MDVIP: The New Way For The Rich To Get The Best Medical Care

Who thinks it's a good idea? People who are money motivated. Who thinks it's a bad idea? The rest of us. What a total crock.

I take it you're in the market for a new PCP? I certainly would be.

The root of the problem is that there is not enough time to give each patient a proper exam and appropriate time to talk to the patient. As it is, one is herded thru the front office system, gets maybe 10 or 20 minutes with the doc, is maybe handed off to a lab or eray dept. but more often just given a prescription and a followup date -- and that is that.
How does one get any good advice on lifestyle changes to prevent the problem from escalating into a lifetime, chronic disease?
Yes, I had heard about this gold-plate medical care before -- not sure where, NPR? Some TV newsmagazine? Anyway, there are many MDs who are fed up with the way things are -- the wars with insurance payors, the lack of impact on individual patients, the mill that modern medicine has become. Some have become so disenchanted that they are leaving the profession altogether.
It is a disaster when highly-trained professionals walk away. It is a disaster when patients cannot get anything that deserves to be called medical 'care'.
The system is breaking down, bad. Going to a universal plan is not going to help the issues raised here.

I do not see a viable alternative to a single-payer health care plan. But I do NOT see it as any panacea. There will still be problems with waits, with the Big Pharma pushing drugs onto everybody, with Big Pharma dictating high prices, with the AMA trying to suppress natural health alternatives and with our food being poisoned by agribusiness and the food manufacturers.
Plus we have a healthcare industry that has learned how to game the (pricing) system when billing for services.
Sorry if I sound like a pessimist but I am.
PS - wrote a story today on the FDA permitting the food industry to put alloxan into the white bread -- alloxan has been shown to cause diabetes and metabolic syndrome by shutting down pancreatic function. How does a person stay healthy when even the food on the grocery shelves is destructive of health?

There should be a Federal law which would deny Medicare compensation to any doctor or medical practice that requires as a condition of being included in such doctor's practice the payment of an upfront fee either to the doctor or to his medical group or to any third party. Doctors who try to establish such a country club style of operation are greedy to the nth degree and totally discredit the medical profession which has historically been devoted to promoting the health of its patients, not the wealth of its doctors.

Well, lets just get as many good years out of our primary care physicians as we can and then when they burn out from the stress of caring for 3000 patients and dealing with a broken medical care system we'll just get a new batch of physicians. A recent article in our local newspaper mentioned an increase in the size of medical school classes to become effective within the next year. Thats a great idea since no one in their right mind is going into primary practice anymore. You cant convince 10% of your medical school class to go into internal medicine. We are going to have a big problem on our hands and its just beginning now.

" They're basically offering to do their job well for a bribe, IMO and I think that's BS."

Let me ask you this... do you think that private schools are schools doing their job well for a bribe?

This seems to me to be essentially the same thing as a private school. You pay the money and get much more detailed and individualized care.

Rather than 6-8 minute visits with the Dr you get 30-60 minute visits, if you need them. You get virtually 24/7 access to the Dr. Have a sudden pain in your side, or experiencing a sudden numbness in your leg? You could scour the internet for an hour or more trying to figure out whats wrong with you, or you can page your Dr who can tell you if he or she thinks that you need to visit them immediately or not. That's a lot of piece of mind, especially for those approaching middle age and older.

My Dr is joining MDVIP, and I just started seeing this Dr a few months ago for the first time. $1500 is a lot of money for me, even if I can use my FSA or HSA account to pay for it over 12 months, pre-tax. However, I am giving this serious consideration because I see the value in it.

Alex:

I disagree with you basics premise at least in the State of Florida. My wife and relocated down here about 6 years ago. We could not find a Doctor. The system down here for the most part is that many Doctors get together start a Hugh practice and we never got to see the same Doctor Twice. If that is not bad enough one could wait many months to see a specialist.

So, we gladly pay the $3,000.00 per year, not to get premium care, but just to get the level of care that was provided 30 years ago

I always worry that people will think that I am whining when I talk about what medicine has become. It is just that most of us in primary care soon learn that the ideal of being someone's "doctor" we were sold during our years of training is entirely different from what we now find ourselves doing. I spend my days trying to see enough patients to pay the 5 1/2 office employees now required per physician to handle all of the insurance and documentation hassles. I have to call and ask an HMO pharmacist to allow a patient to receive a medication I believe they need. I have to call the patient's insurance company and ask a nurse for permission to admit a sick patient to the hospital. It goes on and on and on. I wanted to practice medicine and help people, not figure out how many patients I have to see just to make it all work out.

