27. March 2008 by Jon Moss.

Washington Post
March 18, 2008

Between now and next month, Lou Bruhn, 65, of Fairfax County will have to make an important decision about his medical care: Should he pay $1,500 a year to stick with his primary care physician of three years — a doctor who he says has given him excellent care? Or should he resign himself to finding another doctor?

Some 5,000 Northern Virginia residents are mulling the same question after learning that their Franconia family practitioners, Brett Wohler and Andrew Wise, are switching to what’s sometimes called boutique, or concierge, care. On April 15, the pair will join a national doctors’ network and will charge each patient an annual retainer of $1,500. In return, the physicians say they will offer more attention, including round-the-clock cellphone access, same-day appointments and time to accompany their patients to specialists.

The move follows a nationwide trend that began nearly 12 years ago as a reaction to what some doctors see as the excesses of managed care. More than 1,000 doctors have switched to this mode of practice, according to the Society for Innovative Medical Practice Design, a trade group in Richmond.

Under concierge plans, doctors typically reduce the size of their practice so they can stretch patient visits to 30 minutes, compared with the seven to 16 minutes that various studies have found to be average under managed care. In addition to their annual retainers, doctors collect the usual fees for service or reimbursements from patients’ health insurance plans. The doctors also accept Medicare patients.

Proponents say concierge care lets doctors give patients the time and services they deserve, and allows them to focus more on preventive care. But critics say the development exacerbates inequities in the American health-care system by limiting access and increasing the workload of doctors who don’t join such networks.

Several years ago, only a handful of Washington area doctors listed themselves as members of MDVIP, the nation’s largest retainer health-care company and the one Wohler and Wise are joining. By June 1, the area will have nearly two dozen MDVIP doctors, according to company officials, with 15 in Northern Virginia, six in Maryland and one in the District.

“It’s not really about the money; I can afford it,” said Bruhn, a retired engineer and a patient of Wise’s. “I guess I’m still curious to see if it works as well as the doctors seem to believe, and if that would be worth the price for me.”

But some other patients are less sanguine.

To convert to the new plan, Wohler and Wise plan to drop about 4,000 of their 5,000 patients. Remaining patients, up to 1,000, will be selected on a first-come, first-served basis, they say, leaving the rest to find a new physician they can trust.

Lisa Zuber, 51, of Springfield, is one of them. A patient of Wohler’s since 2004, she said that she initially considered following him into his new plan. But the more she learned about concierge care, the more it made her uncomfortable.

“I guess what bugs me so much is that even if everyone wanted to join, they couldn’t,” said Zuber, an administrator for a national professional association. “It sets up this situation where people are competing against each other to get health care. I just didn’t want to be a part of that.”

Wohler voiced regret about the situation. “There are patients that I’ve seen for years that probably will not continue, and that’s hard,” he said in an interview last week. “Part of me asked myself, ‘Is this right?’ But I firmly believe I’ll be getting back to doing the things that I set out to do when I first became a doctor.”

MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don’t stop seeing them until they do.

Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. “I’m absolutely going to join,” said Arthur Smith of Fairfax County. “There doesn’t seem to be any drawback.”

Others were more cautious.

“It makes you wonder where we’re going as a health-care system,” said a patient of Wise’s, who identified himself only as Ray and declined to give his last name. “I understand where these doctors are coming from — all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you’re really not doing your job.”

Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.

In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, “they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.

A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.

“This really isn’t a solution to the chief problem in our health-care system, which is maldistribution,” said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn’t involved in the survey. “By giving more people an opportunity to opt out, they’re not addressing the problem of access to health care.”

Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.

“Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy,” said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. “But it’s unclear to me how viable the market is right now.”

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13. March 2008 by Jon Moss.

Two new benefits - dental implants and oral cancer screening - are now being offered in many UnitedHealthcare Dental^® plans. These added benefits increase the value of our dental plans for your clients and their employees

Dental Implants:   Beginning April 2008, dental implants will be covered in many UnitedHealthcare Dental plans. Implants provide artificial teeth that look and feel natural. Implants are a surgical procedure requiring patients to be in good health, have healthy gums, and have adequate bone to support the implant. With a commitment to meticulous oral hygiene and regular dental visits, dental implants can last a lifetime.

Oral Cancer Screening:   United Healthcare is also enhancing many of their dental plans to cover new non-invasive technology used to screen patients for oral cancer.

This puts UnitedHealthcare Specialty Benefits on the leading edge of the “Wellness” trend, focusing on research-based programs and enhancements that show a connection to improved health outcomes. Experts agree that every adult should have an oral cancer exam at least once a year. 

