doghouse
King Of The Elite Idiots
- Messages
- 12,388
Why Is Health Care In America So Fucked Up?
- Thread starter Grand Potentate
- Start date
doghouse
King Of The Elite Idiots
- Messages
- 12,388
Good grief.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
Good. Maybe now we'll get some fucking cost controls in place.
doghouse
King Of The Elite Idiots
- Messages
- 12,388
You're a funny guy.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
Just here for the comic relief
- Messages
- 4,752
California passed single payer in the senate.
Thruth
Big Winter Daddy
- Messages
- 21,706
$400 billion
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
what good does that do the country?
Thruth
Big Winter Daddy
- Messages
- 21,706
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
well then, self-congratulations are in order.It makesMonkeyface feel better prior to his move to Cali
InstaHate
Well-Known Member
- Messages
- 1,980
Congratulations
Monkeyface
we knew you could do it
Monkeyface
we knew you could do it
- Messages
- 4,752
It makes
You got that right!
Also, it'll show the rest of the Americans single payer can be a good thing. Someone has to be the first mover. You could compare it to the legalisation of gay marriage and weed. One state did it first, the rest are following.
- Messages
- 4,752
That's not too bad, about $400/month per person.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
yes and in the meantime, countless millions will have "expired". I'm sure all those case studies will pay off for the dead.
- Messages
- 4,752
Congratulations
Thank you, thank you. Haven't even moved yet and I'm already having a positive influence!
- Messages
- 4,752
Shouldn't have voted GOP.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
- Messages
- 4,752
California is democratic.
Thruth
Big Winter Daddy
- Messages
- 21,706
It only passed appropriations and still has to go to a full senate vote
Thruth
Big Winter Daddy
- Messages
- 21,706
Let us know when you arrive so we can send Jan Libourel over to welcome you and beat you with his Indian Clubs so you can test out the health system first hand
- Messages
- 4,752
I know, I know. It has happened before, but this time might be different. The anti-Trump sentiment is high, which will help. It'll make passing this law a rebellious act, and people love rebels.
- Messages
- 4,752
Better than no welcome I suppose!
Thruth
Big Winter Daddy
- Messages
- 21,706
Exactly!
- Messages
- 4,752
Or is that one of those notorious LA gang initiations?
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
hahahahaahahaha
LelandJ
Chicken Testicle Enthusiast
- Messages
- 6,002
Thruth
Big Winter Daddy
- Messages
- 21,706
Please keep up to date:
https://www.cancer.org/cancer/cancer-causes/water-fluoridation-and-cancer-risk.html
A partial report of a study from the Harvard School of Public Health, published in 2006, found that exposure to higher levels of fluoride in drinking water was linked to a higher risk of osteosarcoma in boys but not in girls. However, researchers linked to the study noted that early results from a second part of the study did not appear to match those of the report. They therefore advised caution in interpreting the results.
The second part of the Harvard study, published in 2011, compared the fluoride levels in bones near tumors in people with osteosarcoma to the levels in people with other types of bone tumors. The researchers found no difference between the fluoride levels in the two groups.
More recent studies have compared the rates of osteosarcoma in areas with higher versus lower levels of fluoridation in Great Britain, Ireland, and the United States. These studies have not found an increased risk of osteosarcoma in areas of water fluoridation.
viaattovannucci
No Custom Title
- Messages
- 1,375
Monkeyface
You sir are a jealous arrogant idiot. He is turning 40 and could easily pass for 25, not to mention he is married to a drop dead gorgeous wife. PRO TIP come to LA and say things like "Shouldn't have voted for GOP" around me and the people I know; on my mothers life I could make one phone call and send you back to puberty with your balls cut off and stuffed in your face, later to be found in a ditch on the outskirts of Tijuana by Polica Federal. No joke, have respect for everybody and yourself or deal with the consequences of your actions. That is grown man talk so handle your business accordingly.
- Messages
- 4,752
Ah, a real classic, haven't seen it in a while! I wonder if I'll ever see him in real life. He can't be missed easily with that top hat of his.
fxh
OG Party Suit Wearer
- Messages
- 8,573
Congratulations monkeyface on getting the California legislation changed. Now once we get Trump impeached we can install you as next POTUS. please keep fake cashmere horse blanket jacket just in case.
fxh
OG Party Suit Wearer
- Messages
- 8,573
PS. Do not imperil long term plan by mixing with Fedora wearing school kid with Mexican Italian connections.
- Messages
- 4,752
Thank you, I do my best. It's all I can do. I already sold it, but it's too elite for the presidency anyways. Rumpled suits and long ties is where it's at these days.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
BLUE CROSS BLUE SHIELD WANTS PEOPLE IN GEORGIA TO SELF-DIAGNOSE BEFORE HEADING TO THE EMERGENCY ROOM
BLUE CROSS BLUE SHIELD is quietly telling its individual market patients in Georgia that it will stop reimbursing some emergency room visits.
The revelation comes from the Atlanta Journal-Constitution, which reports that Georgians are getting letters warning them that the insurer will no longer cover emergency room visits unless it determines them to have been necessary.
This raises the worry from some public health advocates that patients will be afraid to go to the emergency room out of the fear that their treatment will not be reimbursed by their insurer. Laura Harker, a policy analyst who studies Georgia’s health care system at the Georgia Budget & Policy Institute, explained some of the possible outcomes to The Intercept.
