NPR: The controversy of concierge medicine

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Some states have been considering whether to regulate fee-for-service physicians who practice what is sometimes referred to as “concierge” medicine. Tamara Keith explores why the option has garnered controversy.

Steve Chiotakis: Imagine having unlimited access to your doctor. Some physicians do offer that, for a fee. But this “concierge” or “boutique” medicine is drawing some controversy. Maryland is the latest state to consider regulating fee-for-service medicine. Tamara Keith reports.

Tamara Keith: Doctor Alan Sheff was under a lot of stress. He had more than 3,000 patients, and was getting squeezed by declining insurance reimbursements.

Dr. Alan Sheff: I was going to leave medicine. Carpentry started to sound like a very good career option to me.

So he did something dramatic. He shut down his practice in Bethesda, Maryland, and re-opened it offering more personalized care — what many call concierge medicine. Sheff’s patients pay a $1,500 annual fee. They get a comprehensive annual physical for that. Other appointments are billed through insurance the usual way.

[Dr. Alan Sheff greets patient Marianne Bastnagel]

Marianne Bastnagel is getting her physical. She has a strong history of cancer in her family and says she wants a doctor who consistently monitors her health. Sheff says that since he now has 80 percent fewer patients, he can take more time with them.

Marianne Bastnagel: This is old-time medicine. This is a giant leap back in time to the way things used to be 15 or more years ago.

But the giant leap is generating lots of controversy. The Maryland Insurance Administration is now weighing whether concierge practices should be considered insurance, and subject to regulation. The debate has cracked open an even bigger issue: whether fee for service medicine is contributing to a shortage of primary care physicians.

Baltimore’s commissioner of health, Dr. Joshua Sharfstein, thinks it does. He says when a doctor converts to a concierge practice, a couple thousand patients are displaced.

Dr. Joshua Sharfstein: There are high rates of preventable hospitalization in the area and that’s sort of saying that already we have a relatively weak primary care system and if suddenly you have hundreds of patients needing to find primary care doctors, that’s going to make it even weaker.

That couldn’t be further from the truth, says Darin Englehart. He’s president of MDVIP. It’s helped set up a couple hundred concierge-style practices, including Dr. Sheff’s.

Darin Englehart: Intuitively, we believe that if you have great physicians and you give them more tools and more time to focus on prevention and early detection, you should be able to see reductions in hospitalizations. But it’s been very gratifying for us to be able to actually document that.

There’s no official count of how many practices have switched to the concierge model. But MDVIP claims 100,000 patients and growing.

In Bethesda, Maryland, I’m Tamara Keith for Marketplace.

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