I have been at it 6 years now and am nearing burn-out. I am always sleep deprived and tired. I am about to leave the hospital because I can't afford to go there anymore to see my sick inpatients. I will be an outpatient only doc just because I can't see enough patients to make the numbers work out otherwise. Almost every patient comes in to an appointment with an insurance form to complete, 10 medical problems to address, labs to review, and, "oh, by the way, I need my 20 medications refilled with handwritten scripts so that I can mail them off and save some money, and can you fill out this handicapped parking form while you are at it?" I do all this in 10-15 minutes and pray that I haven't missed something. Not sure how long I can keep it up. On top of this, it looks like there is a 10% medicare rate cut coming in July - that should really help things around the office!

Anyway, I found this site researching an invitation I received in the mail from MDVIP. I had never heard of them before today, but who knows, maybe I will call them......Not what I saw myself doing 10 years ago in medical school, but neither is what I am doing now.

From my limited research, most "concierge" physicians can only find 200-400 patients and it takes a few years to get there. Most lose significant money the first 1-2 years. Maybe with VIPMD helping, one could build to 600 patients, but I bet that the VIP corporation gets a significant cut for managing the practice and helping recruit and retain patients. If I truly thought I could earn $900k, I'd be a fool not to jump at it.

In response to your question, each full time employee costs about $40-50K in total. The typical overhead cost for a primary care office is 60-65% of receipts which includes rent/mortgage, property taxes, payroll and payroll taxes, liability and profession insurance, the light bill, the guy that takes out the trash and mows the grass, etc. Uncle Sam then takes his 40% of what is left and then I get paid (hopefully). Everybody gets their piece before the doctor and they won't accept the 90 day terms that the insurers force us to take.

The typical reimbursement (not what is billed, but what is actually paid) for a physician visit is between $40-80. I suspect that the VIP visits would be billed at a higher rate due to the time spent, so estimate $80 per contact, about 10 patients/day x 5 days per week x 47 weeks/year = $188,000 year. This won't even cover your employees' salaries or the basic practice expenses. I pay $20k per year just for malpractice insurance to give you an idea of my usual expenses.

Figure out how to see more patients, drop out of medicare, add ancillaries (x-rays, etc.) - thats about it unless there is a major change in the "system".

I was a conservative long before I was a physician. I believe in less government rather than more. I do not favor socialized medicine, I favor a free market approach with personal responsibility and something akin to health saving accounts that will hopefully encourage people to make wiser choices with their health care dollars and their health in general. Currently, medicare sets the fee schedule and the other insurers follow - not a free market system by any definition. There is a disconnect between the customer (the patient) and the provider of the service (the physician). The insurers are the true customers and the patients are the pawns.

The health care funding crisis will require some severely painful choices to fix that will include some difficult ethical and moral dilemmas. As an example, if someone refuses to wear a seat belt while driving or a helmet while riding a motorcycle and invariably wrecks, the public picks up the $200K tab for their neurosurgery and hospitalization and then continue to fund the lifelong ongoing cost for their care and rehabilitation that all could have been prevented by common sense. Why should you and I pay as much as a million dollars because someone decided they wanted to "be free" while they ride? As a society, I don't know how long we can afford to pay for the bad choices that people make. I don't know how long we can afford to keep over 10000 near vegetative people with no hope of recovery on long term ventilators in special vent hospitals each year at a cost of $100k each or how long we can afford to save each 24 week premature baby at a cost of around $1MM. It costs around $50 to 100K taxpayer dollars to keep your grandma in the nursing home for a year, depending on how much care and medications she requires. I don't want to be the one who makes any of these decisions, that is for certain. The problem with medicine today is that there are many things we can do, but not that many that we can really afford to do. As health care consumers, we all want the latest Cadillac at the used Huydai price.

Anyway, back to the question, none of the candidates, including Mr. McCain, are conservative enough in my view, but then I think Rush is a bit liberal at times....

My internist is going MDVIP. I have paid for 30 years the highest level of health insurance provided by my employers so I could continue seeing him. I think the rate for my annual physical probably is around the $1500 annual fee (1/2 hour MD time, X-ray, EKG, spirometer, blood draws and tests, fecal smear). I am more concerned about whether he is under any obligation to work only with MDVIP specialists who may not be affiliated with my PPO (so far colonoscopy, sleep clinic, dermatologist, CAT scan, surgeon, infectious disease doc) and whether his partners will still be available to see me (he has never been in town for any of my medical emergencies, Murphy's law). I am also concerned about my medical records -- what if I don't want MDVIP to have them, and am willing to give up the website, e-mail and CD. If I do let them have my medical records, can I ever regain control of them? The HIPAA form was not a big deal when the records stayed in my doctor's office, but the harm that can come with them being available in electronic form perhaps not even owned by me is really scary. I don't (knock on wood) need much in additional services (paper prescriptions every year, yes, but not even flu shot), and the best health promotion would require that he get me back to the dietician (which he was able to do when affiliated with a university clinic) and be my workout partner, which I don't really expect. He'll probably be retiring in 10 years, what should I do?

