Tuesday, July 10, 2012

Markets in Everything: Concierge Medicine



Watch the PBS News Hour segment above on "concierge medicine," featuring Texas doctor Raymond Solis who recently converted his 21-year-old traditional medical practice of 3,000 patients to a concierge-based practice serving just 400 patients.  Dr. Solis changed his business model with the assistance of national medical consulting firm MDVIP, which helps doctors switch from traditional, "conveyor belt" medicine to concierge practices, and go from patient loads of 2,500 to 3,000 down to 400 to 600.  

For about $1,500 a year, patients can join a MDVIP concierge practice and be assured of personal attention and more face time with the  doctor.  Monthly fees run about $150 per month, which allows most patients to get same-day appointments that last 30 minutes or longer. Most MDVIP doctors accept insurance.

HT: Paul Cerni

26 Comments:

At 7/11/2012 1:04 AM, Blogger randian said...

The question is whether Obamacare is going to make such business models illegal, by making the acceptance of an Obamacare patient (who naturally will not pay the entry fee) mandatory by doctors.

 
At 7/11/2012 2:34 AM, Blogger PeakTrader said...

"Go from patient loads of 2,500 to 3,000 down to 400 to 600...Monthly fees run about $150 per month."

I wonder how long Obamacare patients will wait with the doctor shortage?

I'd like a dentist like that for cleanings (every three months), cavities, root canals, gold crowns, etc.

 
At 7/11/2012 6:52 AM, Blogger Methinks said...

by making the acceptance of an Obamacare patient (who naturally will not pay the entry fee) mandatory by doctors.

congress will call it a "penalty" to pass it, CJ Roberts will uphold it as a "tax" and the U.S. will have fewer physicians as a result.

I can see that happening, but so far there is a shortage of medicaid and medicare doctors and they haven't done that. According to the original post, concierge doctors accept insurance, so as long as the fee is paid, they'll b okay.

I have some doubts that government will successfully force physicians to do anything for two reasons: the AMA is a strong lobby and Obamacare has nothing to do with healthcare. The two main objectives of Obamacare is to expand government and raise taxes. That's it. You and your kids can go to hell for all they care.

 
At 7/11/2012 8:17 AM, Blogger Krishnan said...

True Methinks - Obamacare is not about Health and Care - and if this model were to be successful, we will see Congress impose penalties and Roberts will call it a tax and they will keep raising this penalty (tax) till the businesses are killed.

The world at large has relied on our physicians and hospitals and pharmaceutical industry - if the next Congress, President cannot (or will not) stop the monstrosity, the world will find out what they cannot enjoy - but it will be very late.

The AMA is indeed the biggest lobby in the US - and their objective is to keep the earnings of their members as high as possible (it is not about care) - so they have worked to restrict "supply" - people interested in becoming physicins (there was a link to that fact a while ago on these pages)

 
At 7/11/2012 8:39 AM, Blogger jd said...

There was a doctor in Massachusetts who tried to set up his own plan where patients paid him a set fee per month (per year?) and he would treat them. The law in Mass. wouldn't allow him to do it. That seemed outrageous to me.

 
At 7/11/2012 8:46 AM, Blogger Jet Beagle said...

krishnan: "The AMA is indeed the biggest lobby in the US"

They are certainly one of the biggest. According to the website OpenSecrets.org, though, the U.S. Chamber of Commerce is a much larger lobby, year in and year out. In recent years, both the Natl Assoc of Realtors and General Electric have spent more money lobbying. That is, assuming that the figures at OpenSecrets are correct.

 
At 7/11/2012 8:49 AM, Blogger morganovich said...

my parents use a doctor like this and love it.

 
At 7/11/2012 8:52 AM, Blogger morganovich said...

jet-

fwiw, i think that opensecrets only counts federal lobbying.

this is why the unions (teachers etc) do not show up near the top as their efforts take place mostly at a state of local level.

of other interest, the donors list looks far more different from the lobbying list than i would have expected.

http://www.opensecrets.org/orgs/list.php

it appears that big biz likes to lobby and the unions like to donate.

 
At 7/11/2012 9:36 AM, Blogger Moe said...

This sounds like doctors trying to get back to the way it was when I was a kid (1960s) - more face time/less pateints. Sounds logical.

Next: I would also like to see Pharma commercials banned!

 
At 7/11/2012 9:59 AM, Blogger sethstorm said...

Also known as the very thing to stop dead cold. Agreeing to an appointment does not have any less ability to get the doctor.

No real good side to it since its current expansion is a function of PPACA's existence.

