Mar 6, 2014 • 19M

Concierge Medicine Helps Physicians But at What Costs to the Patient: A Conversation with Casey Schwarz (March 5th)

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Appears in this episode

David Introcaso, Ph.D.
Podcast interviews with health policy experts on timely subjects. The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics. An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void. Among other topics this podcast will address: •Implementation of the Affordable Care Act •Other federal Medicare and state Medicaid health care issues •Federal health care regulatory oversight, moreover CMS and the FDA •Healthcare research •Private sector healthcare delivery reforms including access, reimbursement and quality issues •Public health issues including the social determinates of health Listeners are welcomed to share their program comments and suggest programming ideas. Comments made by the interviewees are strictly their own and do not represent those of their affiliated organization/s.
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Concierge medicine (also termed membership medicine, direct pay or cash only practice) has become a rapidly-growing care model moreover among primary care physicians.  In concept, physicians charge patients a monthly or annual fee that can vary widely from approximately $50 per month to $25,000 per year (or accept cash only per visit).  In exchange patients are promised greater access, longer appointment times and possibly services not typically reimbursed by payers.  The current number of physicians practicing concierge medicine is today small, approximately 5,500 nationwide, however, concierge practices are expected to continue to grow at a healthy rate, currently estimated at 25% per year.  While these fees enable physicians to reduce patient panel size and presumably improve physician satisfaction, the model by definition posses access problems for the sickest patients, typically those least able to afford a concierge fee.  For example, among Medicare beneficiaries, in 2012 half of all had annual incomes less than $22,500 and for African American and Hispanic Medicare beneficiaries annual income was less than $15,000. 

During this 21 minute discussion Ms. Schwarz explains the intersection between concierge medicine and the Medicare program, related investigative efforts by CMS and the DHHS Office of the Inspector General, whether there is any data showing improved care quality and/or reduced health care system costs, whether the practice of concierge medicine constitutes patient abandonment and what would the Medicare Rights Center tell a beneficiary if they called the Center inquiring about the appropriateness and merits of concierge medicine.    

Ms. Casey Schwarz is currently the Policy and Client Services Counsel at the Medicare Rights Center in Washington, DC.  Among other duties Ms. Schwarz represents individuals in appeals and directly counsels individuals with complicated Medicare questions.  She works closely with the Medicare statute, regulations, and guidance on a daily basis, including drafting responses to proposed regulatory changes.  She also provides trainings for legal and other professionals working with Medicare clients.  Prior to her Rights Center work Ms. Schwarz served as a Court Attorney in the New York County Supreme Court.  Ms. Schwarz is a graduate of Brown University and the New York University School of Law.  She is a member of the New York  and Maine State Bars.