettes, a cell phone bill, a dinner for two (with wine)at a moderately priced restaurant, a typical date, or a pair of new Nike’s.
    Amazingly enough, when Fido or Kitty is sick, no one thinks twice about paying a VET $ 150.
    My “Rich”, “Greedy” doctor makes between $16 and $28 an hour working 6 days a week, 12 hours per day, no vacation, no overtime, no holidays… A plumber, automechanic, registered nurse, computer programmer, or office manager makes more money per hour than my physician.
    Final Facts:
    20% to 25% of all primary care residencys remain UNFILLED. 30% of all primary care doctors are 55 years of age – or older. More doctors are quitting medicine or retiring early… and fewer are coming into the workforce.
    When the Medicare cuts go into effect in January ’08, don’t be surprised when the elderly have a very difficult time being tended to. Many practices have stopped adding new Medicare patients. These cuts are expected to exceed 30% over the next 5 years.
    Let’s see… rising expenses for goods and services, higher tax rates… and office visits dropping to $35.
    Better news, since most health insurance contracts are based on Medicare rates… those payments will drop too.
    The only option for small medical practices to survive is to offer better value, better service and quit playing the insurance game with a clientele that appreciates their dedication and skill- and pays for those services at the front door.
    For those who advocate “universal healthcare”, here’s another fact – the government likes to make promises, but doesn’t want to pay for them. You want proof, look at the treatment our veterans receive at VA hospitals – if they can get in. Spend some time at the county health clinic. That’s the reality of government healthcare – and the future of medicine.
    This doctor is quitting the insurance game while she still can. For the physician, it is a life or death decision. For her patients, it’s a choice. Be thankful they have one.

  41. What does the annual physical cover? Also, when I called the MDVIP in my area, the office staff said that I would occasionally see his associate. I thought one of the main reasons for this program is that you would routinely see the same dr each visit.

  42. Concierge Medicine is alternative form of practice, another choice for patients. It is not and should not be tauted as teh healthcare solution, as I steadfastly disagree with my SIMPD counterparts. As per the GAO report, it’s not a threat ot access. By my calculations, it represents less than 0.04% of the current physicians in the country. So if the number doubles, it’s still insignificant.
    Choice is not bad. $100 a month is a good value, infact for my patients, it’s probably the best investment with teh highest Return on Invesment than anything else that spend $100 a month on. http://www.myconciergedoc.com

  43. Hey Pat:
    You make it sound like a primary care physician earning a decent living is a bad thing! You will forgive me for thinking that after 20 + years of education, an average medical school debt of $150K, an average practice loan of $50K, countless hours on call and being available to your patients 24/7 yeah, a 6 figure salary is merited!
    It seems society wants it doctors to take a vow of poverty along with their Hippocratic oath. I assure you when a patient is seriously ill in an emergency room, scared that they might die, the last thing on their minds is whether or not their doctor is “greedy”.

  44. The price is regionally based. Most practices are at $1500 but in some places like LA, or New York the price (like everything else) is a bit higher. The fee is split 1/3 MDVIP and 2/3 for the doctor.
    RC

  45. I recently decided to become a patient of a PCP pracice recently converted to MDVIP. I’m happy with my physician and upscale concept, but the cost is $1,800/year. Until reading this blog, I didn’t realize the cost for all others seems to be only $1,500.
    Does anyone know of if there is a standard fee for MDVIP patients?
    Also, can someone advise me what percentage or portion of the Fee goes to MDVIP?