My Doctor just switched to this program. I think it is completely unethical and goes totally against the Hippocratic oath. Just another way middle class people get screwed by the Medical Profession. It is a shame and a sham!!! $900,000 up front for doing nothing!! I would love to hear from some doctors and get their opinion. Fat chance!!

Just got back from the sales pitch and was curious about how the $900k annual fee was split between MDVIP and my doc who has just made the switch. Was informed that $1000 goes to the doctor and $500 to MDVIP. Not sure how my family benefits from handing over $1000 per year to MDVIP who does not seem to provide anything much beyond marketing for the doctors. Certainly little if any of the $1000 goes toward direct patient care. Was informed that program has about 250 providers and 77,000 patients nationwide so ad MD in Tennessee noted, average practice size is well below the 600 per doctor. But to hear the presentation, one would think they have to sign up immediately to avoid missing out and winding up on a waiting list. The national operation has been in business for about 8 years and individual practices appear to be growing slowly. Renewal satisfaction is quoted at 90%.

The MDVIP salespeople ran the show tonight with the doctor trying to field a few questions after reading a scripted presentation. I fully respect her decision to make the move, but let's call it what it is...a better economic model for the doctor and a hefty franchise fee to MDVIP, but not the right choice for us.

Watch out for some of the sales pitch stats. MDVIP is proud of the fact that it's patients are "up to 65% less likely to have a hospital stay". The implication is that this is due to the excellent care provided by MDVIP doctors. My suspicion is that their current cohort of 77,000 patients would be less likely to experience a hospital stay regardless of their MDVIP affiliation. More than likely, the hospitalization frequency is more highly attributable to factors other than MDVIP service.

Although there was a lot of rhetoric about the higher quality of care being provided for the $1500 per person per year, the contract states that for this fee, only two services are covered:

1. An annual preventive care physical exam including comprehensive wellness planning based on the examination; and
2. Personal health records via CD-ROM and patient website.

For those patients willing to part with their cash, that might seem to be a worthwhile economic exchange, but based on my limited exposure to the program I would encourage potential clients to approach this arrangement with caution.

After reading many of your comments Scott, I have decided you are just "sour grapes" and very uninformed. This MDVIP thing is a choice, first of all and secondly I believe anyone can afford it. It is all about priority. People smoke, drink, buy expensive coffee, eat fast food...just some things that are not so good for your health and cost more per day that joining your doctor that you trust and believe in! I can not understand why people that do not want to do this continue to whine on and on ...just go get another doctor....you obviously do not think much of the one you have or your well being or you would see the value. You can not tell me you do not spend at least 4 dollars perday on something NOT good for your health? I pay a little extra to have my hair done by someone that does a good job and I trust so why not pay extra for a doctor I feel the same way about? Maybe you can associate this with your mechanic or whatever. Again, if its not for you ....move on...you nor Obama or going to be abkle to solve adll the world problems here!

There is MUCH more than 24/7 care involved. You may need to do your homework and look at the physical that you will be receiving annually. This done elsewhere costs 2-3 thousand dollars and can save your life. It takes about 2 hours compared to the 15 minute one the insurance company pays for and most doctors give. You also have longer appt times and a CD with all your medical information on it. These are other worthy things, in MY opinion, but I joined to keep a doctor that is above and beyond and has the potential do keep me well rather than wait till I have something and try and keep me alive.
Again I am sure besides your truck and house (and by the way you must have a good deal on both to pay only $1500 for all that) I am sure you must spend 4 dollars a day on something. I choose to spend it on my health! I suggest going to MDVIP website and really see what it is all about OR find another doctor and hope you can stay well.

Here is a follow-up. I had thought I was invited to go to an informational dinner to learn about VIPMD. The offered a steak dinner and $300 for my time. It seemed I had nothing to lose and a full belly and $300 to gain. Actually, the "invite" was an opportunity for them collect information to pre-screen my practice and patient/insurance mix. After reviewing the general information that I provided, they contacted me and informed me that my practice would not work for them and "good luck", etc. The invite was rescinded - no steak dinner and no $300!

So much for the big payoff with VIPMD! I guess I will just get back to work......

I've been married to an internal medicine physician for almost 30 years. He still gets the highest patient satisfaction rankings even though he now has to see twice as many patients per day (about 20-25) to make less money in actual dollars than he did when he started practicing 17 years ago. He and his primary care colleagues are all on the verge of serious burnout; They didn't enter this field to become wealthy, and their pay is less than half of what sub-specialists, surgeons, and radiologists take in. But they feel exhausted, abused and disrespected by health insurance companies, Medicare bureaucrats, and both political parties, who all take advantage of their sense of ethical duty. The reason you are being asked to pay more for their services is because these other interests have been paying too little. And that is why you will see more and more primary care providers opt out of their traditional relationships with these interests, either partly or entirely, and try to forge a different path. Good luck finding a replacement internist of quality who's willing to practice for pitiful reimbursement rates that don't even cover their costs. They are a rare breed in danger of becoming rarer still.

