Posted on 07/22/2003 3:40:26 AM PDT by PBRSTREETGANG
Recently Dr. Nick Fitterman gave a patient a 25-minute physical after she had waited 45 minutes to see him. This was unusual, he said, in that many of the 3,800 patients he treats only see him when they are sick.
Fitterman is sick of that.
So he has made what he says was a difficult choice: to cut his Huntington practice back to 600 patients, and charge them each a $1,500 annual fee to continue using his services as of September. Routine doctors' visits and services will continue to be covered by insurance payments, but the extra payment allows the doctor to schedule more visits with fewer patients and to concentrate on preventive care and wellness.
Critics say the fees will create a new tier in the health care system, one that is accessible only to the well off, and leave even insured patients unable to find medical care they can afford.
Fitterman says the new practice model, known as boutique or concierge medicine, will let him pay more attention to patients and preventive care than he can now, when he feels pressured by low insurance company payments to see thousands of patients.
"This is the most difficult decision I have ever made," Fitterman said. "A half-dozen times a day, I think, am I doing the right thing? But patients are frustrated. I think (the medical profession) is compromising our quality of care."
But Fitterman's decision to restructure his practice along a model provided by MDVIP, a Florida-based medical management firm, will leave more than 3,000 of his patients searching for a new doctor. Another Long Island general practitioner, Dr. Steven Goldfarb of Southampton, also has signed on with MDVIP, and some of his patients say they are disturbed that their health insurance is no longer enough.
"On principle I think it's wrong. We have medical insurance, we have our co-pay," said Laurie Lenz, a Southampton resident who said she is having a hard time finding a new doctor who will take her Oxford health insurance. "When you become a doctor, you take an oath, and part of that is dealing with insurance," she said.
But the Hippocratic Oath doesn't mention managed care. Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania, said he thinks boutique medicine is a symptom of a larger problem with the health care system.
"I don't blame doctors who say, 'I want to have the ability to spend time with patients,' but how did we get to a position where that isn't what everyone gets?" he asked. According to Caplan, patients who pay fees for access to their doctors "are buying their way into coach."
Fitterman and Goldfarb said their patients will receive additional services in exchange for the annual fee. All patients will be entitled to annual checkups and wellness care, such as extra visits for nutritional counseling, that many insurance plans won't routinely cover, they said.
Larry Akey, a spokesman for the Health Insurance Association of America, said boutique care serves a section of the market, but it remains to be seen whether it will become a major trend. He acknowledged that managed care plans remain affordable by limiting some health care choices for both doctors and patients.
"Doctors are not forced to join managed care plans," he said. "If the fees are inadequate, they can simply choose not to participate in a plan."Both Goldfarb and Fitterman stressed that they are asking other doctors to take the patients who do not sign on to their new practices. New ethical guidelines issued in June by the American Medical Association, require doctors switching to boutique practices to do this. The guidelines say that if no other physicians can care for patients who cannot pay the retainer, the doctor may ethically have to continue caring for them. Both Fitterman and Goldfarb say they will continue to see patients with no other options.
"Out in this area, no one takes Medicaid, so I have decided that I will continue to take all my Medicaid patients," Goldfarb said. "There are also patients at the Shinnecock nation here who have been with me for a long time, and I can't abandon someone who doesn't have an option for someone else. We've made accommodations for them."
But the two doctors say they know they will lose some long-time patients. Karen Larson's family has gone to Fitterman for five years, and she paid his fees herself when he stopped taking her insurance plan. But $4,500 annually to cover herself, her daughter and her husband is simply too much money, she said.
"I think he's excellent, but for one visit a year, I think it's extravagant," she said. "We're going to find someone else." Still, Larson added, she would prefer to stay with Fitterman, but cannot justify the cost while her family remains healthy. "Who knows?" said Larson, a nurse from East Northport. "Maybe someday down the line, if something happens."
Copyright © 2003, Newsday, Inc.
The use of the insurance "system" to pay for low-cost, primary care visits has doomed primary care, at least as delivered by physicians.
I assume that there will be some free market attempts to revive it before Hillary's final victory.
The 1993 comprehensive healthcare proposal made this illegal (five years in jail for the MD), and since the government will never be able to compete with this type of service, I assume it will eventually be banned (except for Members of Congress).
If people truly get better care for their $$$, and this doctor is that much better than some other doctor on the plan, then it MAY be worth it.
But practically, how much extra time is this guy really going to spend with someone for their $1500 annual fee. One hour (maybe), two hours ( doubt it), calculate the cost of those extra couple hours and it doesn't look like such a deal to me.
It doesn't to me either, hence we are probably changing physicians. The only wrinkle is that my wife has had some serious health issues this past year and it makes it a rotten time for her to be switching to a new doctor.
Presumably, demand may bring this figure down (or boost it), depending on the realities patients face. On the surface, I think the idea is ok. Personally, I don't think I could receive much value for that kind of outlay, but maybe someone with persistent health problems would pay for the focused attention.
I've said this before: the best health care reform would include options for the elimination of insurance payments for routine care. People love paying $10 bucks for their annual checkup, but it's not a very efficient way to keep overall insurance prices down. If the patient bears a larger burden for routine care, premiums may decrease and coverages may expand for more serious conditions and procedures. I know nobody wants to implement a disincentive for people to seek medical attention, but right now a doctor's visit is virtually free for millions of people. I think that should change.
I've got a chronic health condition too, and have had to switch GP's (actually I see an Internist). I stay with the same specialist, in my case, a neurologist.
Switching GP's or internists doesn't bother me too much. Find a specialist that deals with her problem and stick with him/her. As far as switching, just get a copy of all her records and have them sent to the new doc and the specialist you choose.
I'm really much more pleased with the care I'm receiving at my new internist. Sometimes I think doctors that you've seen for years may get too comfortable with the patient and overlook issues (just MHO).
A new GP or Interist has to "start from scratch" so to speak, aided by the previous doctor's notes. When my husband switched to our new doc, he got more help in his first appointment for a health problem he's been dealing with for quite a few years, than he's gotten in the past 5 years with our previous doc. So changing isn't always bad.
Revolutionary thought. And it will get you lynched in the public square. Pipe down. Any injection of reality to the health care debate is frowned upon.
How dare you?
Did your mommy charge you for milk and cookies when you came home from school?
Did your daddy get payment up front when he put a band-aid on your boo-boo?
Mommy Party or Daddy Party, the People just ain't paying for these services any more!
BWAHAHAHAHAHAHAHAHA!!! I must have missed the part of the oath that said it was my solemn obligation to deal with insurance. LOL!!!!
Idiots like this will vote for Hillary.
Sure, doesn't the Hippocratic Oath state...
"First, do nine forms..."
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