Is boutique medicine worth the price?

[Guest guest]

Is boutique medicine worth the price?

By Cohen

CNN Medical Correspondent

http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html

Two friends of mine recently received the same letter in the mail

from their internists: Fork over $1,500 or you're out of my practice.

Make sure you know what you're getting for your money if your doctor

practices boutique medicine.

Of course, they didn't say it quite that way. The doctors said they'd

be cutting their practices down from around 2,500 patients to 600

patients. Those willing to pay the annual fee were promised primo

service in return: The doctor's cell phone and/or pager number; " same

day or next day appointments that start on time and last as long as

needed " and a " full, thorough, comprehensive physical examination

that is typically not given in most traditional primary care

practices. "

" Is it worth it? " my friends asked. " Should I spend the extra money,

or should I go find myself another doctor? "

" Get prepared to receive this letter, " says Dr. Santa, director

of the Consumer Reports health ratings center. " You can absolutely

count on more internists and family doctors doing what these folks

are doing. "

Virtually unknown 10 years ago, in 2005 there were 500 doctors

practicing what's referred to as concierge medicine. Now there are

5,000, according to the Society for Innovative Medical Practice

Design, a professional society of concierge physicians.

As with any business deal where you're being asked to pay hard, cold

cash for an intangible service, the buyer should beware. " Just

because they charge a fee and behave exclusively does not make them

good, " warns bioethicist Art Caplan.

So, if you're thinking about becoming a patient in a concierge

practice, here are the right questions to ask:

1. Specifically, what services will I get for my money?

Don't accept vague promises that with a reduced patient load the

doctor will be able to provide better service, advises Rother,

executive vice president of policy for the American Association of

Retired Persons. Instead, ask specific questions, such as:

• How long will it take you to return phone calls?

• How often will you check e-mails?

• Am I guaranteed same-day appointments, or are you just promising to

try to get me in the same day?

• What's the after-hours plan? If I get sick in the middle of the

night, will you come to my house? Meet me in your office? Meet me in

the emergency room?

2. When I get sick, will I see you, or another doctor?

The big selling point for concierge medicine is access to the doctor.

But when you get sick, will you really get to see your own doctor, or

one of his partners?

If your doctor practices alone (and many concierge doctors do), ask

what will happen if you need her and she's busy tending to another

patient. After all, concierge doctors promise care that's not rushed,

so if you're getting un-rushed care, so are the doctor's other 599

patients.

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" There's no way one doctor can be three places at once, " says Rother.

3. What capital investments will you be making to improve service?

Maybe the reduced patient load will solve all the problems in your

doctor's office, but maybe not. Electronic medical records, more

staff, or training for current staff could improve patient service.

Ask whether your doctor plans on making any of those investments,

advises Santa.

4. How will you save me money?

Given that you'll be spending $1,500 you hadn't planned on, ask

whether the doctor can save you money in other places, Santa says.

For example, your doctor could suggest less expensive alternatives to

drugs you're taking or devices you're using.

The fee is generally considered payment for an in-depth wellness exam

not covered by insurance. Most doctors in these practices work with

your existing insurance for coverage of office visits, hospital stays

and visits to specialists.

5. Ask yourself if money will make your doctor better.

" In the past, has this doctor ever done anything that struck you as

extra, as special? " Santa asks. " Have they ever gone out of their way

for you? If they haven't, I'd be skeptical. Fifteen-hundred dollars

isn't going to convert a doctor. They have to be that kind of person

to begin with. "