Boutique Health Care: The Wave of the Future?

Have you ever called your doctor, only to be told that you could not get in to see him/her on the same day as you called? Or, have you ever gotten that precious appointment, only to wait for thirty minutes or longer once you arrived at the office? Residents of Summerlin (a populous neighborhood of Las Vegas, Nevada) have dealt with this frustration for some time. Now, Dr. Gunther, one of the local physicians in question, has proposed a solution and Summerlin residents have until December to decide whether to accept it or not. The solution? MDVIP.

MDVIP is a service that doctors may sign up for. Here is how it works: Dr. Gunther has 2,000 patients. Due to insurance regulations, he cannot currently spend more than eight minutes with any patient. This includes time spent filling out forms. As you can see, this is a very frustrating situation, not just for the patient, who doesn't really get to see the doctor for all that long; it is also frustrating for any good doctor, who naturally would want to spend time with the patient. With MDVIP, the doctor's caseload is cut to 600 patients, maximum. Each patient pays Dr. Gunther $1500 per year, which guarantees same-day appointments, with no waiting time. It also guarantees that you can reach the doctor at any time, via cell phone or pager. In addition, you receive a state-of-the-art physical examination, including blood tests, etc., once a year. The doctor takes this information and develops a personal wellness program for you. All of your medical information is then compiled into a 3" CD-ROM, which you can carry with you. Were something to happen to you on a trip, or even in your home town, your medical information would be immediately available to whoever cares for you. This service, through MDVIP, is called boutique health care. It has been written up in the local papers as well as in the weekend edition of The Wall Street Journal. Here are a few of the issues that concern patients as they decide whether to enroll for MDVIP, and pay the $1500.

According to local papers, the city of Las Vegas is comprised of 40% senior citizens. Summerlin, a neighborhood about ten miles West of the Strip, has several housing developments, some of which are quite large (2,000 homes or more) exclusively for people over 50. One of the reasons that there are so many older people here is, there is no state income tax. In addition, property is cheaper here than it is in California, with comparable weather, other than the extremely hot summers. You can still buy a home in Las Vegas for $350,000. California real estate, by comparison, hovers around the $500,000 mark. Another attraction is the cheap food: Food in Las Vegas supermarkets is cheaper than in California and in Washington (state), and, because the casinos rely on gambling for their revenue, residents can eat out in a "locals casino" for relatively little money. These casinos, such as the Stations Casinos, have cafe's where some dishes run as little as $6.00. All of these factors have combined to make Las Vegas one of the fastest-growing areas of the nation for the past ten to fifteen years.

When you consider that many of the reasons that people move to Las Vegas are monetary, it is reasonable to assume that the first reason that patients of Dr. Gunther may be leery of MDVIP is the cost. According to Marla, a spokeswoman for MDVIP, the $1500 goes primarily to the cost of the annual physical. Other than this physical and the CD-ROM, and the access to a doctor sooner than before, a patient under MDVIP continues to receive the same care they would receive without the program. According to literature provided by MDVIP, the program is "entirely compatible with Medicare." The patient's insurance continues to pay for a doctor's visit, hospital stays and visits to specialists. The patient still has a co-payment. Referrals still go through the primary care physician, as before. The $1500 annual fee is not covered by insurance. However, you can use your credit card to pay for it. There is also a quarterly payment plan.

One comment by a person considering whether to join MDVIP, was "I'm fine now. Why should I pay the $1500?" The MDVIP literature provided at a doctor's meeting with patients in late October states, "It is one thing to think about prevention and early detection; it's another thing to work with a doctor focused on this approach to care. Here the doctor is a partner, not just in treating illness, but in working with you towards wellness. This kind of preventive care cannot be offered in a large practice." It continues: ". . .your doctor can offer dramatically enhanced coordination of specialty care. Unlike traditional practices in which a patient is referred to a specialist without further involvement by the primary care physician, your MDVIP-affiliated physician will actively coordinate your specialty care." The problem is, should this type of care be available only for those able to pay $1500 a year for it? I was at the meeting a few weeks ago, and there were a few people who got up and left, probably because they couldn't afford the $1500. Most of the people at this meeting were elderly. Is this a fair thing to do to our older people? Regardless of how many can afford it, at least 1400 elderly patients will be looking for a new doctor. Is this right?

There are comments made in the media about the fact that so many poor people, particularly children, are not insured. What about the elderly? What does it mean when a doctor's attempt to improve his practice brings about a situation where other doctors, who may also be in the same boat as Dr. Gunther, have to take on additional patients? Will more of them elect to join MDVIP? Will there be a snowball effect? I understand that the AMA restricts the number of prospective doctors allowed to enter the medical schools each year. There is a shortage of rural doctors, already. As the population grows older, what will happen to those who cannot afford health care? What does this occurrence -and MDVIP is now in several states, particularly Florida, which also has a high concentration of older people - mean? Is "Boutique Health Care" the wave of the future? And, if so, what does it mean?