MDVIP

MDVIP
June 6, 2010

I’ve been going for my primary health care to an office in Riverdale, near Southern Regional Hospital when I was employed at the State Hospital in Panthersville, because the location was easy to get to. Since my retirement I wanted a doctor’s office close to my condo in Atlantic Station and there’s a practice there belonging to the Piedmont Physician group. One of the doctors has a practice called MDVIP so I asked whatever is that? Having been in Psychiatry and retired I was not up on all the trends of general medical practice. Never heard of an MDVIP practice before. Well, it’s concierge medical practice, personalized or boutique or yeah, VIP care. You pay an annual fee of $1500 on top of what is reimbursed by your health insurance or Medicare, and for that you get to make same day or next day appointment, you get seen promptly by the doctor himself, not a PA or NP, no reception room wait, no crowds of sick patients where you can catch an infection from, and you can spend time with your doctor during the visit and ask all your questions, and you will not be hurried, you can have the doctor’s home or cell phone number and you can call him anytime 24/7, and if need be he can make house calls too, he remembers all the particulars about your health problem and calls you to follow up, or inquires how you’re doing, he does an executive annual physical exam and screening lab work and spends time with you discussing the results and explaining needed treatments or prevention and health maintenance strategies, he monitors your weight loss or smoking cessation program, and if you need specialist care, he makes the referrals, forwards your medical records, and coordinates hospital admission or specialized treatments and facilitates all process and keeps you informed and educated about everything. The practice has affiliations with national medical centers of excellence like the Mayo Clinic, Cleveland Clinic, etc and he insures that visits to these institutions will be hassle free, including welcoming representatives at the facility or providing guidance in practical arrangements like flights, lodging, etc. You’ll also get your medical records in CD-ROM and a personalized website.

What? Isn’t this how primary health care should be in the first place? This is how we were taught in medical school at the UPCM in the 60’s after all. But alas, times have changed. Doctors have been squeezed by managed care and reduced reimbursement and added bureaucracy and paper work and increasing overhead costs, ballooning malpractice premiums, among the egregious ones, that they are forced to see an ever increasing patient caseload and to reduce the time spent in patient visits in order to make up for lost revenue and maintain a practice. A primary physician’s patient caseload can be as much as 2500 patients. Many have felt they were on a treadmill, felt disillusioned or conflicted, closed their practices, and retired early. Some continued working but not in private practice and instead sought employment in public institutions where other frustrations and challenges abound. It is in this climate that innovations in medical practice like MDVIP have come about. For $1500 annual fee, a physician will reduce his caseload to 600 patients to meet the requirements for personalized patient care, MDVIP gets $500 and the physician $1000. For the doctor, that’s $600,000 income free and clear on top of the usual reimbursement for medical care. Brilliant! Why did I not think of that myself? MDVIP was founded in 2000 in Boca Raton,FL and has grossed over $23M recently. Apparently many patients are satisfied, the renewal rate is around 93% and it has expanded into over 28 states and signed up hundreds of doctors and thousands of patients.

Why did I have a knot in my gut when I heard about this? I got angry and I announced to the nurse and the doctor who attended me in this practice group (they are not part of the MDVIP practice) that I’m going to blog about this and and vent to my friends and email group and facebook. So they asked how I was treated so far in my visit. I was treated very well, I got a next day appointment, I didn’t have to wait very long in the reception area, the nurse was very pleasant and friendly and I had to wait a bit for the doctor in the examining room, but she apologized and chatted me up and in the process I discovered that she did her residency at George Washington and had my classmate Carmen in her Infectious disease rotation. But I’m an exception to the ordinary patient. I am a doctor and I know my way around receptionists, I can charm or be a bitch and demand, I can announce I’m a doctor and can get the doctor to talk to me, and I can tell if I’m getting good medical care or not. I’m always treated very well in doctor’s offices.

This MDVIP to me smacks of elitism, is undemocratic and an indictment of the broken health care system in our country. After the posturing of politicians and self-interest groups and industry lobbyists in the legislation of health care reform this year and the continuing challenge to it being planned by the states, it would appear that universal access to quality health care is not forthcoming anytime soon, that medical care as it should be provided is available only to those who have money and influence.

MDVIP is good for the doctor and the patients in the program. It is the ideal world for both, the doctor can practice excellent medicine without worrying about his income and feel professionally fulfilled. But what about the 1900 patients who will be dropped from a 2500 patient practice so the doctor can qualify to be an MDVIP provider with a 600 patient caseload? True, MDVIP requires that these patients are properly referred, and maybe in this early phase other regular practices can absorb these patients but there will come a saturation point, and there will not be enough doctors for all these patients. How will this play out in the heath care reform scenario?

There had been VIP patients and MD partnerships before MDVIP. Just recall Elvis Presley, Anna Nicole, and Michael Jackson. Purportedly every MDVIP clinical practice is monitored for quality assurance. There are no complaints so far from patients already in the program. However there are complaints in the business marketing and recruitment process. Apparently it is very aggressive and akin to the sales pressure many have experienced when attending complimentary weekends in time share resort developments. Potential doctors and patients are wined and dined and supplied with slick brochures and entertained in plush venues.

Ours is a free market economy, and health care, under the system of insurers and managed care and giant multi-specialty medical groups has joined the ranks of big business and has adopted the culture of corporations focused on market share and the bottom line and investor profits. Innovations in medical practices will continue to be invented like MDVIP. Who knows what tomorrow will bring.