  46. I converted my practice to a concierge model of care a little over a year ago. I thought I would provide some insight into the experience.
    The real issue is the fact that health care is being run as a for-profit enterprise with insurance companies making billions of dollars in profit on the backs of doctors and patients alike. When the CEO of United Healthcare can accrue $1.6 billion dollars in stock options then you know there is a problem. Even Blue Cross/Blue Shield, a non-profit, consistently showers there senior executives with large 6 figure salaries and bonuses. The same HMO that consistently reduced my fees to an average of 70-75% of Medicare raised my own medical insurance premiums by as much as 100-150%! Who decided to make Medicare the standard and why should I discount me fees below that which my own government (taxes) pay me?
    As a consequence, primary care medicine has become a volume driven business. In my area it is not unusual for a PCP to see 30 or more patients a day. Most of them no longer admit or follow their patients at in the hospital because it is not financially advantageous to do so. It seems HMOs would rather pay a hospitalist who does not know the patient rather than the patient’s own doctor. Lets add the medical malpractice crisis and you have the recipe for a disaster
    Our medical schools are not cranking out new primary care doctors at a time when America’s baby boomers are entering their late 50’s and 60’s. Given the above environment can you blame a medical student with an average debt of over $150,000 for not going into primary care? They can make 2-3 times as much as a PCP by becoming a subspecialist or dermatologist?
    So where do we go from here? If you are a patient then you can either take your chances with the system or decide you will invest $1500 a year on your health. Essentially, the patient is being asked to dig deeper into his pocket to make up for the fact that the insurance companies and Medicare simply do not pay doctors enough. I would be the first to switch back to a regular practice if I were paid a fair fee for my time. Another option for a doctor is to just say no to these insurance companies. Open up a cash only practice. When I switched to my concierge practice I eliminated 2 FTEs because I no longer needed them to make referrals, deal with paperwork, answer 6 phone lines, etc. With a good electronic health record a PCP can get by with 1 FTE and outsource the billing. Such a venture is a risky one. It seems patients are willing to spend money on everything but their doctors. They will pay for vitamins, acupuncture, massage therapy and other non-traditional practitioners but balk at a $10 copayment at their PCP’s office. In the end, you get what you pay for and in this country we have traditionally undervalued primary care medicine.
    A great deal is written about the possible ethical issues involved with concierge practices. I personally consider it more unethical to have a for-profit health care system that directly benefits shareholders and senior executives when we have over 45 million Americans without health insurance!

  47. As a healthy senior, I see my doctor once or twice a year for a physical and tests. That’s it! I felt joining MDVIP wasn’t worth the $1500. Not for me anyway. It’a a different story for the MDVIP folks. If my doctor signed up the maximum 600 patients, he starts out with $600,000, plus continues to bill the insurers for services rendered! MDVIP had 40,000 patients on the program in 2005, that’s $20,000,000 for Dr. Goldman and team. I call it GREED…..

  48. I recently attended a meeting (by letter invitation)held by a physician who is converting his practice to MDVIP with a 600-patient limit. There were approximately 500 in attendance. When Dr. Goldman’s video started I almost expected to hear about a great condo opportunity in Florida. I just knew this was going to cost more than I had. When the $1500 annual membership fee was revealed, 1/2 the crowd left and not surprising, many were elderly. Although the general concept of preventive care is smart and the “no waiting for an appointment” certainly appeals to everyone, including me (having had acute asthma for many years), the additional expense is unappealing and probably impossible for many. Obviously, this physician wants to cut back on his workload and I can appreciate that. So now those of us who are on a limited budget will have to look a little harder and longer for the physician practicing preventive medicine, who takes time with his or her patients and who encourages a holistic approach when possible without the $1500 membership fee. The sales rep. from MDVIP could not stress enough the fact that if we did not sign up immediately we could lose the opportunity to join and we would be placed on a waiting list. I wondered if there really would be a waiting list. The physician also announced that he would not be accepting Aetna/United Health Care (an HMO). That decision alone will in all probability diminish his numbers and I’m wondering if MDVIP had a hand in that decision. HMOs are well-known for practicing without a license. Until I went to this meeting the other night, I had never heard of the “Concierge Practice.” Well, now I wish I hadn’t. It’s just one more thing that is not in my budget.