“Patients do not always know if they are having a true emergency or not. This policy could make some patients more likely to put off care that they need,” Harker said. “Many hospitals in rural Georgia are already struggling financially, and this policy could further hurt their bottom line. If BCBS decides that a visit does not count as an emergency, the hospital would most likely not get paid at all. Many patients wouldn’t be able to afford the full cost of an ER visit or they could end up with medical debt.”
Debbie Diamond, a spokesperson for Blue Cross Blue Shield of Georgia, did not provide a copy of the letters being sent to patients to The Intercept. She did, however, offer a defense of the policy.
“Please know that this policy is not intended to keep our members away from the emergency room if that is where they need to be treated. We worked with four board-certified emergency medicine doctors employed by Anthem, our parent company, to develop a list of non-emergency conditions that would be better treated by a patient’s primary care doctor than in an emergency room,” she wrote in an e-mail. “The list includes conditions such as suture removals, athlete’s foot, common cold symptoms and seasonal allergies including itchy eyes.”
“If a member choses to receive care for these common ailments in the ER when a more appropriate setting is available, their claim will be reviewed by an Anthem medical director using the prudent layperson standard before a determination is made,” she continued. “In reviewing the claim, the medical director considers the member’s presenting symptoms that may have appeared to be an emergency even if the diagnosis turned out to be a non-emergency ailment.”
The Medical Association of Georgia, the top lobbying group for physicians in the state, expressed concerns about the shift.
“What Blue Cross is asking patients do is determine without a clinical background whether their certain situation is truly an emergency, which is a lot to ask of a patient when they’re obviously presenting themselves to the emergency room because they do have concerns,” Executive Director Donald Palmisano told The Intercept.
As the AJC reports, BCBS is the only insurer in the health insurance marketplace in 96 of Georgia’s 159 counties. Particularly in rural Georgia, it has a monopoly over patients. As the Washington Post noted in 2014, southwest Georgia is “one of the most expensive places in the nation to buy health insurance.”
One way to weaken that monopoly would be for Georgia to expand Medicaid. Its Republican governor and GOP-dominated legislature have blocked the expansion, and national BCBS funded Republican Governors Association ads attacking unsuccessful Democratic candidate gubernatorial Jason Carter, who campaigned on expanding Medicaid during the 2014 cycle.
By not expanding Medicaid, Georgia puts more of the onus for covering the cost of caring for patients on the hospitals themselves. Hospitals respond by charging people who can pay — namely, insurance companies — more.
The unnecessary use of emergency departments for ailments that would be better treated at an urgent care center is indeed a real issue, said Palmisano and Harker. But the solution, they said, is better education and preventative and comprehensive care, rather than warning patients their trip to the ER may or may not be covered.
“I’m happy to say that I’m glad that I do not have Blue Cross Blue Shield as my health insurance company with this kind of restriction,” Palmisano said.
BLUE CROSS BLUE SHIELD is quietly telling its individual market patients in Georgia that it will stop reimbursing some emergency room visits.
The revelation comes from the Atlanta Journal-Constitution, which reports that Georgians are getting letters warning them that the insurer will no longer cover emergency room visits unless it determines them to have been necessary.
This raises the worry from some public health advocates that patients will be afraid to go to the emergency room out of the fear that their treatment will not be reimbursed by their insurer. Laura Harker, a policy analyst who studies Georgia’s health care system at the Georgia Budget & Policy Institute, explained some of the possible outcomes to The Intercept.
“Patients do not always know if they are having a true emergency or not. This policy could make some patients more likely to put off care that they need,” Harker said. “Many hospitals in rural Georgia are already struggling financially, and this policy could further hurt their bottom line. If BCBS decides that a visit does not count as an emergency, the hospital would most likely not get paid at all. Many patients wouldn’t be able to afford the full cost of an ER visit or they could end up with medical debt.”
Debbie Diamond, a spokesperson for Blue Cross Blue Shield of Georgia, did not provide a copy of the letters being sent to patients to The Intercept. She did, however, offer a defense of the policy.
“Please know that this policy is not intended to keep our members away from the emergency room if that is where they need to be treated. We worked with four board-certified emergency medicine doctors employed by Anthem, our parent company, to develop a list of non-emergency conditions that would be better treated by a patient’s primary care doctor than in an emergency room,” she wrote in an e-mail. “The list includes conditions such as suture removals, athlete’s foot, common cold symptoms and seasonal allergies including itchy eyes.”
“If a member choses to receive care for these common ailments in the ER when a more appropriate setting is available, their claim will be reviewed by an Anthem medical director using the prudent layperson standard before a determination is made,” she continued. “In reviewing the claim, the medical director considers the member’s presenting symptoms that may have appeared to be an emergency even if the diagnosis turned out to be a non-emergency ailment.”
The Medical Association of Georgia, the top lobbying group for physicians in the state, expressed concerns about the shift.
“What Blue Cross is asking patients do is determine without a clinical background whether their certain situation is truly an emergency, which is a lot to ask of a patient when they’re obviously presenting themselves to the emergency room because they do have concerns,” Executive Director Donald Palmisano told The Intercept.
As the AJC reports, BCBS is the only insurer in the health insurance marketplace in 96 of Georgia’s 159 counties. Particularly in rural Georgia, it has a monopoly over patients. As the Washington Post noted in 2014, southwest Georgia is “one of the most expensive places in the nation to buy health insurance.”