 
At 7/11/2012 10:41 AM, Blogger Methinks said...

I'm not that worried about medical care for those who are willing or can pay out of pocket and who are willing to exercise, eat well and generally taking care of themselves.

Since Obamacare is nothing but a giant tax increase and a huge expansion of the tyrannical state, I'm far more worried about what will happen to the American economy and liberty. My prediction is that it'll become a comparatively unpleasant place to live in about ten years. Of course, that's holding everything constant.

 
At 7/11/2012 11:18 AM, Blogger Jon Murphy said...

I'm far more worried about what will happen to the American economy and liberty.

Going completely off topic here, but I wonder if the door isn't wide open for a Supreme Court review of its decision.

Let me explain:

There was no "majority opinion" in the case. 5 judges said the mandate did not fall under the Commerce Clause. The mandate was only upheld because 5 judges said it was constitutional. There was no agreement as to why it was constitutional. One could make the argument that the court left it completely ambiguous as to the powers of Congress. In seeking clarification, the court would have to issue a majority opinion as to why the mandate is constitutional or not. The mandate could subsequently be overturned then.

At least, that is what I am thinking. I am no legal expert.

 
At 7/11/2012 12:39 PM, Blogger randian said...

My prediction is that it'll become a comparatively unpleasant place to live in about ten years

Think of all the medical innovation that won't happen (ref Bastiat's "seen and unseen" formulation).

For another, Obamacare makes high-deductible health plans (HDHP) illegal. Not only does that make health insurance even more expensive and unaffordable, but if you think of Obamacare as a tax-raising scheme then it makes sense to prevent as many people as possible from avoiding the excise tax on "luxury" insurance plans by forbidding cheaper insurance.

 
At 7/11/2012 12:47 PM, Blogger morganovich said...

randian-

i think it's even more ominous than that.

obamacare is like installing a cliff and driving a bulldozer.

the cliff is the 40% tax on cadillac plans.

the bulldozer is banning cheap plans and and hiking up coverage and benefit requirements and letting inflation work (note that the cadillac level in not inflation indexed) until you push most of the market off the cliff.

they, you cry "market failure" and drive through signle payer, for which this has been a trojan horse all along.

it's an ugly, duplicitous business.

 
At 7/11/2012 1:13 PM, Blogger randian said...

I had always assumed that the reason the excise tax doesn't immediately kick in is because Obamacare won't have had time to work its inflationary magic.

I should note that Obamacare doesn't technically ban HDHPs. What it does is forbid high deductibles, while the HDHP law itself deems said low-deductible plans not eligible for HSAs (Health Savings Accounts). Forbidding HSAs from paying for over the counter drugs was just the first step. Preventing you from being eligible for them is the second.

 
At 7/11/2012 1:34 PM, Blogger Methinks said...

Yep. You'll be forced to pay for a low deductible plan that acts like a high deductible very bad catastrophic coverage plan. If you end up in a car accident, you'll be seen right away (of course it could take a week to get that MRI the way it does in Canada).

Of course, a lot of people are going to figure out very quickly that they're better off paying the "tax". When they are in an accident or get sick, they can just sign up for insurance then, can't be turned away and can't be charged more. Sweet. Right?

That'll drive existing insurance higher, encouraging more people to dump insurance. Great plan.

I really can't find a reason to be optimistic about this country.

I'm also not as worried about innovation coming to a halt, Randian. I understand what happened in Europe when socialized medicine was introduced, but that just meant innovation happened here instead. Since innovation is global phenomenon, I expect it to continue maybe in Asia, Israel, etc. I also expect highly motivated, innovative people to start leaving the United States as they left Europe before. There will likely be a brain drain and I think the U.S. government is going to become very aggressive in trapping these people in the United States.

I am very pessimistic about the United States and very optimistic about the world in general. This government has done what all large governments do - destroy everything in its path. Unfortunately, the larger the government the more aggressive and damaging it is.

 
At 7/11/2012 2:04 PM, Blogger randian said...

If you end up in a car accident, you'll be seen right away (of course it could take a week to get that MRI the way it does in Canada).

That's the miracle of socialized medicine. It's less expensive because it doesn't actually provide care. When it starts happening in the US I hope the voting public gets outraged enough to cancel Obamacare.

When they are in an accident or get sick, they can just sign up for insurance then, can't be turned away and can't be charged more. Sweet. Right?

That's how it works in New York. You will note how expensive health insurance is in New York.

 
At 7/11/2012 3:17 PM, Blogger Methinks said...

That's how it works in New York. You will note how expensive health insurance is in New York.

