Eutrusca
30-10-2005, 21:26
COMMENTARY: Healthcare in the US is often characterized by a wide variety of organizations, plans, etc., and many times by considerable expense. This new trend costs the patient a yearly "retainer," but offers much better care than many other options.
For a Retainer, Lavish Care by 'Boutique Doctors' (http://www.nytimes.com/2005/10/30/health/30patient.html?th&emc=th)
By ABIGAIL ZUGER
Published: October 30, 2005
BOCA RATON, Fla. - It was on the plane from Shanghai to Beijing last year that Dorothy Lipson of Delray Beach, Fla., suddenly began to cough up blood: first in streaks, then in frightening, tissue-soaking spoonfuls.
But Mrs. Lipson, who was in China visiting an expatriate daughter, was lucky on two counts. First, her daughter happens to run a corporation that builds gleaming Western-style hospitals in China; Ms. Lipson was rushed to the Beijing hospital on landing. And second, Mrs. Lipson's internist back home in Florida is Dr. Bernard Kaminetsky, one of a new breed of "concierge" or "boutique" doctors who, in exchange for a yearly cash retainer, lavish time, phone calls and attention on patients, using the latest in electronic communications to streamline their care.
Since its debut in 1996, concierge medicine has evoked criticism from many corners. Some ethicists say it is exacerbating the inequities in American health care. Insurance regulators have raised concerns about fraud. Government watchdogs, worried that it threatens the tenuous equilibrium of the health care system, are keeping an eye on trends.
"Concierge care is like a new country club for the rich," Representative Pete Stark, Democrat of California, said at a joint economic committee hearing in Congress last year. "The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today."
But for Mrs. Lipson, who pays $1,650 a year, the niceties enabled by concierge medicine can make all the difference.
Dr. Kaminetsky was in daily touch with her doctors in Beijing. E-mail messages, X-ray reports and digitalized images flew back and forth. When the bleeding was stabilized and Mrs. Lipson returned home, Dr. Kaminetsky immediately connected her with a local specialist for a biopsy of her diseased lungs, and then with infectious disease experts for treatment of the unusual infection that was found.
Mrs. Lipson's long convalescence was seamless, with none of the snags that can magnify the misery of serious illness: no long hours in strange waiting rooms, no lost X-ray or culture reports, no contradictory pronouncements by specialists confused by missing information. Dr. Kaminetsky's office coordinated all her appointments, tests and treatments. He personally telephoned her with all results and saw her as often as necessary to make sure everything went smoothly.
Now, still on medication over 18 months later, Mrs. Lipson applauds her foresight in signing up for this deluxe model of medical care. The yearly expense, she points out, is far smaller than more traditional luxuries like cruises or late-model cars. "I highly recommend it," she said. "It's well worth the money."
More Money, More Attention
Anyone searching the country for a group of patients who are perfectly happy with their medical care, neither brutalized by the system nor fearful that the onset of a serious illness will plunge them into a morass of confusion and neglect, need look no farther than Dr. Kaminetsky's waiting room here in Boca Raton.
Not that the waiting room usually has anyone in it. One promise made to patients paying for concierge service is that waiting will not be a part of their health care experience. Patients are guaranteed that phone calls will be returned promptly, appointments will be scheduled on a same-day basis if necessary, and appointment times will be honored. A bowl of fruit salad and platters of bagels and sponge cake set out for patients in the waiting room can go barely touched over the course of a day, and the television often plays to an empty couch.
A relatively simple tradeoff is responsible: the extra fees collected from patients let concierge doctors, who leave regular practice for concierge medicine, slash their caseloads. Before Dr. Kaminetsky became a concierge doctor five years ago he had 2,500 patients in his practice - a standard number for most primary care internists. His list now numbers 600.
Sick and well alike, patients are delighted with the results.
Joan Holzman, 69, takes no medicines and has no health problems; she comes to the office once a year for a physical exam, an X-ray, an electrocardiogram and blood tests. "I adore it," Ms. Holzman said. "Before, wherever you went you felt like cattle. But everyone here is top-notch - the doctors, the secretaries, the nurses. They're warm, like family. It's a wonderful feeling of security."