One way to weaken that monopoly would be for Georgia to expand Medicaid. Its Republican governor and GOP-dominated legislature have blocked the expansion, and national BCBS funded Republican Governors Association ads attacking unsuccessful Democratic candidate gubernatorial Jason Carter, who campaigned on expanding Medicaid during the 2014 cycle.
By not expanding Medicaid, Georgia puts more of the onus for covering the cost of caring for patients on the hospitals themselves. Hospitals respond by charging people who can pay — namely, insurance companies — more.
The unnecessary use of emergency departments for ailments that would be better treated at an urgent care center is indeed a real issue, said Palmisano and Harker. But the solution, they said, is better education and preventative and comprehensive care, rather than warning patients their trip to the ER may or may not be covered.
“I’m happy to say that I’m glad that I do not have Blue Cross Blue Shield as my health insurance company with this kind of restriction,” Palmisano said.
doghouse
King Of The Elite Idiots
- Messages
- 12,388
The fun never stops around here.
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
read this. i mean just fucking READ this article and try not to be bowled over by the sheer audacity of this shit.
https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html?_r=0
The Doctor Is In. Co-Pay? $40,000.
SAN FRANCISCO — When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.
“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”
Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.
For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.
“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”
Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.
Money has always made a big difference in the medical world: fancier rooms at hospitals, better food and access to the latest treatments and technology. Concierge practices, where patients pay several thousand dollars a year so they can quickly reach their primary care doctor, with guaranteed same-day appointments, have been around for decades.
But these aren’t the concierge doctors you’ve heard about — and that’s intentional.
Dr. Shlain’s Private Medical group does not advertise and has virtually no presence on the web, and new patients come strictly by word of mouth. But with annual fees that range from $40,000 to $80,000 (more than 10 times what conventional concierge practices charge), the suite of services goes far beyond 24-hour access or a Nespresso machine in the waiting room.
Continue reading the main story
Photo
From left, Dr. Jordan Shlain, the founder of Private Medical, with his partners, Dr. Eric Swagel, Dr. Leila Alpers and Dr. Yan Chin, in their offices in San Francisco. CreditPeter Prato for The New York Times
Photo
Dr. Chin and Dr. Diana Montgomery examining a young patient. Private Medical can coordinate care for family members of all ages. CreditJim Wilson/The New York Times
Indeed, as many Americans struggle to pay for health care — or even, with the future of the Affordable Care Act in question on Capitol Hill, face a loss of coverage — this corner of what some doctors call the medical-industrial complex is booming: boutique doctors and high-end hospital wards.
“It’s more like a family office for medicine,” Dr. Shlain said, referring to how very wealthy families can hire a team of financial professionals to manage their fortunes and assure the transmission of wealth from generation to generation.
Only in this case, they are managing health, on behalf of clients more than equipped to pay out of pocket — those for whom, as Dr. Shlain put it, “this is cheaper than the annual gardener’s bill at your mansion.”
There are rewards for the physicians themselves, of course. A successful internist in New York or San Francisco might earn $200,000 to $300,000 per year, according to Dr. Shlain, but Private Medical pays $500,000 to $700,000 annually for the right practitioner.
For patients, a limit of no more than 50 families per doctor eliminates the rushed questions and assembly-line pace of even the best primary care practices. House calls are an option for busy patients, and doctors will meet clients at their workplace or the airport if they are pressed for time.
In the event of an uncommon diagnosis, Private Medical will locate the top specialists nationally, secure appointments with them immediately and accompany the patient on the visit, even if it is on the opposite coast.
Meanwhile, for virtually everyone else, the typical wait to see a doctor is getting longer.
Waiting Longer to See a Doctor
The average number of days to get a non-emergency doctor’s appointment in 2009 versus this year among five specialties: cardiology, dermatology, orthopedic surgery, obstetrics/ gynecology or family medicine.
60
days
’17
Boston
’09
50
40
Philadelphia
30
Seattle
Los Angeles
All cities
20
Atlanta
New York
Dallas
’17
10
’09
0
Source: Merritt Hawkins | The New York Times
A survey released in March by Merritt Hawkins, a Dallas medical consulting and recruiting firm, found it takes 29 days on average to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are similarly long, with a 32-day wait to see a dermatologist, and a 21-day delay at the typical cardiologist’s office.
And some patients are willing to pay a lot to avoid that. MD Squared, an elite practice that charges up to $25,000 a year, opened a Silicon Valley office in 2013 and within months had a waiting list to join.
“You have no idea how much money there is here,” said Dr. Harlan Matles, who specializes in internal medicine and joined MD Squared after working at Stanford, where he treated 20 to 25 patients a day and barely had time to talk to them. “Doctors are poor here by comparison.”
Continue reading the main story
Photo
Virginia and John Cocke having lunch in her room at Lenox Hill Hospital in Manhattan, which recently hired a veteran of Louis Vuitton to create an atmosphere that would remind patients of visiting a luxury hotel.CreditEmon Hassan for The New York Times
Photo
The couple’s lunch included French rack of lamb encrusted with fresh herbs.CreditEmon Hassan for The New York Times
Doctors as Asset Managers
Nowhere is the velvet rope in health care rising faster than here in Northern California, where newfound tech wealth, abundant medical talent and a plethora of health-conscious patients have created a medical system that has more in common with a luxury hotel than with the local clinic.
