The concierge medicine model is becoming more and more prominent around the nation, as healthcare providers continue to adopt the new payment system. While many hospitals and physicians are finding medical payment reform and the move toward value-based care reimbursement challenging, the concierge medicine model may offer a solution to some of the struggles doctors are facing today. (more…)

Expert Advice on Exercise: Make it a Habit

The key to reaping the benefits of exercise as you age is to develop a regular, consistent exercise habit. “Consistency trumps intensity when it comes to exercise,” says Joseph Barry, MD, an internist and geriatrician at SignatureMD in Camillus, NY. “If you push too hard, the likelihood of injury increases. If you aren’t consistent with your exercise, like a daily walk, you won’t develop the habit and you won’t keep at it.” (more…)

Listen to full podcast here.

SignatureMD helps physician practices convert to a concierge model. Their approach is a little different in that they offer a hybrid model that doesn’t involve kicking any patients out of the practice. (more…)

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Doug Pitman, MD
Image courtesy of hcplive.com

Why should primary care physicians consider the concierge model of medicine? The question should really be rephrased: Why shouldn’t they? (more…)

Is consumer access to direct testing good or bad? (more…)

Joseph Barry, MD, visits his local farmer’s market at least twice every month. He does so for reasons beyond his own preference for healthy eating. That’s where he greets many of his patients. (more…)

Dr. Ditz, from Signature MD, is interviewed on Health Professionals Radio by Neal Howard. (more…)

Credit: Davide Trolli/Shutterstock

Ever wonder what it’s really like to be a doctor? Physicians in all sorts of niches help to keep people everywhere healthy and do everything from comforting kids with the common cold and helping women give birth to handling emergency situations and treating terminal illnesses. (more…)

Signature MD is featured in Physicians Practice’s  slide show about “Top Reasons To Switch To Concierge Medicine. See Below:

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This article was written by Jim Williams, MD, a family physician with a private practice at Sibley Memorial hospital in Washington, D.C. His piece is the second in our Physician’s Corner, a place for doctors to tell their stories about how medicine is changing in the twenty-first century.

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Dr. Marcela Dominguez visits her concierge patient Greg Smith at his Laguna Beach home.

When Greg Smith wants an appointment to see a digestive specialist for his acid reflux problem, all he has to do is text his primary doctor. (more…)

A Syracuse, NY doctor is actively fighting in the trenches with his patients for their health and well being.

If you ever have had to check into a hospital, you will appreciate the good work of Syracuse area physician Joseph T. Barry, M.D., a primary care doctor in Syracuse that makes it his policy to be by his patients’ side whenever they’re hospitalized. (more…)

When Kathy McCoy started taking a new blood pressure medication, she felt a little dizzy, so she asked her husband to drive her to work.

Over the next few days, her dizziness subsided, but then McCoy got fatigued and turned very pale. She called the physician who’d switched her meds, who told her to stick with the medicine, verapamil (a calcium channel blocker), for another week. (more…)

Some family doctors fed up with assembly-line medicine and reimbursement pay from insurance companies have honed a pitch for their most loyal patients: Pay an annual fee of $1,500 or more in exchange for perks such as longer appointments, expanded care, prompt scheduling, after-hours service, and maybe even house calls. (more…)

Who says the House Call is Dead?

To stave off the pressures prompting many physicians to sell their practices to hospital systems, Manhattan internist Peter Bruno has tried a number of creative solutions. They have ranged from forming a now-disbanded group practice with 60 colleagues to his ongoing strategy of working at a nursing home one day a week to supplement his income in his current solo practice. (more…)

“As people age, they can develop a ‘shell’ or become shy about participating in things…..and learning to socialize and be a part of a group so helps remove that issue” – Dr. John Verheul

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A new study on cardiac health, whose results were published this week in the Journal of the American College of Cardiology, makes it all seem so simple: Five changes in lifestyle can reduce your chance of heart attacks by 80%.

Sign us up! But with most things in life, the devil is in the details. (more…)

Physicians say direct pay models offer a viable alternative to health insurance, but require careful planning and outreach

MDVIP Corporate Office Headquarters at 1875 Corporate Boulevard NE in Boca Raton Melanie Bell

Boca Raton-based MDVIP Inc. is to concierge medicine as Hollywood is to movies.

It is very much the alpha dog in the growing health care niche, which once was the bastion of the rich but is now an available option to many workers through their employer’s insurance plans. (more…)

Most family practice and internal medicine physicians working in private practice today are burdened by ever-shrinking reimbursement rates and a growing list of administrative tasks required by insurance companies. In response, many primary care physicians are exploring alternative practice options, some of which are being encouraged by policy changes embedded in the Affordable Care Act.

Some doctors are embracing the economic security and reduced administrative burden that comes with employment. Others are selling their practices to hospitals and/or larger groups. And a small but growing number are showing interest in direct- pay practice models that allow doctors to reduce, or in some cases eliminate entirely, the administrative hassles and costs of dealing with insurance.

