Concierge Medicine - Time on Target
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Vaccines and Good News
Here is a story from the University of Texas Houston (link) that demonstrates a positive correlation between getting a flu vaccine and reduced risk of contracting Alzheimer’s disease.
People who received at least one influenza vaccine were 40% less likely than their non-vaccinated peers to develop Alzheimer’s disease over the course of four years, according to a new study from UTHealth Houston.
An online version of the paper detailing the findings is available in advance of its publication in the Aug. 2, 2022 issue of the Journal of Alzheimer’s Disease.
They found that flu vaccination in older adults reduces the risk of developing Alzheimer’s disease for several years. The strength of this protective effect increased with the number of years that a person received an annual flu vaccine – in other words, the rate of developing Alzheimer’s was lowest among those who consistently received the flu vaccine every year. They analyzed a much larger sample than previous research, including 935,887 flu-vaccinated patients and 935,887 non-vaccinated patients.
Get a flu shot.
Time on Target
Recently we discussed a young woman who died in an ER because no one paid attention quickly enough. This is actually a pervasive problem in medicine. Doctors are pressured to increase the volume of patients they see so they can increase billing and generate significant income for their network. This happens in both for profit and not for profit settings. Of course, private equity situations tend to exacerbate the problem.
One of the problems that arise when doctor’s can’t spend enough time with patients is that the doctor really has no idea who you are or what your lifestyle is and whether that could have an effect on symptoms presented or the doctor’s advice. The result can easily be a suboptimal recommendation.
I have some friends with cardiac issues who keep winding up in the ER because the ER doctor only has so much time for them and can’t address the full problem. It takes some time to see a cardiologist and so there are multiple return visits to the ER. The system doesn’t allow for a full investigation when needed.
I want to refer you to a book you can read quickly, “ The Healing of America”, by T. R. Reid. He is a reporter who wanted to document the different kinds of healthcare systems around the world. He had a bad shoulder at the time and his US doctor said it should be replaced. His idea was to visit doctors in several countries with different kinds of healthcare systems and document their recommendations.
A number of doctors spent significant time getting to know him and how he damaged the shoulder, how he would like to use it to have the best quality of life. Were there activities or sports that were important to him. All those played into their recommendations as to whether certain exercises or therapies might be better than the shoulder replacement, that his US doctor recommended. Time on target affects the outcome.
Does Money Fix the Problem?
Yes and no. There is a rising trend towards concierge medicine, direct primacy care (DPC). This is usually primary care medicine, that requires an up-front subscription. The cost varies dramatically. From $1000/year to $60,000/year per person. Family rates available.
What you get is more rapid access to a doctor or suite of doctors. Does it matter? Maybe. Where we are in the Pacific Northwest we have to wait months to get an appointment for a checkup to make sure that regular medicines are in order. We can email our doctors and someone they will get back to you in a couple of days. I remember, not so long ago, if you were ill you showed up at the doctors office and sat on the sick side of the waiting room and they would fit you in. Those days are in the rear view mirror.
So subscription primary care is one way doctors have found to address the problem. It tends to lower the number of patients a doctor sees dramatically. I’ve seen numbers between 150 to 600 patients/doctor. In the normal non-concierge setting the ideal average patient load for a primary care provider has been estimated at 1,000; however, many physicians say the reality is around 2,500. One organization, the American Association for Physician Leadership, says the number is closer to 3,000.
On average, people that use concierge medicine visit their doctor four times/year and spend about 35 minutes with the doctor each time. Of course, you still need to have health insurance to cover tests, hospitalizations, prescriptions, etc.
According to Concierge Medicine Today, there are between 10,000 and 25,000 physicians practicing membership-based care in the United States and abroad. The Direct Primary Care Coalition estimates that 1,600 DPC groups provide care to more than 300,000 people in the US.
About 20% of the wealthiest 1% of Americans make use of such services. we looked into it a while ago and found it was expensive and we had a hard time finding a practice with the right specialists for our family.
However, as we used to say in engineering, your mileage may vary. That is, it isn’t a panacea and there are myriad complaints. Sometimes the patient is told they have had enough visits with the doctor, sometimes the doctors are not able to really find the problem and the patient is given the run around. I have friends who have had that problem. After multiple visits, with no real improvement, they chose to find a doctor elsewhere who understood the problem and they were able to get some relief. You can read actual stories like that here.
The real problem is that healthcare in the US is dysfunctional and this is a response to that dysfunction.
Even the AMA offers warnings about Direct Primary Care services. They are in the link and mostly caution doctors not to promise that they will provide better outcomes for patients with concierge medicine.
Summary
Paying more may or may not get you better results. But it is a symptom of the degeneration of the US healthcare system.
I still favor improving the system for the vast majority of Americans. The way that makes most sense is to make sure everyone is covered, cradle to grave, no copay/deductible, and expand where coverage is offered and increase the number of providers. Oh yes, that’s universal healthcare.
Action
If you have a minute give your member of Congress a call and tell them to support HR 3421 the Improved Medicare for All act. Here is their number (202) 224-3121.
RESOURCES
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Important Healthcare Resources
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Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Thank you for your response. I do not want to have an advantage plan now that I know these companies have been scamming the government AND do everything they can to avoid paying large bills.
I also do not wish to have Kaiser. Longer story, but with Kaiser, I have had some great doctors and unwarranted denials, while watching some people die through Kaiser mismanagement. A person cannot sue Kaiser while insured. A family friend did successfully sue once her husband was dead. I personally had to pay a hospital bill because I didn’t get a referral and went to the wrong hospital from an urgent care.
I’m looking for the type of coverage your wife has opted for.
At my age, I’ve witnessed the de-evolution of insurance companies throughout my life. I don’t trust them at all. But I need coverage as I age and am more likely to need coverage for hospitalization or larger cost things.
Thank you for your help.
I was referred to you by a woman in my Women’s Group. I have a question. Since Im quickly becoming disillusioned by my Providence Medicare Advantage Plan, do you know of a way to compare other Medicare Insurance Plans without being hounded by phone calls and agencies I do not wish to deal with?
By the way, I am a healthy senior who when faced with one ambulance, clinic/ER visit and one prescription while on vacation in Hawaii, saw all three charges denied by my insurance. I was suspicious about all the little carrots these plans offer, likely to distract from atrocious service and denials when a patient really needs them.
Thank you.
Cathy