In fact, before founding Private Medical, Dr. Shlain, 50, worked as the on-call doctor at the Mandarin Oriental hotel here, an experience he said taught him about how to provide five-star service as well as good medical care.
Private Medical started 15 years ago with a single location in San Francisco, and has since opened practices in nearby Menlo Park, in 2011, and Los Angeles, in 2015. Dr. Shlain is now eyeing an expansion into New York, Seattle and Santa Monica, Calif.
The annual fee covers the cost of visits, all tests and procedures in the office, house calls and just about anything else other than hospitalization, as well as personalized annual health plans and detailed quarterly goals for each patient.
Although Private Medical provides its patients with doctors’ cellphone numbers and same-day appointments, like more conventional concierge practices do, Dr. Shlain does not like the term “concierge care.”
“When I’m at a country club or a party and people ask me what I do, I say I’m an asset manager,” Dr. Shlain explained. “When they ask what asset, I point to their body.”
“We organize health care for the entire family,” he said, sitting in his hip-but-not-too-fancy office in a nondescript building in upscale Presidio Heights. Dr. Shlain and his team will coordinate treatment for grandparents in a nursing home and care for their middle-aged children, as well as provide adolescent or pediatric medicine for the grandchildren.
For example, when a teenage patient with a history of depression or anxiety moves across the country to Boston for college, Private Medical will line up a top psychiatrist near the school beforehand so a local professional is on call in case there is a recurrence. Or if a middle-aged patient is found to have cancer, Dr. Shlain can secure an appointment in days, not weeks or months, with a specialist at MD Anderson Cancer Center in Houston or Memorial Sloan Kettering Cancer Center in New York.
“It’s not because we pay them,” he added. “It’s because we have relationships with doctors all over the country.”
‘We Can Get You In’
As with the ever more rarefied tiers of frequent-flier programs or V.I.P. floors at hotels, the appeal of MD Squared and Private Medical is about intangibles like time, access and personal attention.
“I am able to give the time and energy each patient deserves,” said Dr. Matles, the MD Squared physician in Menlo Park. “I wish I could have offered this to everyone in my old practice, but it just wasn’t feasible.”
Continue reading the main story
Photo
Dr. Harlan Matles, a physician at MD Squared in Menlo Park, Calif., says working there allows him “to give the time and energy each patient deserves.” CreditPeter prato for The New York Times
Photo
A fruit bowl and fresh magazines in the waiting room at MD Squared in Menlo Park.CreditPeter prato for The New York Times
So in addition to providing immediate access to specialists, concierge doctors also come in handy when otherwise wealthy, powerful people find themselves flummoxed by a health care system that is opaque to outsiders.
“If you need to go to Mass General, we can get you in,” Dr. Matles said. “We are connected. I don’t know if I can get you to the front of the line, but I can make it smoother. Doctors like to help other doctors.”
But for all their confidence about the advantages of their particular brand of concierge medicine, these physicians are quick to admit they struggle with the ethical issues of providing elite treatment for a wealthy few, even as tens of millions of American struggle to afford basic care.
Dr. Shlain founded a software start-up, HealthLoop, that aims to “democratize” his boutique approach by allowing patients to communicate directly with their doctors through daily digital checklists and texts.
He sees no reason that the medical world should not respond to consumer demand like any other player in the service economy. “Whenever I bump into a bleeding-heart liberal, which I am, I mention that schools, housing and food are all tiered systems,” he said. “But health care is an island of socialism in a system of tiered capitalism? Tell me how that works.”
Dr. Howard Maron, who founded MD Squared, is similarly candid about the new reality of ultra-elite medical care.
“In my old waiting room in Seattle, the C.E.O. of a company might be sitting next to a custodian from that company,” he recalled. “While I admired that egalitarian aspect of medicine, it started to appear somewhat odd. Why would people who have all their other affairs in order — legal, financial, even groundskeepers — settle for a 15-minute slot?”
It’s a fair question — but the new approach does not sit so well with veteran practitioners like Dr. Henry Jones III, one of Silicon Valley’s original concierge doctors at the Palo Alto Medical Foundation’s Encina Practice. He charges $370 a month, a fraction of what newer entrants in the area like MD Squared and Private Medical do. “It’s priced so the average person in this ZIP code can afford it,” he said.
A third-generation doctor from Boston, Dr. Jones offers a version of concierge medicine that is a way of providing more personalized service — the way doctors did when he graduated from medical school more than four decades ago — rather than delivering a different standard of care.
“Encina is like a Unesco World Heritage site — we practice medicine the way it has been traditionally practiced,” he said. “Just because you’re an Encina patient doesn’t mean you can go to the front of the line, unless you need to because of your case.”
Plusher Quarters
Not far from Dr. Jones’s office in Palo Alto, the new wing of Stanford’s hospital is taking shape. Designed by the star architect Rafael Viñoly, it will feature a rooftop garden and a glass-paneled atrium topped with a 65-foot dome. And unlike the old wing, all of the new building’s 368 rooms will be single occupancy, a crucial amenity for hospitals competing to attract elite patients from across the United States and overseas.
Stanford raised a significant portion of the project’s $2 billion cost by cultivating wealthy patients — a funding model used by university hospitals around the country, which is especially effective among the millionaires and billionaires of Silicon Valley.