[ This article is three pages long. To read the rest of the article, go here (http://www.nytimes.com/2005/10/30/health/30patient.html?pagewanted=2&th&emc=th). ]
For a Retainer, Lavish Care by 'Boutique Doctors' (http://www.nytimes.com/2005/10/30/health/30patient.html?th&emc=th)
By ABIGAIL ZUGER
Published: October 30, 2005
BOCA RATON, Fla. - It was on the plane from Shanghai to Beijing last year that Dorothy Lipson of Delray Beach, Fla., suddenly began to cough up blood: first in streaks, then in frightening, tissue-soaking spoonfuls.
But Mrs. Lipson, who was in China visiting an expatriate daughter, was lucky on two counts. First, her daughter happens to run a corporation that builds gleaming Western-style hospitals in China; Ms. Lipson was rushed to the Beijing hospital on landing. And second, Mrs. Lipson's internist back home in Florida is Dr. Bernard Kaminetsky, one of a new breed of "concierge" or "boutique" doctors who, in exchange for a yearly cash retainer, lavish time, phone calls and attention on patients, using the latest in electronic communications to streamline their care.
Since its debut in 1996, concierge medicine has evoked criticism from many corners. Some ethicists say it is exacerbating the inequities in American health care. Insurance regulators have raised concerns about fraud. Government watchdogs, worried that it threatens the tenuous equilibrium of the health care system, are keeping an eye on trends.
"Concierge care is like a new country club for the rich," Representative Pete Stark, Democrat of California, said at a joint economic committee hearing in Congress last year. "The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today."
But for Mrs. Lipson, who pays $1,650 a year, the niceties enabled by concierge medicine can make all the difference.
Dr. Kaminetsky was in daily touch with her doctors in Beijing. E-mail messages, X-ray reports and digitalized images flew back and forth. When the bleeding was stabilized and Mrs. Lipson returned home, Dr. Kaminetsky immediately connected her with a local specialist for a biopsy of her diseased lungs, and then with infectious disease experts for treatment of the unusual infection that was found.
Mrs. Lipson's long convalescence was seamless, with none of the snags that can magnify the misery of serious illness: no long hours in strange waiting rooms, no lost X-ray or culture reports, no contradictory pronouncements by specialists confused by missing information. Dr. Kaminetsky's office coordinated all her appointments, tests and treatments. He personally telephoned her with all results and saw her as often as necessary to make sure everything went smoothly.
Now, still on medication over 18 months later, Mrs. Lipson applauds her foresight in signing up for this deluxe model of medical care. The yearly expense, she points out, is far smaller than more traditional luxuries like cruises or late-model cars. "I highly recommend it," she said. "It's well worth the money."
More Money, More Attention
Anyone searching the country for a group of patients who are perfectly happy with their medical care, neither brutalized by the system nor fearful that the onset of a serious illness will plunge them into a morass of confusion and neglect, need look no farther than Dr. Kaminetsky's waiting room here in Boca Raton.
Not that the waiting room usually has anyone in it. One promise made to patients paying for concierge service is that waiting will not be a part of their health care experience. Patients are guaranteed that phone calls will be returned promptly, appointments will be scheduled on a same-day basis if necessary, and appointment times will be honored. A bowl of fruit salad and platters of bagels and sponge cake set out for patients in the waiting room can go barely touched over the course of a day, and the television often plays to an empty couch.
A relatively simple tradeoff is responsible: the extra fees collected from patients let concierge doctors, who leave regular practice for concierge medicine, slash their caseloads. Before Dr. Kaminetsky became a concierge doctor five years ago he had 2,500 patients in his practice - a standard number for most primary care internists. His list now numbers 600.
Sick and well alike, patients are delighted with the results.
Joan Holzman, 69, takes no medicines and has no health problems; she comes to the office once a year for a physical exam, an X-ray, an electrocardiogram and blood tests. "I adore it," Ms. Holzman said. "Before, wherever you went you felt like cattle. But everyone here is top-notch - the doctors, the secretaries, the nurses. They're warm, like family. It's a wonderful feeling of security."
[ This article is three pages long. To read the rest of the article, go here (http://www.nytimes.com/2005/10/30/health/30patient.html?pagewanted=2&th&emc=th). ]