There are several models in which physicians collect a monthly retainer fee directly from patients instead of relying on fee-for-service reimbursement from third parties. Although the services provided for this charge varies, some of the benefits to physicians in adopting a direct-pay model include:

• reducing patients panel sizes, often by as much as half,
• minimizing administrative and staffing costs,
• increasing the amount of time spent with patients, and
• potentially increasing incomes

The services covered by the monthly retainer fee vary across practices. Often, however, patients can expect to have all primary care services covered, including care management and care coordination. Typically these include seven-day-a-week, around the clock access to doctors, same-day appointments, office visits of at least 30 minutes, basic tests at no additional charge, and phone and email access to the physician.

Although these models can look different, at their core, experts say, they share the common aim of providing high service levels, and increased access for patients.

Monthly membership models are especially attractive for patients with chronic conditions, but healthy people interested in a higher level of service find these models appealing as well.

Medical Economics spoke with experts to discuss some of the more common direct-pay practice models, along with some of their benefits and drawbacks.

Concierge medicine

Concierge medicine practices charge an annual fee that can range from $1,200 to $10,000, depending on the practice.

There are several models that physicians can choose from when transitioning a practice to concierge from traditional fee-for-service.

Full Conversion

One of the main goals in moving to a concierge-style practice is to reduce a practice’s patient panel size to just 300 or 400, rather than several thousand, which is now more typically the case.

Some doctors start with a full conversion of their practice whereby they terminate all patients who choose not to participate and pay the monthly retainer fee.

“It’s a high-risk, low-reward model,” says Matt Jacobson, founder and chief executive officer of  Signature MD, a national concierge medicine provider headquartered in Los
Angeles, California.

Benefits of this approach include reduced physician work hours and the ability to eliminate many of the administrative burdens that come with insurance contracts, but not much increase in income.

Immediate conversion to concierge medicine is also high risk. “What happens if you don’t get the 300 or 400 patients that you need? What if you only get 200?” Jacobson says. “You’re going bankrupt, or you’re working at the urgent care [center] or something else to supplement.”

Hybrid concierge model

In the hybrid concierge model, a physician delivers differing levels of care to two distinct patient groups–those who pay the concierge fee and those who don’t.

“If you pay me $2,000, you’ll have my cell phone number, and you’ll get to the front of the line at the office. If you don’t pay me $2,000 it’s business as usual,” Jacobson says.

Although doctors operating under this model can see a small increase in their income, they increase their clinical hours, Jacobson says.

In addition, there are ethical issues inherent in a two-tiered practice in which some patients pay for a higher level service than others. For example: does the physician spend 30 minutes with a healthy patient who has chosen the concierge model and only a fraction of that time with a patient facing myriad health issues who has chosen not to pay the annual fee?

Market segmentation

Jacobson describes a third model of concierge medicine–a market segmented approach–that he says was developed by SignatureMD. “It’s a high-reward, low-risk model,” he says.

Similar to other approaches, physicians seek to convert roughly 300 patients. The practice then brings on either a junior physician or nurse practitioner. Patients who participate in the concierge model will continue to see their doctor. Those not participating will see the new physician and/or nurse practitioner.

With this approach, Jacobson says, it’s feasible for physicians to more than double their income while reducing their workload by 25%.

According to Garrison Bliss, MD, president of Qliance Medical Group and founder of the second monthly fee practice in the United States, concierge medicine offers physicians many benefits. However, he cautions against a major trap of the model.

“In the concierge world, there’s this fear that if you didn’t do a bunch of exotic testing, and you didn’t have a cool new medicine that you knew about that other people didn’t know about, that it would be hard for people to believe they were getting better care from you,” Bliss says.

Direct primary care model

Bliss envisioned an alternate membership-based approach to routine and preventive care called direct primary care (DPC), which he started in 1997.

“I decided to come up with a healthcare model, rather than a business model. And then, to figure out what the business model would have to look at if we were a monthly fee practice,” Bliss says.

With DPC, the monthly fee for patients is lower than in concierge medicine–often ranging from $50 to $150. The size of the practice is generally larger as a result–600 to 800 patients as compared with 300 to 400 in concierge practices.

“We stopped being focused on the issue of getting paid and started being focused on the issue of what do we have to do for people,” Bliss says.

Markets for DPC

DPC is a small but growing movement, says Thomas Charland, chief executive officer of healthcare consultancy for Merchant Medicine, LLC. The two primary markets include individuals who have high-deductible health plans and see the value in paying a low monthly fee for increased access to primary care.

The biggest potential, Charland says, is among employers who have given up on a traditional approach to primary care. Many firms recognize that physicians with large panel sizes don’t have the time to spend with patients and must refer anyone with complications to specialists. That, in turn, is causing costs to skyrocket.

“If it takes off with employers it’s a game changer,” Charland says of DPC.

Building high-deductible insurance products that incorporate this model and that cover the services that direct pay practices don’t is an important step in moving this model forward. And it’s already happening.

“We’re involved in two instances of that in Washington State right now with, I think, more to come,” Bliss says.

Is Direct Pay right for your practice?

Experts offer these considerations when determining whether some form of direct pay model is right for your practice:

It must feel natural.

