In HI, most of the MDs, including all of mine are or were solo practitioners or at most had a partner. Now, many are part of the hospital or Accountable Care Org. It is different but it has the potential to be better or worse for providers AND patients.
For most newly minted doctors, those who’ve finished residency and are about to take up practice, their debt precludes opening a practice of their own. They need a guaranteed salary to make the monthly payments of the medical school loans. To take on either more debt to set up a practice and then have the uncertainties of building a practice is not feasible.
Yes, We know a dentist who wants to retire and is having a very rough time getting anyone to give him the money he wants to take over his practice.
Longtime posters might know that understanding medical costs and medical systems is one of my hobbies. In pursuing my hobby, I’ve read about the passage of ACA, and interacted online with people who wrote it. I can therefore state categorically that this is untrue:
I don’t dispute that medical systems like (boo, hiss) Sutter have been buying up hospitals and medical groups. As a result, big medical systems end up with far too much market power. I would have liked to see more antitrust enforcement to stop this. But this provider consolidation was not an intended result of the ACA. I can state that with certainty.
Me too. “Siloed” is the term I’ve heard used to describe medical records systems not playing nicely with other medical records systems. It seems such an obvious flaw. When I’ve asked why this is allowed to continue, I’ve heard that hospitals like it this way.
On the other hand, electronic records are fantastic. I just emailed my doctor yesterday-- I had some new information that made me think I should try a medicine we’d talked about, rather than wait a few months as initially planned. She was able (probably from home) to check my records, put in the order for the med at the pharmacy, and email me back. When I got back from my bike ride, there was her email, plus the email from the drugstore that my med is there. This is great! It’s much more efficient for everyone.
Since insurance billing is probably one of the biggest drivers of paperwork requirements for medical providers, it is not surprising that physicians going concierge may like it if there is enough of a market of patients who can pay the prices involved. But that model may not be affordable for many patients.
That was already happening before ACA, courtesy of the tug of war between providers and insurance companies and the resulting paperwork burden for insurance billing. ACA or no ACA probably made little difference in this trend.
Yes, silos are common if providers don’t happen to choose systems compatible with other providers you use. VA and Kaiser all have their records throughout the US in one system apiece so any KP provider and patient should be able to see everything no matter if care was provided nearby or across the country.
My providers are still mailing and scanning stacks of records from one institution and one provider to another. It’s very challenging! I physically carry CDs and DVDs among my providers so they can add them to my records.
What horse puckey. I work in mergers & acquisitions (mostly in health care and financial services), and bigger corporations have been gobbling up the smaller entities in the field of medicine for my whole adult life. The pace has not accelerated under the ACA (except that the economy has recovered in general from the ditch it was in at the end of 2008, and in general M&A work dipped with the economy and has now increased again).
Doesn’t your 84 year old relative have Medicare
If there are insurance companies (whether under ACA, or under another model like the proposed AHCA) big hospital corporations will have a large negotiating advantage over individual hospitals. When the insurance company wants lower rates, the hospital corporation which controls all or most hospitals in an area can fight back. Northern California, where I live, has insurance rates that are about 40% higher than southern California, probably because mega-corp Sutter controls most of the hospitals and can demand any rates it wants (and it wants big rates).
I don’t think that any physician who transitioned to concierge medicine was concerned with patient access.
How unfair. Perhaps these MDs don’t want to be constrained by corporate guidelines, patient time constraints & quotas and just want to practice the best medicine they are capable of providing. Perhaps they do volunteer or humatarian work in their “free” time. Why are the physicians always the sacrificial lambs in the access to care discussions while insurance and hospital company execs pull down eight figure salaries?
In 1973, I moved to NH. My primary care doctor was part of group affiliated with a hospital…and this was WAYYYYYY before the ACA passed.
EMR are great, in my opinion. I had a kid who was prescribed a med he was allergic to by an on call doc. That likely would have happened if EMR had been available. Fortunately, I saw the (expensive) RX bottle before any were given to the kid. At $100 for the bottle (and this was over 20 years ago) you can bet I asked the doc to reimburse me…I did not have RX coverage…at all. They did!
They need to be concerned about whether there are enough patients in the area who can afford the cost of the concierge medicine that they are offering. Otherwise, such a business model may not be successful (or may become unsuccessful if too many other physicians crowd into it).
^^^
Yes, and I wouldn’t think there are too many MDs who are setting up these type of practices straight out of residencies. They would only be successful if they already have a good reputation and following. In other words, have been practicing at a high level for several years…and have paid their dues, IMO. I would also think it is an alternative to retirement for some. And how would that affect access to care?
Concierge medical services are fine for EACH doctor. BUT they don’t pay for things like multiple doctors (unless younare willing to pay concierge monthly fees to multiple doctors), most specialists, lab tests, hospitalization, ambulance rides…and the like.
So…many people find they need a high deductible regular health insurance plan…AND then pay the concierge costs for their PCP.
Doctors and clinical services account for twenty cents of our health care dollar, on average. Your primary care doctor is only part of that cost. So, if you’ve got a concierge doctor, you still need to pay for the rest of the 80-95% of your care: hospitals, emergency services, prescription drugs, rehab, mental health services.
Concierge doctors are a nice luxury if one can afford them, but not a solution to the cost problem in American health care.
I think JazzyTXMom may just have mis-worded it. Of course they need to view both sides of the equation: what makes dollars and service sense to the doc and meets patient needs. And as Thumper points out, pre-pay only works for the doc you buy into.
We have concierge here, but the percent of the whole is quite small, barely a handful. Not a factor I’d say suggests some huge turn in the tides. And think about it, how many patients, at $x annually, to make salary for the doc and some assistants, the rent and etceteras. And what really happens during,eg, a tough flu season, when demand surges.
Many of us don’t feel the docs are sacrificial lambs. Yes, insurance and hospital execs are paid mind boggling amounts. But the difficulty in many areas of the country is the service a patient can receive, at what real cost, in premiums, copays, deductibles, some pretty tough choices. High deductible can be short sighted, cost-prohibitive, if costs begin to add up (in some cases, thousands,) before the ded is met.
None of this is simple and something that can easily be generalized into finger pointing.
@audiophile et al. My comment about access was in response to a post that concierge medicine may not be an affordable model for many patients.
I think that all of the reasons @audiophile listed are what has motivated some physicians to move into concierge medicine. However, there is no denying that there was an impact on those patients who could not afford this option, which included my husband. He had been seeing his PCP for ten years when his doc made the switch and was left to look for another provider.
Also, having a concierge medicine provider is not a replacement for having health insurance as you still need to cover all of the other expenses–ancillaries, specialists, ED, hospital, etc.
Many physicians limit access, not just concierge doctors. Many limit the number of Medicaid or Medicare patients they take due to the low reimbursement rates. Some doctors will continue to keep you as a patient once you go on Medicare if you were a patient of theirs before, but will not take new Medicare patients. My local hospital takes no ACA plans at all, just employer plans.