Concierge Medical Care

The name is different depending where you are but the concept is the same. Concierge medicine tailors care to those who can afford the fees. When physician providers attempt to maintain their income and dump third party payers for more lucrative clients it would seem somewhat unethical. However with decreasing reimbursement rates and increasing administrative and other costs that physicians are having to contend with you can't blame them for trying to maintain their standard of living, or can you? U.S. News has an article about this "experiment"in care.

For those that are unfamiliar with concierge medical care it is basically a VIP form a service that physicians provide for those that can afford the cost. Typically an annual payment is provided from the patient to the provider at a negotiated rate which is dependent upon the services provided. Fees as low as $1000 and upwards of $20,000 or more per year is what patients will pay out of pocket to their provider for such services as the following:

• Nicer and less crowded reception areas.
  
• Priority/same day/ guaranteed next day/ extended/ Saturday appointments.
  
• 24-hour pager, cell phone, home phone access to the physician.
  
• House calls and out of office care, possibly including accompanying patients to appointments with specialists.
  
• Preventive care/ weight loss/ nutrition/ wellness advice and programs.
  
• Telephone and email consultations.
  
• Spa-like amenities.
  
• Free check ups.
  
• Physicals and other normally uncovered services.

Sounds great doesn't it. Well it is, but it also costs. Some of the issues related to this type of medical care is that it is not likely to help those that are already having troubles paying their insurance premiums, and it will do nothing to provide access to the 47 million that we know of that don't have health insurance.

Another issue is the patient load for providers that practice this way. Clearly these providers are only caring for a few hundred patients not a thousand or so patients that one might find in regular practices. This causes access issues for those trying to find a primary care provider. Additionally for those providers that opt out going the concierge route, the patients that they will not be retaining are left hanging in a sense. Providers must help these patients obtain new primary care providers but that may be harder than it would seem.

Lots of other issues surround this form of healthcare as well. Bottom line, this type of healthcare is clearly based on privilege and not based on rights, a seemingly common thread in our current healthcare delivery model. You can access this type of program now on-line through such vendors as MDVIP , but again this type of care and access are for only a few. The question that looms in my head is, is this a possible strategy option for hospitals to develop and offer to patients? However make it a more complete concierge healthcare experience not only with physician providers but nursing and other providers as well.

Source: Physician's News Digest

Payment up front stirs some controversy

From Hospital Impact comes a brief posting about patients providing up front renumeration for outpatient services prior to services being provided. The posting authored by Nick Jacobs, CEO of Windber Medical Center in PA has seemed to have stirred the proverbial pot a bit in the comment section - posting is here.

The practice of requesting payment prior to services being provided is not new for some institutions. Typically healthcare organizations base decisions such as this on the assessed ability of a patient to pay for services, which is what Mr. Jacobs mentioned. It is a difficult pill to swallow knowing that your local hospital may require up front payment before they will provide services. The one aspect that is critical to realize is that these types of services that are involved in this type of situation are considered non-emergent.

I have seen this up front payment program in use is some hospitals that I have worked at over the years. In fact a co-worker who is a nurse was subject to this very policy. His health insurance would not adequately reimburse a hospital for some outpatient surgery and he was required to pay some $1200.00 up front to the hospital before he could have his surgery.

It may sound cruel but the reality of today's healthcare environment demands this type of approach to maintain the financial viability of some hospitals. Rising medical indigence and mounting bad debt that many hospitals are carrying can not continue to go unattended.

In the end the business of healthcare must be run like a business if it is to continue to provide services to the community. The sad fact is that the burden is placed on the patient much of the time.

If healthcare consumers feel outraged by this, which I'm sure they would, the proverbial smoking gun need not to be pointed at hospitals. Some might say point the gun at insurers and legislators but the truth is that our current system needs repairs on many fronts not just one, and no single aspect of our healthcare system can be blamed.

Vendors, vendors, and more vendors.

Like any other professional conference this year's American Association of Critical Care Nurses (AACN) National Teaching Institute & Critical Care Exposition (NTI) is packed with the latest patient care technology, equipment, supplies, and education resources for both staff and patients. When you add 9000 conference attendees, it gets a little crowded.

Pens galore for the taking, ID badge holders in every corner of the exhibit area, and oodles of single serving chocolate in bowls on almost every counter just there for the taking. The prized and expensive items such as scissor packets and clogs were only given to those who completed a specific number of informational sessions with some of the vendors.

Some take issue to this type of advertising stating that this routine set up of elaborate displays that are shipped to the conference site along with company and product representatives which are flown in, in many cases add needless cost to health care.

How much money is spent by healthcare product manufacturers each year in this type of venue? How much of this cost to companies is passed on to the the healthcare consumer? Some see this as needed advertising, some see this as a way of educating healthcare professionals about recent advances in healthcare product technology so practice changes can be made. This subject is clearing polarizing for some. What are your thoughts?

AACN's National Teaching Institute (NTI): 9000 Nurses

Today completes the first full day of the American Association of Critical Care Nurses (AACN) annual conference called NTI. A whopping 9000 nurses have traveled from far and near to attend this year's conference in downtown Chicago. The theme for this years conference is all about reclaiming priorities. In today's volatile healthcare environment the theme is very apropos.

Dynamic speakers, novice critical care nurses, and seasoned critical care nurses representing all sizes and shapes of healthcare organizations collected in one area for a few short days to learn the latest evidence based practices, to learn innovating ideas and solutions for shared problems, to enhance knowledge bases, to see the latest critical care technology, and finally to network with new and old colleagues is an amazing site when you see 9000 nurses engaged in all of it.

Why do 9000 intensive care nurses come together for a week long conference? To be better nurses. To provide better care for patients. To bring back a wealth of knowledge to their parent hospitals and healthcare organizations so that they can facilitate positive change, not an easy task, but a sorely needed task.

This year's theme is about launching nursing back to basics, providing better care, focusing on what the patient needs, less distractions, to shun and shed non-nursing tasks that so many hospitals have put on the shoulders of nursing such as jobs that should be done by dietary, environmental services, customer relations personnel, and other ancillary staff. Reclaiming priorities is about focusing on patient care.

NTI Preconference over, the main event tomorrow.

National Teaching Institute (NTI) preconference activities come to an end, more participants arriving this afternoon, the final touches on vendor displays are taking place. The American Association of Critical Care Nurses (AACN) main assembly starts tomorrow.

Commercialism in healthcare is alive and well with the many sponsors and healthcare field related businesses that are in attendance. Lots of great opportunities for providers to hone skills with simulation labs, on-site web based learning during conference sessions, and a plethora of clinical and leadership centered lectures to attend.

Tomorrow the week starts off with NTI in full swing for the next several days.