Boutique Options Offer Greater Choice in Medical Care
Although technology and research success have enabled medical miracles unimaginable decades ago, many patients and doctors crave personal care more typical of yesteryear. Boutique or concierge hospitals may be able to provide you with that option, but only if you can afford it.
“My experience has been so positive,” says Trudy Suits of Jupiter, FL. She started paying $1,500 annually to continue with her primary care physician, Mark W. Gocke, MD, after he switched to a boutique practice. “Now I have a coach as a partner to a greater level of health. He has more time to be involved in my total care.”
Andrew Ripps, COO and co-founder of MDVIP in Boca Raton, FL, says his company’s practices attract people interested in disease prevention, early detection, and wellness. The annual fee includes a complete physical, screening, and counseling about nutrition and other lifestyle issues.
“While the MDVIP program is a niche solution for people, it is at the forefront of beginning to create choice for people who want something better from the current healthcare system,” Ripps says.
Most boutique practices charge an annual retainer that typically includes same-day appointments, short waits, and email or cell phone contact with the doctor. Some models include home visits and travel-medicine services. To provide this level of access, doctors accept a limited number of patients.
If you have a health spending account, you may be able to pay the retainer with your pretax dollars. Insurance companies, including Medicare, will most likely pay for regular services. But, you will need to carefully read your policy to make sure that the visit is covered. You may need to pay out-of-pocket for preventive care and certain types of screening.
Gordon Moore, MD, of Rochester, NY, has taken a slightly different angle, borrowing a number of efficiencies from manufacturing's best practices. He relies on computers rather than clerical staff. He answers his own phone and files the insurance claims. “I want to deliver VIP-level care,” Dr. Moore says, “but not charge a dime extra.”
Nancy Hilliard, a patient of Dr. Moore, raves about his care. With three children and two stepchildren, she had spent hours waiting in doctors’ offices only to feel rushed during the visit. “If you need five minutes or an hour and a half, he talks to you. He gives you options, not just ‘this is what you do,’” Hilliard says. “He makes a point to know our family and the issues we are going through. He is amazing.”
Concierge practices have ignited controversy in the medical community. “I have massive concerns,” says John Goodson, MD, associate professor of medicine at Harvard Medical School. “This has a country club feel and all the negatives that goes with that. It is a highly discriminatory pattern of practice and represents a very frightening trend on the part of some physicians to opt out.”
Dr. Goodson understands doctors’ and patients’ eagerness to escape the managed care rat race. But dropping out will not solve the underlying issues creating the stress and frustration. Some fear limited practice sizes could increase crowding at remaining offices.
Another concern—busy practices help doctors stay proficient. “Dealing with lots of situations and solving complex problems is part of the enjoyment and challenge of being a busy practitioner,” Dr. Goodson says.
Equal Care for All?
Nearly everyone recognizes that those who have the financial means more often buy better cars, private schooling, and other services. Medicine, though, has prided itself on providing equal care to everyone, yet differences have always existed.
“Some prestigious, academic centers have had contractual arrangements or special exams for a long time,” says Yank Coble, MD, former president-elect of the American Medical Association (AMA). Dr. Coble is a Jacksonville, FL endocrinologist. “That is a similar type of thing and not considered inappropriate.”
Dr. Coble said the AMA believes in a pluralistic system—one in which doctors offer quality, ethical, science-based care, and in which patients can make informed choices.
Do You Want to Make the Switch
Being well informed is essential. If you are considering changing to a boutique-style medical practice, take these steps:
- Learn about the doctor’s experience and credentials.
- Ask if the practice accepts your insurance plan, and find out about their billing practices.
- Be cautious of practices trying to have it both ways, with some patients receiving boutique access and others not.
- Look for extra value, such as comprehensive exams and wellness plans.
- Stay within your budget.
While debate continues about the bigger issues, individuals that can afford it seem eager to embrace the added convenience. Trudy Suits believes she is healthier due to the additional attention from Dr. Gocke. And Nancy Hilliard credits Dr. Moore with improving her family’s care. “In every aspect of our life, Dr. Moore is there for us,” Hilliard concluded. “What he is doing is going back to what medicine should be.”
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Franklin D. Morning rounds: boutique hospitals and health insurers. National Public Radio website. Available at: http://www.npr.org/blogs/health/2009/07/morning_rounds_boutique_hospit.html. Published July 13, 2010. Accessed June 30, 2010.
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Last reviewed July 2010 by ]]>Brian Randall, MD]]>
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