  49. Mdvip is just the beginning when it comes to alternative or concierge or boutique or as I like to call it in my pediatric field “attentive care” New practice models are emerging that make mdvip obselete. Try a marriage of tech and personalized care in the form of Personal Pediatrics administrative support system that is actively practiced by Natalie Hodge MD. As opposed to Goldman, she has invented a new practice, or reinvented an old, model the communication system of which makes the entire office obselete. Providing care for children where they need it most when they are sick, AT HOME. Watch the story of Personal Pediatrics unfold. “Personal Pediatrics… The Pediatrician of the Past and Future…Today” http://www.personalpediatrics.com

  50. I went on the MDVIP website and was pleased to see that my husband’s dental practice fits the definition of a “concierge practice.” We have a small practice providing extensive preventive care and treatment of acute and chronic dental conditions, with a focus on individualized attention and dental planning. (see their website 🙂 We don’t charge our patients an annual membership fee, but offer similar services. (small practice, on-time appointments, coordination of referrals, give out the cel phone, etc.)
    The big change we made to allow him to do this was to drop the PPO’s and give patients a choice to either pay for their work at the time of service and have the insurance check come to the patient in the mail, or we will accept assignment but they have to leave a CC or form of payment on file with us. This allowed us to actually LOWER our cash fees because we don’t have to compensate for the insurance company hassles and write-offs, don’t have to pay staff to manage claims, don’t have to pay for billing, and don’t have to deal with sending people to collections because a balance was left after insurance paid. He is much happier and also gets to spend more time with the family!
    We did the insurance game, and decided not to fight it anymore. I was curious if this would work with primary care doctors, or if there are doctors already doing this in medicine?
    Thanks!

  51. elliott hasnt been in a hospital lately.
    If he had, he would know that EVERYBODY AND THEIR BROTHER NOW WEARS WHITE COATS. Thats right. Everybody from the senior cardiothoracic surgeon to the janitor now wears the white coat.
    RNs wear it, LPNs wear it, NPs wear it, CNAs wear it, MRI techs wear it, X-ray techs wear it, Nuc med techs wear it, PAs wear it.
    The white coat means NOTHING in terms of status these days.
    Back in the good old days up to the 1970s, only the doctors wore the white coat. Of course those were the days when doctors were considered gods. The other healthcare fields noticed this, and said to themselves “hey maybe we can be gods too if we appropriate the white coat and use it for our own purposes.” So thats exactly what they did. Now that everybody who works in the hospital wears a white coat, it renders the status of the coat meaningless.

  52. Well the SEC investigation of Cybear (which was a bit of a joke company) was around a pretty minor revenue recognition issues, and I can’t find any information on the web about Goldman being disciplined by the license board.
    Maybe I am being snowed, but if this approach can really show that paying the primary care doc more to look after fewer patients saves money overall, then it’s very interesting–and has huge implications for the future of primary and secondary care. If it’s just rich people trading up for a better class of waiting room and the doc’s cell phone, then it’s less so.
    I assume that the data will come out on that soon.

  53. Goldman is a salesperson for his company first and foremost. He has a proven track record of being less than truthful of which I gave 3 examples. (If you don’t see that a promotional picture of a guy who doesn’t see patients in lab coat and stethescope is misleading then you lack critical judgement skills necessary to evaluate any claims.) His substantive points in his podcast are
    1. That patients and doctors appreciate the concierge relationship.
    I think that this is true, but a result of ignorance on the part of patients. Patients always like doctors they have a long-term relationship with and there are costs to switching. MDvip does not sign up new doctors; they convert established practices and squeeze out anywhere from 60 – 80% of the current patients. If this was such a wonderful deal then why is only that the model that works?
    2. There is value added to patients in a variety of ways such as 24 hour access, same day appts., and specialized information.
    Concierge service isn’t necessary to accomplish this; I everything described by Goldman from the largest, most beauracratic HMO in California. Furthermore, the quality of doctors I see (schools and fellowships) exceeds that of mdvip’s docs based on a quick perusal of a random sampling. In addition, I see doctors with more recent education which, I believe (don’t have the cite handy), make fewer mistakes and provide better treatment than older doctors.
    2. The system reduces healthcare costs.
    This is a fascinating claim. I can’t believe that no published papers have been produced with such wonderful numbers. My guess based on my skepticism is that the claims are subject to a variety of problems. Goldman should hire Matt to write a paper with those numbers. My guess is that they are just spin like his doctor act. (Sure, he is a doctor, but the picture is misleading. Sure the numbers are there, but not adjusted for demographics.) I think the right attitude is to be suspicious of any pronouncement by Goldman until MDvip releases its actual data.
    In short, I think that Matt got spun in the same way he complains that the NYT gets spun sometimes.

