‘Concierge’ doctors’ contracts give patients choice and savings – 3/12/2011

This is an opinion piece I wrote to the Fort Myers News-Press concerning an article they recently wrote titled, “Patients hit with add-on charges,” by Frank Gluck, The News-Press, Jan. 23.
“Drs. Douglas Henricks and Rob Simmons are my practicing partners.  Frank Gluck’s article suggested their recent patient contract offers  were violating health insurance companies’ contractual “rules.”  I wish  to clarify to the public that our group does not have contracts with  private health insurance companies, and thus their rules do not apply. The contracts recently offered to patients by my partners are voluntary and  not new to the local market. Such payment offers are widely used in Naples and have been for several years. Many patients have been asking  for such concierge service and thus there is consumer market pressure to offer this. Several years ago, we canceled private health insurance  contracts because of inadequate reimbursement and ever-expanding controls/regulation being place upon our work. Presently, the system is setting physician fee schedules, not distinguishing quality and at the same time increasing the workload of patient care.  Denial of  physician-ordered care results in more office and physician time  (through exception requests and other authorization processes) which is  not covered by the current fee schedules.  Cost savings to the insurance  companies that result from denials have yet to materialize in the form  of less expensive premiums.
In my 18 years of practice, I haven’t seen premiums go down one single time.
At  the heart of the matter is that Medicare is setting the fee schedule  for physician evaluation and management. Medicare does not negotiate  fees with physicians; it mandates them. Medicare does not distinguish  whether the care is provided by a sub specialist, board certified  physician, physician assistant or a nurse practitioner – the payment is  the same. There is no incentive to provide quality. These policies  started in the mid-1990s and are resulting in a slow fall to the bottom  for U.S. health care.
Private  health insurance plans use Medicare’s fee schedule as the benchmark for  their contract negotiations.  They actually are paying physicians even  less in Lee County. Private insurers figure that if the doctors will  work for the Medicare fee schedule, they need not pay any more than  Medicare does.
Physicians do not need to apologize for expecting to be reasonably  compensated for their time and expertise.  The system’s pay caps with  ever rising demands and work lists is untenable. The latest health care  law adds further regulation (longer work lists). I am concerned the  system is going to fall apart.Mr. Gluck’s  article does serve to highlight that things are at a tipping point.  Physicians should be allowed to set their own fees but Medicare should  only subsidize patients what its budget allows.  Patients would only pay  for services that they personally use, rather than some of the patient  group paying annual lump sums to subsidize the rest (basically what  current concierge contracts accomplish).
I  hope this commentary serves to awaken the public to start taking charge  of how their dollars are being deployed. We should be offered properly  priced insurance contracts which place the patients in the driver’s seat  for consumption. This means more “pay as you use services” options with  a true catastrophic insurance policy as an option.  This would keep  unnecessary wasted resources from being used up and it would mean your  insurance company would only enter the picture when you really had a  significant health care cost.
We  all pay for the maintenance of our cars and homes and only call on our  insurance policies when there has been a wreck, flood or fire. It  doesn’t need to be any different for health care services.”

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