Physicians most likely to succeed using a direct-pay model are already operating as if they run one. “If you’re not already the guy who is taking the calls late at night, if you’re not the guy who is visiting your patients in the hospital…don’t do it because you will fail,” Jacobson says.

Carefully consider your monthly fee.

“I usually recommend that the doctor map out all of the fixed costs of his or her practice: facility rent and maintenance costs, utilities, equipment leases, staff salary, provider salary,” Bliss says.

Consider the size of your practice.

The next step is to consider how large a practice you want to operate. Once you’ve determined that, Bliss says, “divide the costs by the panel size and you have the annual fee you will have to get to make that work.”

Assess your patient pool.

Ask yourself how many of your patients will actually pay the fee. Jacobson’s firm employs a predictive model that relies on a range of information gleaned from a random sample of the patient population to determine the likelihood of success.

“If you don’t do that, you have absolutely no idea whether you’re going to succeed or not,” he says.

Connect with the community.

Charland says doctors should look for primary group companies operating in their area. In addition, they should become part of a community of practices and/or associations focusing on the type of model that they find most appealing.

Signature MD

Original Article

Two companies are battling in court over the Greater Boston market for premium health care services known as “concierge medicine,” a lucrative business that is growing nationally even as the broader industry comes under pressure to control costs. (more…)

NEW YORK (MainStreet) — When Doug Pitman, M.D., sold his private practice to a hospital group 16 years ago, he had to see more patients, which meant less time with them. Eventually, he moved on and became a concierge doctor.

“There is no substitute for time spent with patients,” Pitman says. But this time squeeze is all part of a larger trend.

“Hospitals continue to acquire primary care practices at an increasing rate,” says Chip Harvey, a sales and service consultantat Corporate Benefits Service, a third-party administrator of employer sponsored health benefit plans.

Acquiring practices increases the clout of hospital-owned physician practices “and their negotiating power withinsurance companies,” Harvey says. However, as a consequence, these primary care doctors “lose their independence because they are required to refer patients who need specialist treatment or diagnostic services … only to specialists and diagnostic centers that are also owned by the hospital,” he says.

That close tie appears to affect how much patients are billed.

Researchers at Stanford University examined about 2.1 million claims from non-elderly privately insured individuals from 2001 through 2007. They found that hospitals that owned physician practices had higher prices. The study was published in the journal Health Affairs.

The researchers note that “hospitals may still be sharing profits with physicians who opt to treat patients at more costly facilities or with more costly procedures than is medically appropriate.”

The study didn’t look at the effect of hospital-owned physician practices on patient health outcomes.

The researchers noted that Affordable Care Act creates incentives that will likely increase the number of medical practices legally tied to hospitals, whether by ownership or contract. The ACA “rewards doctors and hospitals that join together in an accountable care organization (ACO) by making them eligible for cash bonuses from Medicare,” the researchers wrote.

–Written by S.Z. Berg for MainStreet

Concierge medicine

Concierge medicine practices charge an annual fee that can range from $1,200 to $10,000, depending on the practice.

There are several models that physicians can choose from when transitioning a practice to concierge from traditional fee-for-service.

(more…)

CHIEF EXECUTIVE OFFICER / FOUNDER

Matthew Jacobson founded SignatureMD, Inc. in 2007. Prior to establishing SignatureMD, he spent fifteen years in operational management roles in public and private companies. Mr. Jacobson spent 2002-2006 at Zenith Insurance Company (NYSE: ZNT). As Senior Vice President of Medical Management at Zenith, he was responsible for turning around a $160M division with 200 employees, doing business in 40 jurisdictions. Mr. Jacobson holds an MBA from the Anderson School of Management at UCLA and an AB from Cornell University.

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Signos de la edad, ¿reveladores de la salud?

View full slideshow here

Independientemente de la edad, la apariencia de los signos de envejecimiento dicen mucho acerca de nuestra salud. Una buena y detenida “lectura” de los mismos, puede advertirnos y ayudar a diagnosticar enfermedades. Conoce lo que dicen los especialistas al respecto.

Original Article

Signature MD

Pros and Cons of Concierge Medicine

When Samir Qamar practiced concierge medicine at Pebble Beach Resorts in Monterey, Calif., the hotel’s “A-list clientele” paid $550 to see him and as much as $30,000 a month to keep him on retainer.

But last year, Dr. Qamar decided to abandon VIP medicine and pursue a no-frills version of his practice, charging just $59 for monthly membership to his MedLion clinics (16 locations in five states) and $10 a visit—and never billing insurance.

Dr. Qamar is part of a new and growing generation of concierge doctors who, in this era of health reform, see more opportunity in the middle class than they do in the jet set. The trend has bifurcated the retainer medicine industry: On one end, patients pay thousands of dollars a month for lavish celebrity-type treatment at traditional concierge practices. On the other, pared-down clinics charge roughly $50 to $100 a month for basic primary-care medicine, more accessible doctors, and yes, money savings for those looking to reduce their health spending.

Of the estimated 5,500 concierge practices nationwide, about two-thirds charge less than $135 a month on average, up from 49% three years ago, according to Concierge Medicine Today, a trade publication that also runs a research collective for the industry. Inexpensive practices are driving growth in concierge medicine, which is adding offices at a rate of about 25% a year, says the American Academy of Private Physicians.