Continue reading the main story
Photo
Construction on the new wing of Stanford’s hospital in Palo Alto, Calif., in December. The university cultivated wealthy patients to help pay for the $2 billion project. CreditLaura Morton for The New York Times
Photo
Bert Hurlbut, the vice president for construction of the hospital, left, and John Jackson, the executive director of corporate health programs for Stanford Health Care. CreditLaura Morton for The New York Times
Not to be outdone, Lenox Hill Hospital in New York recently hired a veteran of Louis Vuitton and Nordstrom, Joe Leggio, to create an atmosphere that would remind V.I.P. patients of visiting a luxury boutique or hotel, not a hospital. “This is something that patients asked for, and we want to go from three-star service to five-star service,” said Mr. Leggio, the hospital’s director of patient and customer experience.
In its maternity ward, the Park Avenue Suite costs $2,400 per night, twice what a deluxe suite at the Carlyle Hotel down the street commands, but that’s not a problem for well-heeled new parents. Beyoncé and Jay Z welcomed their baby, Blue Ivy, into the world at Lenox Hill, as did Chelsea Clinton and her husband, and Simon Cowell and his girlfriend.
With a separate sitting room for family members, a kitchenette and a full wardrobe closet, the suite overlooking Park Avenue is a world away from the semiprivate experience upstairs at the hospital, where families share an old-fashioned room divided by a curtain. Slightly less exalted but still private rooms in Lenox Hill’s maternity ward range from $630 to $1,700 per night.
As the stream of celebrity couples suggests, there is plenty of demand for these upscale options, crowding out traditional maternity wards. Lenox Hill is replacing some of its shared maternity rooms with private rooms, a far more profitable offering for hospitals since patients pay for them out of pocket, not through insurance plans that can bargain down rates.
Hospital executives argue that giving the well heeled extra attention is a way of keeping the lights on and providing care for ordinary middle- and even upper-middle-class patients, as reimbursements from private insurers and the federal government shrink. “I need to succeed to pay for the children we are bringing in from all over the world and treat for free,” said Dr. Angelo Acquista, a veteran pulmonologist who leads Lenox Hill’s executive health and international outreach programs.
Then there are the red blankets that some big Stanford benefactors receive when they check in as patients. For doctors and nurses, it is a quiet sign of these donors’ special status, which is also noted in their medical records.
“You don’t get better care,” Dr. Jones said. “But maybe the dean comes by, and if it’s done well, it’s done invisibly. It’s an acknowledgment of a contribution to the organization.”
Valuing Relationships
Rex Chiu, an internist with Private Medical in Menlo Park, spent more than a decade as a doctor on Stanford’s faculty. “I loved my time at Stanford, but I was spending less and less time with patients,” he said. “Fifteen or 20 minutes a year with each patient isn’t enough.”
“We all say we should get the same care, but I got sick and tired of waiting for that to happen,” he added. “I decided to go for quality, not quantity.”
Besides more money, the calmer pace of high-end concierge medicine is also a major selling point for physicians — Dr. Matles said he never made it to an event at his children’s school until he joined MD Squared. But for Dr. Sarah Greene, it wasn’t really the money or the lifestyle that led her to Private Medical.
“I really have time to think about my patients when they’re not in front of me,” said Dr. Greene, a pediatrician who joined the company’s Los Angeles practice in October. “I may spend a morning researching and emailing specialists for one patient. Before, I had to see 10 patients in a morning, and could never spend that kind of time on one case.”
Getting in the door as a new hire isn’t easy. When it comes to credentials like college, medical school and residency, Dr. Shlain said, “at least two out of the three need to be Ivy League, or Ivy League-esque.”
In many ways, today’s elite concierge physician provides the same service as the family doctor did a half-century ago for millions of Americans, except that it is reserved for the tiny sliver of the population who can pay tens of thousands of dollars annually for it.
“I didn’t know this level of care was possible,” said Trevor Traina, a serial entrepreneur here who is a patient of Dr. Shlain’s. “I have a better relationship with my veterinarian than the doctors I went to in the past.”
What about everyone else? Mr. Traina doesn’t see much future for the conventional family doctor, except for patients who go the concierge route.
“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush. “Even the 25-year-olds at my company either have some form of concierge doc, or they’ll just go to an H.M.O. or a walk-in clinic. No one here has a regular doctor anymore.”
Photo
A CityMD walk-in urgent care facility in Queens. CreditLeslie dela Vega/The New York Times
https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html?_r=0
The Doctor Is In. Co-Pay? $40,000.
SAN FRANCISCO — When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.
“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”
Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.
For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.
“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”
Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.
Money has always made a big difference in the medical world: fancier rooms at hospitals, better food and access to the latest treatments and technology. Concierge practices, where patients pay several thousand dollars a year so they can quickly reach their primary care doctor, with guaranteed same-day appointments, have been around for decades.
But these aren’t the concierge doctors you’ve heard about — and that’s intentional.
Dr. Shlain’s Private Medical group does not advertise and has virtually no presence on the web, and new patients come strictly by word of mouth. But with annual fees that range from $40,000 to $80,000 (more than 10 times what conventional concierge practices charge), the suite of services goes far beyond 24-hour access or a Nespresso machine in the waiting room.
