Cooperating for better care.


Tag Archives

In search of better, SIMPLER healthcare


The simple life: A reconstruction of the inside of Henry David Thoreau’s cabin at Walden Pond.

Ian Morrison discusses the search  in other sectors for lessons to create a simpler, more cost-effective healthcare system with better medical outcomes.

He writes in a Hospitals & Health Networks piece:

“Forget healthcare for a moment and think about other service experiences in your life. How much time do you spend on your phone? Is it the vehicle for your life? Is it your primary gateway to your family, friends, travel reservations, recipes, dates and data?

“The complexity of health care is being judged against other industries that seem to effortlessly deliver services in ways that are simple and easy to use. And not just with mobile apps.

“Think Southwest Airlines. It flies the same planes on all routes so crews are interchangeable. Southwest keeps it simple: no bag fees, no tricks. And it still gives you peanuts.

“Or think Netflix. It knows what you like and makes it easy to binge watch House of Cards without leaving your couch.

“Or Amazon. It will get you absolutely anything on your front doorstep within a day or two. Maybe an hour or two when it gets the drone thing down.

“Or Uber. You press a button, and a Stanford graduate student picks you up in his Prius in three minutes, and you don’t have to tip him or fumble for cash.

“These businesses are backed by enormously complex technology and logistics. They use sophisticated algorithms to customize the user experience. It is immensely difficult to design and execute these services, but to the customer it appears simple.

“We need to learn from them. And we can find signs of simplicity in health care.”

He then gives some hopeful examples from healthcare:

Kaiser Permanente

Covered California

Concierge medicine


To read Mr. Morrison’s piece, please hit this link.

The Direct Primary Care model


A look the Direct Primary Care model of medicine. This Medscape article explains that in the DPC:

“Physicians do not bill the patient’s insurance, and the associated overhead savings result in the chance to offer affordable prices for patients. Patients often have their physician’s e-mail, cell phone number, and so on, and periodic (usually monthly) fees take the place of fee-for-service billing.

“A DPC practice is one that (1) charges a periodic fee and (2) does not bill third parties on a fee-for-service basis (at least for its DPC patients), and for which (3) any per-visit fee is less than the monthly equivalent of the periodic fee. This definition is designed to protect practices from being defined as unlawful ‘insurance’ companies. It also distinguishes DPC from concierge medicine models that typically charge higher monthly fees and continue to bill the patient’s insurance in addition to the monthly fee.”

Concierge physicians better be careful in claims

By PHIL GALEWITZ, for Kaiser Health News

WEST PALM BEACH, Fla. — MDVIP, the nation’s largest concierge-medicine  practice, has seen meteoric growth since it was founded 15 years ago promising “exceptional care” and quick access to doctors in exchange for a $1,500 annual membership fee.

But it took a big hit Tuesday, when a Palm Beach County, Fla., jury returned an $8.5 million malpractice verdict against the company, which has nearly 800 affiliated physicians in 41 states. It was the first malpractice verdict against MDVIP, and is believed to be the first against any concierge management firm. The companies offer such perks as same-day appointments and more personalized care with contracted doctors in return for a retainer.

The jury found MDVIP was liable for the negligence of one of its physicians, who was sued for misdiagnosing the cause of a patient’s leg pain, leading to its amputation. The jury also found the firm had falsely advertised its exceptional doctors and patient care.

Industry experts say the ruling is significant because it shows concierge companies can be held liable for the care provided by their contracted doctors. The companies typically argue they do not actually provide care but merely act as brokers between doctors and patients.

“This pierces that veil…and shows these companies have a legal risk that everyone assumed did not exist,” said Tom Blue, chief strategy officer of the American Academy of Private Physicians, a trade group of concierge doctors.

MDVIP argued it was not responsible for the actions of a physician with whom it had contracted. MDVIP physicians are not directly employed by the company; the physicians pay the firm a per-patient fee for services such as marketing, branding, and other support.

The doctor, Charles Metzger Jr., settled with the plaintiff’s family before the trial.

MDVIP representatives declined to be interviewed, but they indicated they would appeal the verdict. In a statement, the company said it and Metzger acted appropriately.

Karen Terry, one of the plaintiff’s attorneys, said the verdict will push MDVIP and similar companies to scrutinize doctors more carefully before they affiliate with them because they may be liable for the doctors’ actions.

Such companies will also be more cautious about advertising that they offer better care. “You can’t make promises you can’t keep,” Terry said. “This verdict is going to have a huge impact on MDVIP.”

Harry Nelson, a Los Angeles healthcare attorney, agreed the verdict will change how companies market their doctors.  “A lot of people will be taking notice of this verdict…It’s a shocking decision,” he said. “The result of this decision is going to be more caution from the concierge medicine companies in terms of their claims of providing superior care.”

But Roberta Greenspan, founder of Specialdocs Consultants, a concierge medicine consulting firm in Chicago, was skeptical of the decision’s significance.

“This singular verdict will not have a major long-term effect on the industry,” she said. “The industry has evolved from a fad years ago to one that has gained tremendous respect.”

An estimated 6,000 doctors nationally have moved to concierge-style practices in the past 15 years, with the figure doubling just in the past five, according to the concierge trade group. Patients who see concierge doctors typically pay an annual fee, in addition to their insurance coverage, in return for gaining easier access to doctors and more personalized care.

The lawsuit against MDVIP was brought by the widower of the late Joan Beber of Boca Raton, who had sought medical attention for leg pain. Despite what plaintiff’s lawyers described as the progressive worsening of her condition, she was repeatedly misdiagnosed by Metzger and other MDVIP-affiliated staff. She was referred to orthopedists who they contended did not get her medical records or learn of her worsening symptoms.  The information, they argued, might have led to the discovery of a serious circulation problem that eventually required above-the-knee amputation of her leg.

Beber died of leukemia four years after her leg was amputated in 2008.

Dr. Matthew Priddy, president of the concierge trade group, said the verdict will “give national companies pause if they are on the hook” for their physicians’ care.

Still, Priddy said the industry’s track record is good. While concierge physicians are not immune from malpractice suits, they are less likely to face them because they spend more time with patients than most doctors, he said. They typically limit their patients to a few hundred a year – 600 is the limit for MDVIP doctors — compared to a few thousand for an average practice. They are able to do that because the retainer fees make up for lost revenue.


Contact Info

(617) 230-4965

Wellesley, Mass