(more…)

Pros and Cons of Concierge Medicine

When Samir Qamar practiced concierge medicine at Pebble Beach Resorts in Monterey, Calif., the hotel’s “A-list clientele” paid $550 to see him and as much as $30,000 a month to keep him on retainer.

But last year, Dr. Qamar decided to abandon VIP medicine and pursue a no-frills version of his practice, charging just $59 for monthly membership to his MedLion clinics (16 locations in five states) and $10 a visit—and never billing insurance.

Dr. Qamar is part of a new and growing generation of concierge doctors who, in this era of health reform, see more opportunity in the middle class than they do in the jet set. The trend has bifurcated the retainer medicine industry: On one end, patients pay thousands of dollars a month for lavish celebrity-type treatment at traditional concierge practices. On the other, pared-down clinics charge roughly $50 to $100 a month for basic primary-care medicine, more accessible doctors, and yes, money savings for those looking to reduce their health spending.

Of the estimated 5,500 concierge practices nationwide, about two-thirds charge less than $135 a month on average, up from 49% three years ago, according to Concierge Medicine Today, a trade publication that also runs a research collective for the industry. Inexpensive practices are driving growth in concierge medicine, which is adding offices at a rate of about 25% a year, says the American Academy of Private Physicians.

(more…)

It’s Time To Redefine Concierge Medicine

If you’re middle class and you think that your relationship with your family doctor is secure, think again.

Come January 1^st when the Affordable Care Act takes effect, your doctor may not be around, or even if he or she is, you may be seeing a nurse practitioner or physician assistant during your next visit.  The health care system is about to become a game of musical chairs, and when the music stops, there’s no guarantee you’ll have a seat.

Despite the partisan debate concerning the Affordable Care Act (a.k.a. Obamacare), both sides of the political spectrum endorse one aspect of it: Patients should no longer be denied coverage because of an existing medical condition. But the mechanism in the law that makes that possible – mandating that all 33 million previously uninsured Americans obtain health insurance – also will exacerbate the already dire doctor shortage in the U.S., which is projected to be 65,000 by the end of next year. To make matters worse, the doctor shortage is particularly acute among primary care physicians (internists, G.P.’s, family doctors, pediatricians).

(more…)

America, we must stop ObamaCare before it becomes hazardous to our health

New York’s famous 42nd Street will offer natives and visitors a new sight later this week: a mammoth, six-story billboard with a striking message: “Warning—Obamacare may be hazardous to your health.”

It’s part of The Heritage Foundation’s continuing public education campaign to inform the American people about the dangerous side-effects of this unfair, unaffordable and unworkable law, and how it can be stopped.

How will ObamaCare—a 2,700-page law passed by a single vote over bipartisan opposition— harm Americans’ health? 

Well, here are five of its worst side effects.

First, many Americans will lose their current health coverage. That’s what’s happening to Rod Coons and Florence Peace, a married couple in Indianapolis. Rod and Florence like their current plan. 

(more…)

Is There A Doctor In The House?

A family physicial shortage is bring major changes to the way medical care is dispensed. Here’s what you need to know to protect yourself:

Signature MD

Is Concierge Medicine The Correct Choice For You?

As the ObamaCare law is phased in, health policy experts predict a growing physician shortage. Although ObamaCare did not create this shortage, it will worsen the problem.

Many doctors are responding to the new law by retiring early or reducing their hours in what the American Medical Association describes as a “silent exodus.” The Wall Street Journal reports an expected shortfall of 60,000 physicians in 2015 and 90,000 by 2020 (roughly 10-15% of practicing physicians), even as millions of newly-insured patients enter the system. As a result, patients will endure longer waits for doctor appointments. Meanwhile because of declining reimbursements, primary care physicians be forced see as many patients as possible each day in hurried 10-15 minute appointments, simply to make ends meet.

In response to this frustrating situation, more doctors are seeking an alternative practice model. They are establishing “concierge” or “direct pay” practices, where patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Instead of the usual rushed 10-15 minute appointments, these doctors typically offer 45-60 minute visits allowing them to really delve into their patients’ problems and craft individualized treatment and prevention plans.

(more…)

February 18, 2013

New model for medicine Physician happy with concierge practice after four years

Dr. Doug Pitman takes calls from patients anytime and doesn’t mind consulting while on skis at Whitefish Mountain Resort. He even stops by their homes for consultations.

“I’m on call all the time,” he said. “When you know your patients as well as I know my group, you can really do a lot on the cellphone. But then again, I can see them instantly or later that day if I’m up skiing.”

After four years as a concierge physician at Whitefish Personalized Health Care, Pitman couldn’t be more enthusiastic about the risk he took after more than 30 years as a traditional family physician in Columbia Falls.

“In my mind, the concierge model is the biggest thing that’s happened to family doctors since we developed residency programs in the 1970s,” Pitman said.

Concierge doctors limit their patient base to provide personalized service and almost limitless availability to patients who pay an annual retainer.

Pitman works with a company called Signature MD to operate his practice and also now serves as the company’s acting medical director.

