Physiatry Practice Management Resources

Discontent Spurs Patient Interest
Increased scrutiny by regulatory agencies has been an unwelcome surprise, Dr. Goldman said. But the high level of patient interest in the program has exceeded his expectations. "I had totally miscalculated the level of discontent with the current health care system," he said.
In Boston, two internists sparked public attention recently when they announced they were forming a service-oriented practice, scheduled to open in April, with two more doctors joining the group shortly. They will charge patients $4,000 a year for special services not covered by medical insurance.

"What we're selling is the fact that we're far more available and we can provide a higher level of service coordination than is available in other practices," said Steven Flier, MD, one of the founders. He compares the additional fee-for-services with other non-medical costs patients often incur, such as parking fees at hospitals, or paying out of pocket for elective procedures such as lasik eye surgery or cosmetic surgery.

The level of media attention spurred by his announcement has surprised Dr. Flier, who views his new practice simply as one doctor's solution to shortcomings in the existing health care system.

"We aren't doing this to be trend-setters," he said. "We're doing this because we see a need for changing what we do relative to our patients."

He has also been surprised by patients' reactions; some who he expected to oppose it have actually enrolled, while others have switched to another doctor.

One patient accused him of catering to the wealthy. Dr. Flier pointed out that the patient's two-pack-a-day smoking habit cost him about the same amount annually as the medical service fee.

"No one goes around saying that smoking is a habit only for the wealthy," Dr. Flier said. "People do make choices in that range of dollars."

Overall, subscriptions for the first year have exceeded the doctors' expectations, he said, and they now will turn their attention to satisfying patients so that they will re-enroll next year. In the meantime, he welcomes the public debate about problems with the current health care system.

A Catalyst for Change?
Even critics of the new VIP practices hope the trend will force greater public discussion about health care in this country, particularly the question of whether quality health care is a privilege for some or a right for all. The trend could even put pressure on the existing system to provide better service to all patients.
In Seattle, competition introduced by the concierge-practices drove one medical center to create its own special-services unit. The Virginia Mason Medical Center initiated its program, called the Dare Center, after losing some of its patients to the MD2 practice, said John Kirkpatrick, MD, who fostered Virginia Mason's program and now cares for patients who pay the annual $3,000 fee.

As an employee of the medical center, Dr. Kirkpatrick does not benefit directly from the revenue generated by the program, but the medical center has used the extra dollars to support its free care of the poor.

"I'm very confident that this has helped the overall organization," he said.

Patients in the program vary from those who are very demanding and expect lots of attention, to those who simply do not want to spend their time sitting in waiting rooms, he said. Patients can call his cell phone day or night, seven days a week.

"It would be nice to be able to give everybody this kind of service," Dr. Kirkpatrick said. But the government and private insurers simply cannot afford everything that Americans demand in health care, he said.

"This is not the answer for everything," Dr. Kirkpatrick said, "but it may be a partial answer to get more people who can afford it to put more dollars into the medical system."

The notion of some people getting better care than others, however, deeply disturbs critics.

"It's contrary to what American medicine has stood for," said Boston physician Dr. Solomon. He believes that catering to patients' unrealistic demands will drive an even bigger gap between levels of health care.

"Not everybody needs to be seen the day they call," he said. "It's a total luxury."

Advocates of the new service-oriented practices insist, however, that both doctors and patients can benefit from the arrangements, and that they are simply one alternative to the traditional health care system.

Boston internist Dr. Flier asks: "If providers and patients are dissatisfied and want something better that works, why would anyone oppose that?"