Continue reading the main story
Photo
From left, Dr. Jordan Shlain, the founder of Private Medical, with his partners, Dr. Eric Swagel, Dr. Leila Alpers and Dr. Yan Chin, in their offices in San Francisco. CreditPeter Prato for The New York Times
Photo
Dr. Chin and Dr. Diana Montgomery examining a young patient. Private Medical can coordinate care for family members of all ages. CreditJim Wilson/The New York Times
Indeed, as many Americans struggle to pay for health care — or even, with the future of the Affordable Care Act in question on Capitol Hill, face a loss of coverage — this corner of what some doctors call the medical-industrial complex is booming: boutique doctors and high-end hospital wards.
“It’s more like a family office for medicine,” Dr. Shlain said, referring to how very wealthy families can hire a team of financial professionals to manage their fortunes and assure the transmission of wealth from generation to generation.
Only in this case, they are managing health, on behalf of clients more than equipped to pay out of pocket — those for whom, as Dr. Shlain put it, “this is cheaper than the annual gardener’s bill at your mansion.”
There are rewards for the physicians themselves, of course. A successful internist in New York or San Francisco might earn $200,000 to $300,000 per year, according to Dr. Shlain, but Private Medical pays $500,000 to $700,000 annually for the right practitioner.
For patients, a limit of no more than 50 families per doctor eliminates the rushed questions and assembly-line pace of even the best primary care practices. House calls are an option for busy patients, and doctors will meet clients at their workplace or the airport if they are pressed for time.
In the event of an uncommon diagnosis, Private Medical will locate the top specialists nationally, secure appointments with them immediately and accompany the patient on the visit, even if it is on the opposite coast.
Meanwhile, for virtually everyone else, the typical wait to see a doctor is getting longer.
Waiting Longer to See a Doctor
The average number of days to get a non-emergency doctor’s appointment in 2009 versus this year among five specialties: cardiology, dermatology, orthopedic surgery, obstetrics/ gynecology or family medicine.
60
days
’17
Boston
’09
50
40
Philadelphia
30
Seattle
Los Angeles
All cities
20
Atlanta
New York
Dallas
’17
10
’09
0
Source: Merritt Hawkins | The New York Times
A survey released in March by Merritt Hawkins, a Dallas medical consulting and recruiting firm, found it takes 29 days on average to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are similarly long, with a 32-day wait to see a dermatologist, and a 21-day delay at the typical cardiologist’s office.
And some patients are willing to pay a lot to avoid that. MD Squared, an elite practice that charges up to $25,000 a year, opened a Silicon Valley office in 2013 and within months had a waiting list to join.
“You have no idea how much money there is here,” said Dr. Harlan Matles, who specializes in internal medicine and joined MD Squared after working at Stanford, where he treated 20 to 25 patients a day and barely had time to talk to them. “Doctors are poor here by comparison.”
Continue reading the main story
Photo
Virginia and John Cocke having lunch in her room at Lenox Hill Hospital in Manhattan, which recently hired a veteran of Louis Vuitton to create an atmosphere that would remind patients of visiting a luxury hotel.CreditEmon Hassan for The New York Times
Photo
The couple’s lunch included French rack of lamb encrusted with fresh herbs.CreditEmon Hassan for The New York Times
Doctors as Asset Managers
Nowhere is the velvet rope in health care rising faster than here in Northern California, where newfound tech wealth, abundant medical talent and a plethora of health-conscious patients have created a medical system that has more in common with a luxury hotel than with the local clinic.
In fact, before founding Private Medical, Dr. Shlain, 50, worked as the on-call doctor at the Mandarin Oriental hotel here, an experience he said taught him about how to provide five-star service as well as good medical care.
Private Medical started 15 years ago with a single location in San Francisco, and has since opened practices in nearby Menlo Park, in 2011, and Los Angeles, in 2015. Dr. Shlain is now eyeing an expansion into New York, Seattle and Santa Monica, Calif.
The annual fee covers the cost of visits, all tests and procedures in the office, house calls and just about anything else other than hospitalization, as well as personalized annual health plans and detailed quarterly goals for each patient.
Although Private Medical provides its patients with doctors’ cellphone numbers and same-day appointments, like more conventional concierge practices do, Dr. Shlain does not like the term “concierge care.”
“When I’m at a country club or a party and people ask me what I do, I say I’m an asset manager,” Dr. Shlain explained. “When they ask what asset, I point to their body.”
“We organize health care for the entire family,” he said, sitting in his hip-but-not-too-fancy office in a nondescript building in upscale Presidio Heights. Dr. Shlain and his team will coordinate treatment for grandparents in a nursing home and care for their middle-aged children, as well as provide adolescent or pediatric medicine for the grandchildren.
For example, when a teenage patient with a history of depression or anxiety moves across the country to Boston for college, Private Medical will line up a top psychiatrist near the school beforehand so a local professional is on call in case there is a recurrence. Or if a middle-aged patient is found to have cancer, Dr. Shlain can secure an appointment in days, not weeks or months, with a specialist at MD Anderson Cancer Center in Houston or Memorial Sloan Kettering Cancer Center in New York.
“It’s not because we pay them,” he added. “It’s because we have relationships with doctors all over the country.”
‘We Can Get You In’
As with the ever more rarefied tiers of frequent-flier programs or V.I.P. floors at hotels, the appeal of MD Squared and Private Medical is about intangibles like time, access and personal attention.
“I am able to give the time and energy each patient deserves,” said Dr. Matles, the MD Squared physician in Menlo Park. “I wish I could have offered this to everyone in my old practice, but it just wasn’t feasible.”