You people are all insane if you think this is a bad idea. The current health care system in this country is so broken!!!!!
This is a terrific fix!!! The $1,500 is less than 10% of what I am paying in insurance, so if I can get significantly improved care and no hour plus waits to see an overworked Dr., why wouldn't I do it.
I just heard about this concept this morning, and am trying to find a doctor in my area to switch to, but MDVIP has no offices in Colorado, so I will have to try and find one of their competitors.

I too find the dialogue between Tenn and physician Issacs interesting paricularly the injected political hyperbole.
The per capita medical expenditure in France, which has socialized medicine, is about 1/2 that of the US; yet France's quality of medicine is recognized as the best in the world. Why don't the physicians in France rise in "rebellion" as the French do in most instances? The simple answer is French physicians have a higher calling and they are satisfied with their income. As one is quoted as saying "I am satisfied living in a $125,000 condo as opposed to a $500,000 mansion." Sounds to me like the credo of the US physician of 50 or more years ago, when the practice was a calling rather than an alternative to being a hedge fund manager or perversely an insurance company executive. The good Dr. made his decision on the latter and now he doesn't want to live with it. Another example of the right wing conservative Republican mantra: Guarantees for the rich guy and free enterprise for every body else. The medical community as a whole wants to be treated like Wall Street (Bear-Stearns, etc.) but can't generate the political will for fear of losing their image; or, worse yet, losing the entire battle..
Jake

I just got the "letter" from my primary care physician of 11 years. He is a very nice man has always shown an interest in my well being. I am retired from the military so I have Tricare coverage. A very good plan in my opinion. However, I can't see paying $1500 extra for something I'm now receiving for merely a deductible.
Additionally, my wife and I travel the country in an RV. What good does MDVIP do me if I trip on a log and snap a femur 2000 miles from home? Someone posted above that they thought $1500 per year was not bad for health insurance. Well, that may be true, but that's not what you're paying for here!
Medical Country Club, indeed; Maybe you get to play golf with your doctor on Wednesday afternoons!
Lance

It's interesting to hear everyone's opinions on the subject of "boutique" health. I am a 36 year old female who has had a flurry of sudden, and fairly serious, health problems over the past year. I'd been a patient of Internist for 12 years when my problems started. After several dismissive appointments and prescriptions for everything from steroids to ant-depressants to pain medicine (sans actual testing and diagnosis) I decided to pursue a boutique physician (NOT associated with MDVIP but rather Alliance Primary Care). The first appointment was full of promises of quick communication, quick appts, 24 hour access, follow-up with other physicians, etc. Overall I've been pleased with the ease of being able to get in to the doctor as well as the 24 hour access. I will say, however, these private physicians are still "courted" by pharmaceutical companies. I have stacks and stacks of unfilled prescriptions for problems that have yet to be diagnosed. My question is this? How does one "qualify" to be an MDVIP physician? My current physician is kind and caring, but doesn't seem to be any "smarter" than my previous internist. Is there additional training required of these boutique physicians? My point is this ... Sounds to me like anyone can "decide" to become a boutique doc, but the burden is still on patient to research these doctors, their education, and their training. Should anyone decide to enroll in MDVIP, I'd suggest you be vigilant about researching the physician you intend to see before you pay them a dime.

Actually, I am a member of MDVIP and find their service to be the best. I first of all call my doctor with any questions and get him on the phone (not a nurse, recording or other third-party person). I call anytime day or night and get medical questions or assistance that I need taking care immediately. I go into the office same day for appointment and have no wait!!! Which is always nice. He draws all blood work annually and takes x-rays and does other test annually that are for preventive healthcare which most of the test are included in my membership fee. I feel this pays for itself. The fee is like 1 Starbucks per day less that I need to buy, which pays for better and prompt healthcare. Plus, if my family is visiting from out of town, the doctor will take care of them as well. If I travel, my doctor will locate the closest MDVIP doctor to my destination for me and refer me their if needed. After research, I also know that their are others trying to succeed at this business but, I know first hand that MDVIP is not only proven but are the best. I am an athlete who could spend less at a regular health club or more at a better health club for the same results, but I choose the better one because not only my health, service is most important to me and my family than anything else. You get what you pay for. Bottom line. It is not for everyone, not everyone considers health or top-notch service as a priority. A cup of Starbucks, pack of ciggerettes, one gallon of gas less a day, ect... I could go on. Everyone has a choice. Make the one that is most important for you and your family. You have one life to live so do what is important. I love my doctor and the MDVIP model. My father always said, "Don't knock it until you try it"