I did note that when I lived there and paid those rates! I hope people enjoy paying $20K per year for insurance that is increasingly not taken by doctors who are any good. Oh wait. Nobody will pay that.

From what I understand, insurance companies are not expecting people to buy insurance and are coming out with new products at the end of the year to deal with that. I believe it's going to be like an indemnity policy where you get one lump sum and access to their BS negotiated rates and anything above that is out of pocket. It's my belief that they're doing it that way to keep rates down enough to stay in business. You'll get "insurance" but you'll be paying a lot out of pocket with this plan (exactly what Obamacare promised to eliminate).


That's the miracle of socialized medicine. It's less expensive because it doesn't actually provide care. When it starts happening in the US I hope the voting public gets outraged enough to cancel Obamacare.

I doubt it. It's going to take years to destroy medical care. By then, the special interests will be so entrenched that they'll endlessly fiddle with the system as taxes remain high (U.S. rates are among the highest and most progressive), the economy stagnates and the ship will continue to drift toward the welfare state iceberg.

Of course, I hope you're right and I'm dead wrong.

 
At 7/11/2012 3:19 PM, Blogger Methinks said...

I hope people enjoy paying $20K per year for insurance

The fun part of that, btw, is that it's AFTER TAX money you're buying it with. So, if you live in, say, NYC, you have to make $40K before you have enough to buy insurance.

Free lunch anyone?

 
At 7/11/2012 4:24 PM, Blogger sethstorm said...


There will likely be a brain drain and I think the U.S. government is going to become very aggressive in trapping these people in the United States.

The US does have a global reach with its military, which doesn't require as aggressive of a response as you think it should. If you think of it, recapture would just happen when someone crosses into a US-friendly country or a country that can be made friendly to US interests. There is nowhere to hide when you have a sufficiently motivated hyperpower like the US.

The only innovation in Asia is largely on how to subjgate workers and smear/imprison/kill those that complain. The rest is just copying off the West.

 
At 7/11/2012 4:26 PM, Blogger sethstorm said...


I doubt it. It's going to take years to destroy medical care. By then, the special interests will be so entrenched that they'll endlessly fiddle with the system as taxes remain high (U.S. rates are among the highest and most progressive), the economy stagnates and the ship will continue to drift toward the welfare state iceberg.

Well, consider that businesses aren't exactly innocent from any contributions to that stagnation. They're the ones that insist on sinking the ship just so that they can salvage it and remake it to not have the unwanted passengers.

 
At 7/11/2012 4:37 PM, Blogger randian said...

The fun part of that, btw, is that it's AFTER TAX money you're buying it with. So, if you live in, say, NYC, you have to make $40K before you have enough to buy insurance.

Only if you don't want to eat or pay rent. If your bill is $20k for a single person, you have at least $4k of "cadillac" tax to pay on top of that.

Btw, I see that the "cadillac" plan is inflation-indexed, at CPI +1 percentage point. That's still less than the historical inflation rate of medical care, and since it doesn't start until 2018 there are plenty of years for inflation to erode the value of the starting tax threshold. It's also unclear to me if the tax is on the entire premium (making it a tax "cliff") or just the amount over the threshold.

 
At 7/11/2012 4:43 PM, Blogger randian said...

They're the ones that insist on sinking the ship just so that they can salvage it and remake it to not have the unwanted passengers.

There is a certain philosphy that posits that if you want to get rid of bad law, make sure everybody suffers because of it.

 
At 7/12/2012 3:09 PM, Blogger Methinks said...

I made the mistake of reading some of Sethstorms bullshit.

Sigh.

Nobody is going to hunt down refugees from the USSA, fool. They didn't do it for the USSR and they ain't doing it for the USSA either.

 
At 7/12/2012 3:10 PM, Blogger Methinks said...

And forgot an apostrophe. I hate typos.

 
At 7/12/2012 7:45 PM, Blogger sethstorm said...


Nobody is going to hunt down refugees from the USSA, fool. They didn't do it for the USSR and they ain't doing it for the USA either.

The USSR didn't have half the military presence that the USA does all over the world.

With the USSR, they didn't make a habit of hunting people down that made it to the US. You may have been able to make a very good life in the US by escaping the USSR, but I'd strongly warn against being on the wrong side of the United States.



There is a certain philosphy that posits that if you want to get rid of bad law, make sure everybody suffers because of it.

The problem is that the bureaucrats that envisioned and enacted it it rarely get punished. The more common occurrence with that strategy is massive amounts of collateral damage.

Some of us like the country too much to see people try to destroy it - whether it is blatant(9/11) or subtle(withholding work for political reasons).

 

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