For sale: body scans, boutique care & second opinions - Retail Health Care

Physician Executive, March-April, 2003 by David Ollier Weber

At the other end of the scale is a recently announced plan by Rhode Island family physician Michael Fine, MD, to provide primary care to 1,000 patients without insurance who enroll for $22 a month in his Hillside Health Access Alliance--$2 less if deducted automatically from a credit or debit card. There's also a $10 co-pay for each visit to the group's Pawtucket or North Scituate offices.

In between ire a variety of retail practices charging fees scaled to the opulence of the service and the number of patients the doctor is willing to treat. The income target, notes Riddick, is typically about $1 million a year. So a practice with a $1,500 annual fee "will tend to have a panel of 600 patients," he observes, "and one that charges $4,000 a year will tend to have about 300."

Despite much worry in the popular press and ethical reservations by some in the profession, medicine that caters exclusively to those wealthy enough to buy it at a boutique premium is not likely to make a serious impact on the health care system, say most observers.

"If the stock market were going crazy, maybe," comments health care futurist Russ Coile, MBA, of Washington, Texas. "But not with the economy the way it is today. Besides, managed care has backed off. It's easier to get a referral now than it used to be." What's more, even ordinary doctor's offices are beginning to experiment with patient satisfaction boosters like open access and same-day appointments.

Why, next thing you know, things will be just the way they were in Dr. Marcus Welby's day.

Or not.

Note:

In the January/February issue of The Physician Executive journal, health care leaders identified retail pharmaceutical sales among the top 25 trends of 2003. Here's an excerpt of what some health care futurists said about the phenomena:

Direct -to-consumer pharmaceutical advertising is "the cocaine of drug marketing," quips Russ Coile, MBA. "Once you start it's hard to stop. And, hey, this is just the way things are."

"There are elements of backlash present," says Jeff Goldsmith, PhD, "but voluntary stimulation is not going to put it back in the box."

"I want the purple pill!" laughs Leland Kaiser, PhD. "I have no idea what it does, but I want it."

RELATED ARTICLE: Physicians Wrestle With Ethics of Retail Health Care

Is retail health care a sell-out or a savvy business move?

Health care futurist Russ Coile says some physician executives react to direct-to-consumer medical sales with fear. They say things like, "It's a threat! Let's make it illegal!"

The American Medical Association certainly has come close to assuming that stance, Coile adds. Its Council on Judicial and Ethical Affairs studied the matter of e-mail and Internet-mediated communications between doctors and patients and ruled that they "have a potential for deception and unethical behavior."

Nevertheless, the AMA itself is a principal investor in Medem, a Web-based physician-patient communications e-network. And although the organization still maintains that doctors may not clinically diagnose or write prescriptions for patients they know only as bytes or pixels, the AMA is more sanguine about physician-to-physician electronic consultations. And that's how most of the online, second-opinion providers characterize their services.