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Later this month, the first national meeting of the American Society of Concierge Physicians will take place in Denver. The success or failure of this group will say much about where our health care system is headed over the next decade. As DrRich has pointed out, the profession of personal health care advocate (PHCA) has been much slower to take off than he originally predicted. However, many of the same ideas behind PHCAs are now being adopted by a few brave doctors who breaking away from the standard form of medical practice in order to offer their patients a new kind of covenant. These new kinds of practices have been labeled (somewhat disparagingly) "concierge" practices. |
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In concierge practices, patients pay an annual or monthly fee directly to their doctors, and for this fee they receive some form of a restored doctor-patient relationship. The doctors promise, essentially, to place the patient's interests first. The most obvious manifestations of this promise usually include 24-hour access to the doctor, fax and e-mail contact, and same-day appointments, but in fact the greatest benefit received by the patient is the knowledge that the doctor now is obligated to place their needs on a higher level - at least on the same level as for other payers. Predictably, the "concierge practice movement," as small and as under-the-radar as it is, has already engendered a forceful and violent response from both insurance regulators and by legislators - neither of whom are happy with anything that might restore the doctor-patient relationship they have spent so much energy trying to destroy. Insurance regulators and legislators are also constitutionally hateful of any movement that threatens to take the flow of health care dollars out of their hands. For instance, the Washington State Office of Insurance Commissioner is issuing "advisories" that would require many concierge practices to register as insurers - a virtual impossibility, given the financial criteria necessary to become an insurer. And members of Congress - including former presidential candidates John Edwards and Bob Graham - are sponsoring legislation that would forbid doctors from enrolling Medicare beneficiaries in such programs. As DrRich predicted, at the first sign of a plan to restore the doctor-patient relationship, both Gekkonians and Clintonians are pulling out the stops to nip it all in the bud. DrRich, for one, thinks patients should seek out good concierge practices and enroll, both for their own self-preservation and to demonstrate that restoring the doctor-patient relationship is something they value and something they demand. These practices, if managed honestly and ethically, could offer most of the benefits to patients that PHCAs would offer.
May, 2004
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