This new technology improves the dentist’s ability to identify, evaluate and monitor lesions that are difficult to see under conventional lighting. This quick and entirely pain-free exam makes dentists the first line of defense in fighting this deadly disease

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12. March 2008 by Jon Moss.

In late 2006, the AARP completed a survey in which it was reported that nearly 60% of older Americans (age 45 and older) underestimate the cost of long-term care, overestimate the long-term care costs that Medicare and Medicaid will pay and misunderstood the specifics and scope of the services they will receive as part of a public program.

 The AARP results are troubling to many community and insurance industry leaders.  If people mistakenly believe that public programs will step in and cover long-term care, they won’t make arrangements for private care–and they may end up with no long-term care at all.

In a recent blog post, Rep Dan L. Burton, R-Indiana, called the AARP report findings “shocking,” and he encouraged future legislative change to help educate the public about long-term care policies and coverage options.

“With only 10% of seniors currently covered under private long-term care insurance policices to help cover long-term costs, the average cost of a private room in a nursing home running about $75,000 a year, and our nation’s baby boom generation beginning to retire, we are literally facing a huge health care train wreck,” Burton warns.

According to the U.S. Department of Health and Humana Services, the number of recipients age 65 or older in need of long-term care may increase to 12 million by the year 2020.

Posted in Medicare, long-term care | 1 Comment »

10. March 2008 by Jon Moss.

New York Attorney General Andrew Cuomo’s office has issued subpoenas to eight health insurance company CEO’s, including UnitedHealth Group Inc. Stephen Hemsley, according to media reports.

The measure is an expansion of Como’s investigation into reimbursement practices of health insurers.

We previously blogged that New York’s attorney general planned to sue Minnetonka-based UnitedHealth Group (NYSE: UNH) and its subsidiary Ingenix, calling the insurer part of an industrywide effort to defraud consumers by manipulating reimbursement rates.

In February, Cuomo’s office issued 16 subpoenas to health insurance companies including Aetna, Cigna and Empire BlueCross BlueShield as part of a six-month investigation into how the insurance industry handles reimbursements for physicians who are outside of a health plan’s network.

A spokesman for Cuomo’s office told Bloomberg News that it has issued another 20 subpoenas that included demands for depositions of the CEOs, including those at Cigna Corp, Aetna, and WellPoint Inc., the news service reported.

A spokesman for UnitedHealth told Bloomberg, “We’ve been in ongoing discussions with the attorney general and we are continuing to cooperate fully.” UnitedHealth has refused to specifically confirm or deny the subpoenas.

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10. March 2008 by Jon Moss.

The State of Georgia has passed a bill to encourage insurance companies to offer cheap, affordable, and limited health insurance plans. The bill passed by Georgia’s Senate will give insurance companies an opportunity offer health insurance to Georgians who are unable to afford a comprehensive plan. The republican proposal passed 42-12 in the House. Now, individuals searching for affordable Georgia health insurance can pick a plan based on what they can afford. Although the coverage will be limited, the limited coverage is still better than no coverage at all. 

Democrats who apposed the plan are worried that individuals who obtain the limited plans will not truly understand the coverage of the plan and will only make their decision to purchase based solely on price. Democrats predict that the future of this plan is flawed because its popularity may grow tremendously in the future but coverage will not be sufficient for most.

Posted in health insurance reform, individual, medical | No Comments »

7. March 2008 by Jon Moss.

A growing number of business groups have embraced the idea of requiring individuals to purchase health insurance. Supporters of an individual mandate, including Democratic presidential candidate Hillary Clinton, contend it is necessary to achieve universal health care and spread the burden of health care costs more fairly.

Clinton’s rival, Barack Obama, says it is unfair to force people to buy insurance they can’t afford and argues that most people would buy insurance if the cost is reduced. In recent weeks, the National Small Business Association, the National Business Group on Health — representing large employers — and the National Retail Federation have endorsed an individual mandate. The National Federation of Independent Business has not taken a position. The NFIB helped kill Clinton’s 1993 health care plan because it required all employers to provide insurance.

The U.S. Chamber of Commerce opposes an individual mandate, as well as an employer mandate. Both Clinton and Obama would require employers to provide health insurance or contribute to their coverage by paying money to the federal government. Both would exempt small businesses from this mandate, but they haven’t specified what the size threshold for that exemption would be. They also would provide subsidies or tax breaks to low- and moderate-income individuals to help them buy insurance. Likely Republican nominee John McCain opposes mandates. His health care plan focuses on reducing health care costs

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