Who Are the CDHC Pretenders?

Last month, I wrote in this blog about Dr. Benjamin Brewer who reasoned that since his practice covers 80% to 90% of what the average person would ever need a doctor for, he could have covered his salary for 2007 and the costs of all his staff and overhead for less than $20 per patient per month, including maternity and hospital care. Of course, he could not implement such a payment plan with his patients because the Illinois Department of Insurance would prosecute him for running an unlicensed insurance company.

So what about the doctors who practice “concierge” medicine — charging an annual fee to patients in exchange for customized care including house calls? They are not fairing much better. It seems that they are drawing the ire of some big health insurance companies.

An article published in the Houston Chronicle and posted on ahiphiwire.org said that United Healthcare has confirmed it is dropping four Houston area doctors from its network in April because the company disapproves of their so-called “concierge medicine” model. The story said that Cigna also is condemning the practice, in which physicians charge an annual retainer of $1,500 to $1,800 for patients who then receive more personal care.

The article quoted a Cigna spokesperson as saying, “Charging membership fees to guarantee access is a violation of our contract terms and may result in termination.” Well I say, maybe it is time to change the contract.

As the Houston Chronicle article points out, concierge care is considered by some to be a revolt against the modern health care system where diminishing Medicare and insurance payments have forced doctors to herd dozens of sick patients through their offices in five-minute increments every day. I would add that it is also a rejection of the system that says that the insurance plan is the one that controls the financial relationship between the patient and the medical provider. How can we expect consumer-directed health care to gain acceptance when some health plans are so adamant about protecting the status quo that they will kick doctors out of their networks for being so bold as to deal directly with a patient when pricing their services?

While both United and Cigna market consumer-directed health plans, this may be a litmus test to help identify those who truly endorse the concept and those that do not. The article points out that other major health insurers, including Aetna, Humana and Blue Cross Blue Shield of Texas, consider concierge care just fine so long as patients are clearly informed that the insurers will not re-imburse any of the retainer.

“Humana would not exclude doctors practicing this model of care from our networks,” said Dr. Mark Netoskie, medical director of Humana, Houston. “It is the consumer’s choice whether or not to pay for these additional services.”

While that may not exactly be the answer that people with Health Savings Accounts (HSAs) want to hear, it at least sounds like a more market-driven philosophy to me.

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