In that role, he serves as an information source to doctors considering concierge medicine and makes educational videos for patients and doctors for Signature MD’s

“They are the second biggest company that converts family practice and general internal medicine practices to the concierge model,” he said.

Pitman, 66, calls his concierge practice an anomaly because he works just 16 hours a week with a practice of about 100 patients. A full-time concierge physician typically maintains a patient base of 300 to 600 patients.

When he looked into the concierge model, Pitman wanted a way to continue practicing but on a smaller scale with a focus on wellness.

“I was burned out on traditional family practice as its evolved into running the numbers so you can keep your doors open,” he said. “Once I turned 62, I was free of debt and I could take a risk.”

He worked with Signature MD CEO Matt Jacobson to come up with what he calls a hybridized concierge practice where he could work part time with half-time malpractice insurance. Pitman said Signature MD’s research department performs thorough demographic studies of an area before working with a doctor to convert to the concierge model.

“Matt flew up and we did a week of basically recruiting patients,” he said.

The two came up with three different payment systems. His yearly retainer is $1,900 per patient with discounts for couples, half-time residents and a scholarship rate of $1,100.

His patients pay a retainer to Signature MD, which takes a percentage, then sends the rest to Pitman in quarterly payments. He maintains an office in the 1993 building in Whitefish but operates without employees or a billing service.

Pitman said the retainer pays for his availability and covers his overhead and salary.

“That frees me up to spend more time with patients and provide a much higher quality of care,” he said. “The last four years, I’ve gotten back to the basics of prevention and wellness.”

According to Pitman, his patients reap the benefit with his focus on their blood pressure, cholesterol levels and screenings by lowering their risk of heart disease, stroke and cancers of the breast, prostate and colon. He also makes certain they have their immunizations and see a dentist, dermatologist, ophthamologist and gynecologist, if appropriate, once a year.

“I don’t do any chronic pain management which is a big problem in family medicine,” he said. “There are chronic pain clinics. I don’t do any of that.”

His services include taking a medical history and a yearly executive physical examination. Pitman provides same-day appointments and said his contacts from 30 years practicing here get patients into specialists quickly.

If necessary, he makes house calls using his father’s old black bag from the 1950s.

“My dad was a doctor in New York on Long Island for about 35 years,” he said. “I think it was $3 for an office call, $5 for a house call and his records were all on 3X5 cards.”

Pitman’s annual executive physicals take two hours, include an hour follow-up visit and lab tests. He said Signature MD contracts with some state-of-the-art labs to assess cardiac and diabetes risk.

“The testing is sophisticated and it’s not unlike going to Mayo or Scripps and getting a very thorough examination each year,” Pitman said. “My patients look forward to it each year. They are very compliant, very interested in their own health. They have a lot to live for.”

Since becoming a concierge physician, Pitman said his biggest surprise was that patients want to talk and that getting to know patients pays off in better care. Sometimes the thing that concerns the patient the most comes out in the last 15 minutes of a two-hour exam.

“Nothing falls through the cracks because it is all about the time you spend with people,” he said. “The more time you spend with people, the more time you spend thinking about them and dictating a thoughtful physical.”

One patient, Benny Bee, the owner of six local radio stations, credits Pitman with saving his life. Bee became interested in the concierge system when he turned 65 and decided he needed regular “tune ups.”

He said he had known Pitman for years when he signed up as a concierge patient after reading his brochure. Bee liked the idea of not having to wait for two weeks to see a physician when he gets sick.

“Nowadays, it’s hard to get in to see a doctor if you’re in a hurry,” he said. “With concierge, I call to make an appointment and he says, ‘Just come on down’ or ‘I’m in your neighborhood so I’ll just stop by your house.'”

After signing up, Bee provided Pitman with the results of an executive physical he had received at the Mayo Clinic two years earlier. When he came in for the physical with Pitman, he said he was in the best shape of his life.

“I was down 20 pounds and had been exercising,” he said. “My blood work was great.”

Pitman recalled that he spent an hour going over Bee’s Mayo physical. It mentioned a test he should have had in the next three to six months but no one followed up to make sure he had it.

“I put him on my bicycle to do his wellness exam to write a prescription,” Pitman said.

He detected a problem and insisted that Bee go in for a treadmill test the next day for a heart evaluation. Three weeks later, he had triple bypass surgery to repair a main artery that was completely clogged and two others that were 70 percent clogged.

Now 68, Bee describes himself as 100 percent healthy. He remains completely sold on the personal relationship and quick access offered by concierge medicine.

He made a promotional video with Pitman and constantly recommends this model of medicine.

“If it wasn’t for me switching over to the concierge system, I probably wouldn’t be alive today,” Bee said. “Believe me it’s worth it. It pays.”

People interested in more information may visit the website

SignatureMD

Original Article

February 14, 2013

Boomers Vs. Their Parents: The Younger Generation Is Sicker

Obesity is the alpha and omega of modern societal health issues. So much that small children are getting adult onset diabetes and young teens and twenty-somethings are waddling past their grandparents who are trimmer and fitter, perhaps taking in 18 holes or playing tennis.