  54. I’ve heard Dr. Goldman talk about his ideas several times now. And at length. I’ve been impressed by both his presentation and his message. If I were a physician (and I hasten to add I am not) I would be very interested in exploring this model of care delivery, and its implications for my practice. If I were a patient looking for a primary care physician, I’d want to investigate this idea pretty closely.
    It’s a little too easy to write off the concierge concept as elitist or exclusionary – which appears to be the knee jerk reaction of a lot of people, especially in the media. I think there may be a little more to it than that …
    I think a large part of the problem has to do with the way this idea is being sold to the public. If these guys are smart, they’ll drop the term concierge (which personally makes me think of valet parking with stethoscopes and antibiotics), and come up with something with slightly broader appeal ..

  55. “2. He poses as a physician (complete with coat and stethescope) even though by his own admission he sees no patients.”
    He is an MD and has earned the right to wear the long white coat whether he is currently actively seeing patients or not. This doesn’t mean I fully support the goals of MDVIP though.
    Additionally, were you similarly appalled in the early 1990s when Hillary was prancing across the USA in a long white doctors coat trying to promote her HillaBilly healthcare reform disaster? I think not!
    A doctor pretending to be a doctor I can accept, but there is nothing worse than a lawyer masquerading as a doctor.

  56. MDVIP is Goldman’s company, but the point of the story has more to do with the idea of “concierge” medicine than it does with one company’s method of delivering it. MDVIP sets up individual physicians in VIP-type practices, markets them, and takes a piece of the cut in return. But the actual delivery of the healthcare is by the individual physicians, not by Dr. Goldman. If I were a physician interested in joining his organization, I wouldn’t care if he were a doctor or not. If I were a patient interested in seeing one of the MDVIP doctors, I wouldn’t even know that Goldman exists.
    As a physician, I have mixed feelings about the idea of an MDVIP-like practice. What I like is that it would allow me to see a reasonable number of patients and provide really high quality healthcare for them and still earn the same as I am now. What I do not like is that I would lose so many of my current less fortunate patients and instead become a well-paid attendant to a small group of my wealthy patients.
    But I certainly have considered it!

  57. Okay, I’m a bomb thrower and I hate all Republicans especially Flordia Republicans, but it wasn’t hard to smell snake oil salesman here even without the glowing praise of Tommy Thompson.
    1. Goldman has been discplined twice by the Florida Medical Board.
    2. He poses as a physician (complete with coat and stethescope) even though by his own admission he sees no patients.
    3. His former company Cybear was investigated and fined by the SEC.
    Why should I believe anything he says?

  58. As a med-student interested in health policy and bored while working out I have been listening to podcasts like these to educate myself while on the bike, treadmill, etc. Its nice when you can actually kill two birds with one stone. Basically, Mr. Holt I’d love it if you could provide other podcast interviews with innovators of care if/when the opportunities arise.
    Getting back to MDVIP, I remember listening to Dr. Goldman’s podcast interview with Nancy Collins of the Journal of Medical Practice Management awhile ago and have enjoyed hearing about the success of the MDVIP model. I was wondering if the data mentioned in this interview about decreased patient utilization of hospital facilities(ER, Surgical, etc) is readily available on the internet. I am interested to see whether in the future(ie my years of practice) insurers will realize prevented steps like yearly screenings will save them long term money. Seeing decreased patient utilization numbers from a large enough data pool may be enough to wake them up. Until the upfront fee is provided by insurers though it will only generate a two-tier health system: those willing and able to pay and those who aren’t.
    As for the other major problem, getting people like me to go into primary care, I see concierge medicine as a possible lure as it will bring more patient interaction, empower the patient-physician relationship, and create a more stable economic environment. All of these will increase the happiness of the physicians in these practices and allow new physicians to pay off student loans. At private schools like USC $200K is a pretty normal level of indebtedness at graduation.

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