Concierge Practice Betrays the Promise of Medicare
Since there were large numbers of such people, from the providers perspective the payment could be less than other insurance, as it would be made up by the volume of patients who would be treated. This universality of care was ensured by this simple rule, if a doctor wanted access to this pool of clients, he or she must agree to charge no more than these lower rates to all elderly under this program. .
Last week, the day after another showdown in Washington, when for a single day, before Congress retroactively restored what is known as the "doctor fix", Medicare payment had been slashed. My primary physician is also a tennis friend, and by chance we crossed paths and I asked him what he was planning to do; and his response, which could multiplied by unknown numbers of others of his profession, illustrated what we are facing, "I had my letter written that would have switched my current practice." He was not going to give up taking Medicare, which is a good chunk of his clientèle, but rather was about to sign up with MDVIP, the main purveyor of a packaged version of **concierge practice that is now growing rapidly with no public discussion.
Dr. Bob is a good guy, down to earth, competent, with a congratulatory plaque on his wall from the Republican national committee. Over the decade that he has handled our usual medical issues along with a few emergencies, we have developed mutual respect, even though my sympathies generally were not reflected by his award on the wall. We kept away from politics, but issues came up, and recently he commented about his own political evolution with a somewhat cryptic, "You and I are now probably closer than you think." Actually, I found him when my previous provider, after a charade of getting feedback from his current clients, did make the switch in his practice that meant in order to be his patient there was an upfront cost for us of four thousand dollars a couple.
By his joining this organization, he had shut out those very people that Medicare was designed for, those who could be defined by NOT being able to afford that annual fee. Those who promote concierge practice try their best to ignore certain harsh realities-that it changes the entire principle, the promise of Medicare. Rather than a redistribution from the successful to those less so, this changes the direction of the flow. Those with the wherewithal to pay the annual fee, will (most likely*) have more public funds directed to their own care. While those who are the poorest, will be completely shut out. This will not be by any law or regulation, but simply the words of a receptionist, "Sorry, the doctor is no longer taking Medicare unless you are a member of his program."
* Note: My assumption that those on concierge programs will use more Medicare services has not been verified. It is easily testable by tracking all Medicare payments of those in concierge programs compared to others of the same demographics. This rather easy survey would provide tools to evaluate how this program affects the overall cost of Medicare among various income levels.
**"Concierge" refers to two distinctly different types of primary practice. The one that is NOT being described here as ".... often called concierge medicine" is illustrated in this N.Y. Times article. These are physicians who require payment from patients directly, not accepting Medicare or any other insurance. This does not raise the issues discussed here.
Link to website of MDVIP, to see the promotion of this type of practice to physicians.
PBS Program on this practice, comments are interesting.
Discussion site on Concierge Practice