If you’re old enough to remember Sixties supergroup The Mamas and The Papas, then you probably recall their hit song “No One Getting Fat ‘cept Mama Cass.”

It was an autobiographical paean to the origins of the band, but it’s hook hanged on that fact that lead vocalist Mama Cass (Ellen Naomi Cohen) was quite unlike her slender musical peers, and weighed in at 300 pounds.

At the young age of 32, Cass died. Her official Cause of Death: Fatty Myocardial Degeneration due to obesity. Natural Causes, and not the often rumored ham sandwich she allegedly choked on.

Fast forward four decades, and a just released study shows that not only were those of The Mamas and The Papas generation less healthy than their parents but as it turns out, ended up looking much more like Mama Cass than they probably would ever imagined.

In short, the Baby Boom generation, the vain “me” generation who spawned fitness crazes like running, aerobics, mountain biking and mountain climbing, is turning out to be a health bust.

Despite vast amounts of money spent on their health care, the 78 million American born between 1946 and 1964 on almost every level are less health on average than their parents.

The study, published in JAMA Internal Medicine compared data on people aged 46 to 64 in two time periods – from 1988 to 1994 for the older generation, and from 2007 to 2010 for the baby boomers.

In terms of almost every common chronic disease, the younger generation had a higher incidence. Boomers had a higher percentage of people with high blood pressure, high cholesterol and diabetes than did their parents’ generation.
While 32 percent of their parents’ generation described their health as “excellent,” only about 13 percent of baby boomers did so.

The study also revealed that obesity was more common among baby boomers than their parents (39 percent versus 29 percent). In addition, 52 percent of boomers said they had no regular physical activity, while only 17 percent in their parents’ generation reported inactivity.

Boomers reported a higher degree of disability than their parents at the same age. But simply pointing out that obesity is the underlying cause of what ails the Me Generation is not enough.

January 10, 2012

Paying for an open medical door

Michael Campagna finally had enough of the jammed waiting room at the orthopedic surgeon’s office, the rapid-fire exams once he got in and the lack of results with his chronic ankle and knee problems. He’d gone 25 years without health insurance, got it shortly before a motorcycle accident, then wondered why he’d bothered.

“It was a nightmare,” he said of the three-month regimen of twice monthly visits in Alexandria, Virginia. So he entered a small but fast-growing segment of American health care, paying US$1500 a year to see a doctor who offers a “personalized” approach known as concierge medicine.

Now the waiting room he visits has two chairs, one for him and another empty. Instead of seven minutes with the doctor, he gets at least 30, plus email consultations day and night, an annual physical lasting 2.5 hours, appointments within 24 hours, follow-up when he’s referred to a specialist and an intense focus on preventive care. “It’s like old times,” says Campagna, in his mid-60s, “when the family knew the doctor and we had house calls. … This allows a doctor to be a good doctor. It unleashes the inner doctor.”

The personalized approach is variously known as direct care or retainer-based, membership or even cash-only medicine, and involves a “direct” financial relationship between a patient and a physician in the form of an annual or monthly fee. It’s typically charged for some manner of additional care in addition to the fees charged for the normal procedures that are provided. Some providers of concierge medicine do not accept insurance of any manner, whether private or from the government under the federal Medicare and Medicaid programs for the elderly and poor respectively. They’re cash-only (or cheque or credit card) but are still considered concierge if they charge a monthly or annual fee, instead of, or in addition to, the fees they charge for each medical procedure they perform. Most providers of concierge medicine, however, accept insurance. But the fee for retaining the concierge doctor comes out of the patient’s pocket.

For patients, the appeal is more ready access, while for physicians, the lure appears to be a lighter workload. A Congressional advisory committee found that the number of concierge physicians had risen fivefold between 2005 and 2010 to more than 750. Those doctors were serving 100 to 425 patients each, down from more than 2000 they saw while working in a traditional practice. Most were internal medicine specialists or family physicians

Many fear the growth of concierge medicine, should it continue apace, will exacerbate the growth of a two-tiered system under which attentive physicians delivering quality care are available primarily to the well-heeled. But proponents argue that it was ever thus and that concierge medicine is increasingly becoming more affordable to the middle class, even if it does constitute a substantial hit on their wallets.

Although annual fees are increasingly being charged by Canadian physicians, they are typically for services not covered by Medicare plans, such as providing proof of a visit to the doctor’s office or providing an expert opinion Some Canadian physicians now charge an annual administration (block) fee that covers immunizations, completion of medical forms, photocopying of files and returning calls.

The growth of concierge medicine in the United States has left the chairman of the MedPAC advisory committee, Glenn Hackbarth, fretting about the potential impact on access to primary care for the average American. Many doctors could bail from Medicare completely in favour of a concierge practice, he once told a public hearing . “There’s too much money to pass up,” he said. And the result could be a “dramatic erosion in access in a very short period of time” in traditional care, particularly Medicare. “So that’s my nightmare.”

Critics of concierge medicine say that it’s essentially a cash grab by physicians, who are being paid a hefty premium to do the job they are supposed to do anyway.