Continue reading the main story
Photo
Dr. Harlan Matles, a physician at MD Squared in Menlo Park, Calif., says working there allows him “to give the time and energy each patient deserves.” CreditPeter prato for The New York Times
Photo
A fruit bowl and fresh magazines in the waiting room at MD Squared in Menlo Park.CreditPeter prato for The New York Times
So in addition to providing immediate access to specialists, concierge doctors also come in handy when otherwise wealthy, powerful people find themselves flummoxed by a health care system that is opaque to outsiders.
“If you need to go to Mass General, we can get you in,” Dr. Matles said. “We are connected. I don’t know if I can get you to the front of the line, but I can make it smoother. Doctors like to help other doctors.”
But for all their confidence about the advantages of their particular brand of concierge medicine, these physicians are quick to admit they struggle with the ethical issues of providing elite treatment for a wealthy few, even as tens of millions of American struggle to afford basic care.
Dr. Shlain founded a software start-up, HealthLoop, that aims to “democratize” his boutique approach by allowing patients to communicate directly with their doctors through daily digital checklists and texts.
He sees no reason that the medical world should not respond to consumer demand like any other player in the service economy. “Whenever I bump into a bleeding-heart liberal, which I am, I mention that schools, housing and food are all tiered systems,” he said. “But health care is an island of socialism in a system of tiered capitalism? Tell me how that works.”
Dr. Howard Maron, who founded MD Squared, is similarly candid about the new reality of ultra-elite medical care.
“In my old waiting room in Seattle, the C.E.O. of a company might be sitting next to a custodian from that company,” he recalled. “While I admired that egalitarian aspect of medicine, it started to appear somewhat odd. Why would people who have all their other affairs in order — legal, financial, even groundskeepers — settle for a 15-minute slot?”
It’s a fair question — but the new approach does not sit so well with veteran practitioners like Dr. Henry Jones III, one of Silicon Valley’s original concierge doctors at the Palo Alto Medical Foundation’s Encina Practice. He charges $370 a month, a fraction of what newer entrants in the area like MD Squared and Private Medical do. “It’s priced so the average person in this ZIP code can afford it,” he said.
A third-generation doctor from Boston, Dr. Jones offers a version of concierge medicine that is a way of providing more personalized service — the way doctors did when he graduated from medical school more than four decades ago — rather than delivering a different standard of care.
“Encina is like a Unesco World Heritage site — we practice medicine the way it has been traditionally practiced,” he said. “Just because you’re an Encina patient doesn’t mean you can go to the front of the line, unless you need to because of your case.”
Plusher Quarters
Not far from Dr. Jones’s office in Palo Alto, the new wing of Stanford’s hospital is taking shape. Designed by the star architect Rafael Viñoly, it will feature a rooftop garden and a glass-paneled atrium topped with a 65-foot dome. And unlike the old wing, all of the new building’s 368 rooms will be single occupancy, a crucial amenity for hospitals competing to attract elite patients from across the United States and overseas.
Stanford raised a significant portion of the project’s $2 billion cost by cultivating wealthy patients — a funding model used by university hospitals around the country, which is especially effective among the millionaires and billionaires of Silicon Valley.
Continue reading the main story
Photo
Construction on the new wing of Stanford’s hospital in Palo Alto, Calif., in December. The university cultivated wealthy patients to help pay for the $2 billion project. CreditLaura Morton for The New York Times
Photo
Bert Hurlbut, the vice president for construction of the hospital, left, and John Jackson, the executive director of corporate health programs for Stanford Health Care. CreditLaura Morton for The New York Times
Not to be outdone, Lenox Hill Hospital in New York recently hired a veteran of Louis Vuitton and Nordstrom, Joe Leggio, to create an atmosphere that would remind V.I.P. patients of visiting a luxury boutique or hotel, not a hospital. “This is something that patients asked for, and we want to go from three-star service to five-star service,” said Mr. Leggio, the hospital’s director of patient and customer experience.
In its maternity ward, the Park Avenue Suite costs $2,400 per night, twice what a deluxe suite at the Carlyle Hotel down the street commands, but that’s not a problem for well-heeled new parents. Beyoncé and Jay Z welcomed their baby, Blue Ivy, into the world at Lenox Hill, as did Chelsea Clinton and her husband, and Simon Cowell and his girlfriend.
With a separate sitting room for family members, a kitchenette and a full wardrobe closet, the suite overlooking Park Avenue is a world away from the semiprivate experience upstairs at the hospital, where families share an old-fashioned room divided by a curtain. Slightly less exalted but still private rooms in Lenox Hill’s maternity ward range from $630 to $1,700 per night.
As the stream of celebrity couples suggests, there is plenty of demand for these upscale options, crowding out traditional maternity wards. Lenox Hill is replacing some of its shared maternity rooms with private rooms, a far more profitable offering for hospitals since patients pay for them out of pocket, not through insurance plans that can bargain down rates.
Hospital executives argue that giving the well heeled extra attention is a way of keeping the lights on and providing care for ordinary middle- and even upper-middle-class patients, as reimbursements from private insurers and the federal government shrink. “I need to succeed to pay for the children we are bringing in from all over the world and treat for free,” said Dr. Angelo Acquista, a veteran pulmonologist who leads Lenox Hill’s executive health and international outreach programs.
