Dissecting MDVIP costs for patients

I must have a case of lyin’ eyes. I analyzed Melissa Steele’s front-page story on concierge doctoring Dec. 4-7, and my calculator showed that it costs $540.54 per hour to get in to see a Mid-Atlantic Family Care primary doctor. (For us nerdy folks: that’s 2,000 doctor work hours per year - allowing two weeks’ vacation - spread over 600 patients at $1,800 each simply to keep their doctor.)

$540.54 per access hour! And that’s just the entry fee. Insurance premiums and co-pays come on top of that. In the case of the couple cited in the story, adding their insurance premiums attributable to primary care would easily push it over $1,000 an hour. Just to keep the door to your doctor open! As that car replacement warranty commercial asks, “Who does that?”  

I can see why Mid-Atlantic reports their physicians are “humbled” by their patients’ positive responses. I would have also thought “astounded” appropriate. Personally, I’m aghast. My arithmetic adds another perspective on physicians who claim concierge doctoring is why they went into medicine: have 600 folks give me $1 million a year so I can bill their insurance companies for the time I spend with them.

Still, seriously ill patients may flock to this new approach. Indeed, the CEO of MDVIP, which is franchising Mid-Atlantic, reports it attracts those “who prioritize their health... actively interested in having a closer relationship with their doctor.” Do you think folks who forked over almost two grand to keep their doctor are going to take kindly to being ushered out of the office before they feel completely satisfied?

What if even one-quarter of the patients in each doctor’s 600-person practice have serious, chronic problems, maybe even some hospitalizations? Or otherwise want to command more doctoring for ordinarily ignorable aches and pains? If those 150 patients take an average of just one hour per month of their doctor’s time, the remaining 450 patients each get only 30-minutes attention per year. 

Now that’s far more than $2,000 per hour for VIP access and far less time than I get as an episodically well senior in a non-VIP practice. I could slip my doc a crisp $100 bill as a thank you after every visit (which is paid for by insurance) and still be ahead in quantity of care versus the VIP model. 

Further, if concierge primary medical care service survives, the reported Shore View Personalized Medical Care’s tiered pricing by age also reveals the future: Just as one airplane now houses four classes of passengers, tomorrow’s concierge medical care will soon classify into platinum, gold, silver, and bronze with tiered pricing and service. The pricing discrimination could be based on age, health, prior conditions, family history, or utilization - which brings us back to the current business model plus a surcharge all over again.

Which is to be fervently opposed. By patients not wanting to compete with their fellows for attention, by hospitals increasingly burdened by orphaned patients, by insurance companies soon to be competing with a public option, and by other physicians that welcome all comers who need quality medical care at the base level and affordable costs. 

Concierge medicine is a bad model and needs to wither away. Thank you, Ms. Steele, for shining a detailed spotlight on this malodorous emergent practice. Your report gives those of us who are concerned a chance to object and perhaps deter other such efforts.