But advocates say that it’s not quite so cut and dried, particularly when it comes to physician workloads. As the population ages and President Barack Obama’s health care reforms expand access to care for millions more people, practitioners are racing to keep up and sometimes getting burned out. Exasperated by rising costs and complex regulations, physicians appear to be abandoning private practice in droves, with many opting to work for hospitals or large networks instead.

Among those left in traditional care, concierge medicine has become very tempting. “As the doctor shortage worsens, you see family docs step out and go into concierge medicine,” says Dr. Doug Pittman, a family and sports medicine practitioner in Whitefish, Montana, in the heart of ski country five hours south of Calgary, Alberta. “It’s the closest thing to a primary doctor strike. We are withdrawing because we can’t get paid for what we do, and our patients are going to outlive us because we are killing ourselves to try to keep up.”

Pittman switched to concierge medicine in 2009 after family practice left him stressed and bored. “All I was doing was putting out fires.” Instead of seeing 25 patients daily, he’s limited his practice to 100 patients overall. He charges each $1900 for a year’s services. Married couples get a discount ($3400), while snowbirds who are gone for the winter pay $1300 apiece or $2500 per couple. Pittman also throws in “scholarships” to cut the fee to $1100 for some older patients, teachers and folks who work on the mountain.

Instead of seeing patients for eight minutes, each now gets 80 minutes, he says. “You have control of everything. I answer the phone, take out the garbage. No matter where I am, they can get a hold of me.”

“It restores a physician’s independence, and you get paid an equitable wage for what you’re doing, preventing illness. It allowed me to pursue the type of medicine that I did the first 10 or so years.”

It also results in improved care, says Dr. Floyd Russak, an internal and geriatric physician in Denver, Colorado, who runs a personalized practice limited to 300 patients paying $1000 to $1500 annually. Russak had been seeing 30 to 40 patients a day and decided to “get off the hamster wheel” in 2010 because he felt he wasn’t “doing an exceptionally good job with any of them.”

His clients now get a half hour of his time during a routine visit and round-the-clock access. If they go to the hospital, so does Russak. “For patients that can afford it, it’s much better care,” he says.

There’s no question the care is improved, claims the California-based SignatureMD, a network of concierge practices involving 50 doctors in 14 states which was launched seven years ago. “The goal was to create a more direct relationship between patient and physician, a more direct financial relationship which facilitates better health care,” says CEO Matt Jacobson.

Is it elitist?

Not in Jacobson’s mind. “Should we send our kids to private school if that’s something we value?” he asks. “Some people put value on health care, and want to put investment in health care. We have a democratic society.”

For its part, the American Medical Association’s stance on concierge medicine is equivocal. On the one hand, it offers advice on establishing a concierge practice.  But its code of ethics suggests that the quality of care should not be dependent on a patient’s ability to pay extra fees .

“Physicians have a professional obligation to provide care to those in need, regardless of ability to pay, particularly to those in need of urgent care,” the code states. “Physicians who engage in retainer practices should seek specific opportunities to fulfill this obligation.”

Orignail Article

SignatureMD

December 21, 2012

Health Trend of 2013

Original Article

SignatureMD

October 16, 2012

How to Find a Concierge Doctor

Googling concierge doctor for your locality will yield a list of potential primary care physicians, but you might feel more comfortable checking with the consulting firms that provide management services to a large number of “private medicine” doctors. These firms would be happy to refer you to a physician in your area. Here are several:

MDVIP (mdvip.com), a subsidiary of Procter & Gamble, is the largest concierge consulting firm, with 550 physicians in 40 states and Washington, D.C. Doctors’ retainer fees range from $1,500 to $1,800. The MDVIP website lets you find doctors by location or name.

SignatureMD (signaturemd.com) has 40 to 50 doctors in 10 states. Fees run from $1,500 to $2,000. There is no search function, but if you click on “Contact,” then “Patients,” you’ll arrive at a form that will connect you with the company.

Concierge Choice Physicians (www.choice.md) handles doctors who have what’s known as hybrid practices, with some patients on the concierge track and others in the traditional practice. The company works with more than 200 physicians in 19 states, and retainer fees average $1,800 a year.

Specialdocs (special docs.com) works with 111 physicians in 21 states; their concierge feeswill set you back $1,500 to $3,000

Original Article

SignatureMD

September 27, 2012

7 Questions to Ask Your Doctor

During your next visit, don’t forget to ask these important Qs

Admit it: You probably don’t see your doctor as frequently as you should. When you do drop in for a check-up or a physical, you probably want to get that visit over with as soon as possible. It’s a common guy thing: More than twice as many men as women have not seen a physician in the last two to five years, notes Will Courtenay, Ph.D., a specialist in doctor/patient communication at Harvard Medical School and the author of Dying to Be Men (Routledge, 2011).

So the next time you do see your doctor (are you due for a visit?), use your visit wisely by asking the right questions.

Sure, you know the obvious things to ask, like “So, how am I doing?” (see the sidebar, “Four No-Brainer Questions”, below). But other important questions are less obvious. During your precious face-time with your MD, be sure to work in these seven queries.

1. “Have you noticed my blood pressure going up?”