Then there are the red blankets that some big Stanford benefactors receive when they check in as patients. For doctors and nurses, it is a quiet sign of these donors’ special status, which is also noted in their medical records.
“You don’t get better care,” Dr. Jones said. “But maybe the dean comes by, and if it’s done well, it’s done invisibly. It’s an acknowledgment of a contribution to the organization.”
Valuing Relationships
Rex Chiu, an internist with Private Medical in Menlo Park, spent more than a decade as a doctor on Stanford’s faculty. “I loved my time at Stanford, but I was spending less and less time with patients,” he said. “Fifteen or 20 minutes a year with each patient isn’t enough.”
“We all say we should get the same care, but I got sick and tired of waiting for that to happen,” he added. “I decided to go for quality, not quantity.”
Besides more money, the calmer pace of high-end concierge medicine is also a major selling point for physicians — Dr. Matles said he never made it to an event at his children’s school until he joined MD Squared. But for Dr. Sarah Greene, it wasn’t really the money or the lifestyle that led her to Private Medical.
“I really have time to think about my patients when they’re not in front of me,” said Dr. Greene, a pediatrician who joined the company’s Los Angeles practice in October. “I may spend a morning researching and emailing specialists for one patient. Before, I had to see 10 patients in a morning, and could never spend that kind of time on one case.”
Getting in the door as a new hire isn’t easy. When it comes to credentials like college, medical school and residency, Dr. Shlain said, “at least two out of the three need to be Ivy League, or Ivy League-esque.”
In many ways, today’s elite concierge physician provides the same service as the family doctor did a half-century ago for millions of Americans, except that it is reserved for the tiny sliver of the population who can pay tens of thousands of dollars annually for it.
“I didn’t know this level of care was possible,” said Trevor Traina, a serial entrepreneur here who is a patient of Dr. Shlain’s. “I have a better relationship with my veterinarian than the doctors I went to in the past.”
What about everyone else? Mr. Traina doesn’t see much future for the conventional family doctor, except for patients who go the concierge route.
“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush. “Even the 25-year-olds at my company either have some form of concierge doc, or they’ll just go to an H.M.O. or a walk-in clinic. No one here has a regular doctor anymore.”
Photo
A CityMD walk-in urgent care facility in Queens. CreditLeslie dela Vega/The New York Times
fxh
OG Party Suit Wearer
- Messages
- 8,573
haha when I saw this all I could think of was fwiffo - spoilt the rest of the article
doghouse
King Of The Elite Idiots
- Messages
- 12,388
Grand Potentate
Supporter of Possible Sexual Deviants
- Messages
- 39,182
Thruth
Big Winter Daddy
- Messages
- 21,706
Yes. Evil incarnate.
It is all about money and the misperception that there will be loss of control over the dental monopoly and that dental therapist will become competition.
Truth is, neither will happen. Therapists are working and will work only in public health programs for the poor so dentists aren't seeing the poors anyway, so no competition. American dentists are so stupid, they can't look north and see how dental therapists are part of private practice clinics treating patients that the dentist doesn't want to spend time on like kids. Patients are billed the same fees if seen by a therapist. Money in the bank.
Over time, they will become part of your HMO/PPO dental care plans. Not to save you money, but to lower the overhead cost of providing dental benefits.
America went through the same debate with independent practice for dental hygienists. The ADA said that would be dangerous. But intelligent citizens did not flock to hygiene-only clinics because they want their all of their dental care in one place.
Interesting though that they had to dig up Jack Dillinberg for a pro-therapist comment. He has nothing to do with them. Jack is ancient.
Bad fact checking too. Or many trying to manipulate the reader by linking him to the great Harvard University. He got his dental public health specialty training at Harvard but was never faculty there. He has spent most of his time in Arizona, first with the state government and then as the inaugural dean of their dental school. He just retired.
It is all about money and the misperception that there will be loss of control over the dental monopoly and that dental therapist will become competition.
Truth is, neither will happen. Therapists are working and will work only in public health programs for the poor so dentists aren't seeing the poors anyway, so no competition. American dentists are so stupid, they can't look north and see how dental therapists are part of private practice clinics treating patients that the dentist doesn't want to spend time on like kids. Patients are billed the same fees if seen by a therapist. Money in the bank.
Over time, they will become part of your HMO/PPO dental care plans. Not to save you money, but to lower the overhead cost of providing dental benefits.
America went through the same debate with independent practice for dental hygienists. The ADA said that would be dangerous. But intelligent citizens did not flock to hygiene-only clinics because they want their all of their dental care in one place.
Interesting though that they had to dig up Jack Dillinberg for a pro-therapist comment. He has nothing to do with them. Jack is ancient.
Bad fact checking too. Or many trying to manipulate the reader by linking him to the great Harvard University. He got his dental public health specialty training at Harvard but was never faculty there. He has spent most of his time in Arizona, first with the state government and then as the inaugural dean of their dental school. He just retired.
Thruth
Big Winter Daddy
- Messages
- 21,706
Grand Potentate
, I think this is your solution (of course you are going to have to change your ways a tiny bit). It is always on satellite radio when I am driving. I'll find you an evangelical dental plan too.Medi-Share
You and a bunch or hardcore, old school Christians pay for each other's medical care. What could be greater than that? Use the handy, dandy share calculator to determine your costs.
https://mychristiancare.org/medi-share/