Tuesday, April 07, 2009

Doctor's Charges

We were expecting a bill from our doctor. What we received on 1 April 2009 was much worse. It was a letter.

Dear Valued Patient, it began. The adjective was the first false note. Just what made me a "valued" patient? What kind of letter uses the salutation to pay a compliment? How much is this going to cost me?

As you know I love practicing medicine and enjoy being your physician, the letter continued.

Actually, I did not know either of these things.

A little over a decade ago, we chose Dr. Arthur King to be our physician because he was within walking distance of our home. This became particularly important in recent years when we gave up having a car.

I have not seen him in over a year. As I am without health insurance, there is little point. The lab work for a decent physical is more than I can afford.

We procured a high-deductible policy for my wife recently. It was for a diagnostic examination for a condition that could prove serious – but thankfully so far has not been – that we expected a bill.

Therefore, we cannot claim the close relationship that our doctor seemed to think we had. His office staff has been cordial and understanding. He has been professional and never prescribed snake oil. Nevertheless, the last sentence of his overly flattering first paragraph sent a chill.

Unfortunately, the current system does not allow me to provide your care in the way I know you deserve.

Then came the pitch. He was going embark on a new method of medical practice "that enables the patient-physician relationship to be a true partnership." The services under this "new" system were described in bulleted short phrases.

Opposite "Higher quality care experience" was "Total care coordination with specialists and other providers," "Test result consultation," "Post-specialist visit explanations," and "Assistance with insurance filings."

The verbiage was pretty, but the first three points simply describe standard operating procedure when a general practitioner makes a referral to a specialist. The last is how a doctor gets his money.

Opposite "Incredible access at your convenience" was the truly incredible claim of "24/7 access to me via cell phone, email, or office phone." Notice that this is not access to "service," but to Dr. King himself. The FAQ sheet, which accompanied this letter, was equally unambiguous on this point, offering "Direct access to your physician any time of the day or night."

Only God is accessible 24/7. Mere mortals do not have this power. Leaving aside the fact that even doctors must eat, sleep, and take days off, there is the conflict of dealing with a patient in the examining room when the cell phone goes off. "More about your colonoscopy later, Fred, I have to take this call."

There was one new item that followed "Incredible access" – "House calls as needed" (italics in original). There was no statement about who would determine the need or how need would be determined, making this an empty though enticing promise.

All the puffery and empty promises of this letter came down to this. Dr. King claims to have 4,000 patients. Under the new ModernMed practice he can have no more than 500. Of those 500 patients, the first 300 to sign up will be offered the introductory monthly rate of $75 a month. The unfortunate remaining 200 patients will be charged the normal rate of $125 a month. Given the terms offered, everyone will be paying $125 or more a month in the years to come just to be a patient of Dr. King.

That is right, friends, this retainer fee does not cover office visits or tests or anything else. It is a simple retainer fee, promoted with pompous and incredible claims. There is nothing offered under this new system that is not either standard operating procedure of a good general practitioner or available elsewhere for less or nothing.

The advantage is all with the doctor. He dumps 3500 patients. He dumps some who have come to him regularly for any number of reasons. He dumps some who come only under the compulsion of dire illness. He keeps only those who can pay for the privilege to call him their doctor. He receives over a half million dollars annually under the introductory rate, three-quarters of a million in the next year, and undoubtedly, a million and more in the years to come, in addition to any fees charged for the actual practice of medicine.

At $125 a month, his patients will pay an annual $1500 in addition to their health insurance premiums, deductibles, and office visit co-pays. They will receive for this sum nothing beyond what is expected of the general practice of medicine.

What is being promoted here is "a new revolutionary model of medical practice." What we have is medical extortion.


Carl Friedrich said...

Very interesting letter. It's also very nieve. People in the United States believe they are entitled to everything...for free. If you want free health care, go to China. Go to Canada. When you get there, you will be complaining how you can not choose your doctor, and how the government decides whether you can get appropriate treatment.

Here in the United States, we live by CAPITALISM. Why should doctors not be entitled to make a living? Some general practitioners come out of medical school close to $500,000 in debt. That is after serving 3-4 years working 100 hours per week that averages out to be less than $4.00 per hour.

Doctors are so in debt, and have paid so much into the system.. that they need to see 40-50 patients per day. That means, with all the beaurocracy and paper work, you are looking at a 4-5 minute visit.

Maybe concierge medicine is not for you, but there are some patients who would like this privelage. Who are you to call this extortion? Gone are the days when general practitioners saw 4-5 patients a day and made $300,000. Maybe he wants to provide the best care he possibly can, AND make a living. What is wrong with that?

Michael James Hill said...

Mr. Friedrich,
Before lecturing anyone about Capitalism -- or anything else -- learn to read.

There is not one word in my essay which suggests that I expected anything for free, or that doctors should not earn a living from their practice.

Read the essay again. It is not I that want something for nothing.

I do not know where you get your "facts" about the economics of medical practice, but since you did not understand my simple essay, I can be reasonably certain you cannot be relied on with regard to the struggles of doctors. And I am pretty certain you have the situation in Canada wrong and have misdiagnosed what is wrong in China.

Yes, you need to read more.

Nancy Boriack said...

The first part of the proposed business realtionship is clear. Dr. King marketed his new mode of medical practice to his existing 4000 member patient population. He explained the medical service that he'll provide to 500 patients for $1500/yr. He made a sales pitch.

The unknown is the bigger component of making this service work. Will roughly 13% of his current patient pool elect to pay $1500 per year for the access/services he describes? He has extended a product offer much like an attorney or other professionals on retainer extend. Will he garner the necessary number of patients to morph his practice to this new model?

Concierge medicine is not new. It fills a niche. Serving a population of 500 vs a population of 4000 allows the selected 500 the advertised access. These chosen are set apart from the masses who rely on traditional medical care.

If the advertised access lives up to the 24/7 claim (agree that its impossible for a single human but physicians band together to share call) many with a spare $1500/yr will buy what Dr. King has to sell. Logic tells us that eliminating 87% of the patient population must equate to more time for the 13% remaining. And, this 13% is willing to pay.

Will these 500 patients "...receive for this sum nothing beyond what is expected of the general practice of medicine."? Will they benefit from a quicker diagnosis or simply enjoy having their physician's cell phone number on speed dial? Only time will tell if Dr. King is able to fulfill his promises and maintain his projected patient base. If he fails- just imagine how the letter welcoming former patients back into the fold will read!