If your B.P. is 300/90 mm/Hg, your doctor will (or should) say something. But if you’re still technically in the “normal” zone (below 139/89 mm/Hg), he may not think to check your history. If your B.P. has been steadily rising over the years, you may be headed for hypertension — a key risk factor for heart attack, stroke, and even dementia, says Joseph Raffaele, M.D., an age management medicine specialist at PhysioAge Medical Group in New York City. “As soon as I see any rise in blood pressure, I press the patient hard to get into a regular exercise program and drop some weight,” says Raffaele.

2. “How do my lungs sound?”

Unless you’re there for a chest cold, your doctor might not listen to your lungs with a stethoscope. But lung cancer — even among nonsmokers — is the number one cause of cancer death in men, and wheezing is one early symptom. It’s important for your doc to keep an eye (and an ear) on your lung health, and it’s especially critical if you’ve been a smoker. So make sure you’re upfront about your smoking history during your visit.
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September 24, 2012

Why You See Black and Are Dizzy After Standing

A cardiologist gives the reason why standing from a seated position can cause a faint feeling, dizziness or a sensation that everything is blacking out.

How concierge medicine is changing the face of healthcare. Dr. Floyd B. Russak makes the switch to Signature MD and his clients couldn’t be happier.

Signature MD

August 17, 2012

Quality, satisfaction ratings augment referrals

The decision on a health-care provider — be that a physician, chiropractor, or hospital — is a personal one that deserves thought and research.

While Fairview Heights resident Denis Wienhoff didn’t directly choose providers for his employees, he said he began using group health benefits provider ADP to both control costs and be sure his workers could keep their physicians. He owns Missouri Stencil Products in Park Hills, Mo., and labeling firms Chicago Coding Systems and Coding Solutions Inc. in St. Charles, Ill. “As a small business trying to do their own evaluation, we could switch plans every year based on price, but there would be no continuity,” Wienhoff said. “That’s not fair to the employees.”

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More about Signature MD

July 23, 2012

New Trend in Medical Care Comes to Sioux City

News, Weather and Sports for Sioux City, IA: KCAU-TV.com

Healthcare in America is changing, and so are doctors – in an effort to keep their businesses profitable and improve relationships with their patients.

Mark Carlson of Siouxland Adult Medicine is the first doctor in Iowa to convert his practice to the “personalized healthcare” model, also know as “concierge medicine.”

Is this the future of medicine?

After more than two decades as a primary care physician, Dr. Mark Carlson said he felt like he was being pulled farther and farther away from his patients.

“There’s nothing more special to me than the doctor/patient relationship that you build up over a number of years with people,” said Dr. Carlson.

So, three months ago, he made a drastic change: completely converting his practice to a model called “concierge medicine,” or “personalized healthcare.”

It’s like hiring your doctor as a private contractor: you pay them up front and the result is a medical experience tailored to your individual needs.

“What this personalized healthcare concept allows me to do is gives me the financial freedom to spend more time with people and provide more intense services,” explained Carlson.

Dr. Carlson says it’s an ideal arrangement for patients managing one or many diseases or conditions. He’s able to spend about a half hour with his patients at each appointment. Good news, for people like Susan Pinney, who has diabetes.

“I just feel like it’s really personalized care and that’s really important to me that I stay well and healthy, because I’m a mom, I have four children and I have a grandchild now, so it’s really important for me to stay as healthy as I can,” said Pinney, one of Dr. Carlson’s patients.

But the cost is different in this model, too. Patients pay $1,500 out of pocket annually.

Dr. Carlson says the purpose of that model is prevention: putting money up front – saves money that could be spent on trips to the hospital down the road.

“This is where you really save money – you effectively manage those high utilizing patients, effectively manage their medical problems, and keep them out of the hospital – out of the high cost centers,” he says.

So is it worth it? Susan says, for her, it is.

“I think prevention is where it’s at and if you have a good physician and a good working relationship, it’s just a model for success,” she said.

“This is a way for us to provide that high level of quality and patient access and time with the patient that they deserve,” commented Dr. Carlson.

All of Dr. Carlson’s practice is personalized healthcare now. Patients who didn’t choose the new model had help switching over to another doctor.

More about Signature MD

Original Article

Causes of Fluttering Heartbeat After Lying Down

So you get into bed and are ready for the night’s sleep, and only a few minutes later, your heart suddenly skips a beat or flutters. You’ve noticed that usually when you feel a skipped beat or fluttering–palpitations–it’s very soon after settling into bed for sleep. Why is this?

For this article I consulted with Robert M. Davidson, MD, a cardiologist with  SignatureMD, www.signaturemd.com.  I, a layperson, speculated that the cause of a fluttering or seemingly skipping heartbeat, soon after getting into bed, was anxiety and stress.

After all, the minute your head hits the pillow, you may become inundated with the stress of all the things you have to do the next day. Dr. Davidson says, “Yes, this is usually the cause. Also, it is easier to feel your heartbeat when lying down and it is quiet, especially if you are lying on your left side.”

Now that we know it’s usually stress and anxiety, fretting about the next day’s tasks, that causes palpitations or fluttering, just what is the mechanism behind this annoying phenomenon?
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