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I recently left Los Angeles to help my 87 -year -old mother through the discharge of a specialized nursing facility. During my stay I helped her to establish -at home, organized home health care and sailed for the many complexities that launched Medicare.
As a professional in the healthcare industry that deals with insurance and refund problems, I had a special interest in this last task.
One of the first articles on our task list was to organize an appointment with my mother’s primary care doctor. I called in practice to establish a visit and made me fall when the woman asked, “What about this afternoon?” Used to the long waiting time at home, I was surprised that I had such an immediate and friendly response.
In his appointment, I was impressed by his doctor’s knowledge of my mother’s situation. He had been actively coordinating his care with the hospital and nursing facilities, and he knew perfectly well the lettuce of medicines he had been taking.
By the way, these are the responsibilities of any primary care physician in this situation, but it clearly had a level of familiarity and approach that surprised me. Our appointment lasted more than an hour, with the doctor who patiently answered each of our questions and worries, without having to go forward to see another patient.
In the coming weeks, she contacted my mother and was almost immediately available at any time that she had worries or needed to see.
This was not the experience I had accustomed to Massachusetts, where the appointments are sometimes scheduled months in advance, and doctors seem to be constantly playing up to date. Was it just an exceptional doctor?
After a small excavation, I discovered his secret. Did not accept Medicare.
My mother’s doctor had retired years ago and her replacement was a common path in Los Angeles, but she spread elsewhere. It is known as concierge medicine and consists of a side step of the insurance model and connecting the doctor and patient into a simple cash -based agreement.
The advantages for my mother were evident, but I considered the advantages for the doctor. He was able to collect a premium and receive well above what Medicare pays. As a result, it has fewer patients, it can provide more personalized attention and probably have a greater satisfaction to develop closer relationships with their patients.
In addition, he and his office prevent the burden of approvals, authorizations, claims, denials and appeals that reduce the healthcare system in bureaucracy.
Concierge medicine is expensive. My mother pays $ 10,000 a year, as well as her visit rates. But this model also forces doctors to do something that are not with Medicare: to compete. The scarcity of primary care physicians means that an unsatisfied medicare patient can be easily replaced.
My mother’s doctor, on the other hand, has to be continuously struggling to keep it satisfied, as the number of patients willing and capable of accepting this agreement is limited.
This is perhaps the inevitable result of increasing dissatisfaction with the current health insurance model. Doctors and patients seem to say, “This model does not work for us, so we only leave it and we do it ourselves!”
The lack of this model can be evident. Leave those who cannot pay these abrupt rates. However, the trend is growing rapidly. According to Grand View Research, the concierge medicine market is worth more than $ 7 billion and is expected to grow to more than $ 13 billion by 2030. A web search of these practices reveals various in Massachusetts, including one in Massachusetts General that requires the same annual $ 10,000 a year as my mother charges.
This trend aims to a fork on the health insurance market where HAVES will experience high quality personalized attention through the concierge model and those with notes will have to settle for Medicare.
Could there be something we can learn from this model that we can apply to Medicare before that happens?
Doug Rosien, from Hampden, has a 30 -year career in healthcare finance and is the director of care managed in Baystate Health at Springfield.