Reform or Innovation: Common Sense Should Prevail

This week I ventured into the blogosphere in search for updates or any innovative idea that may contribute to the momentum of health care reform. Soon after Google’s announcement of its health initiative on February 28, I wrote about the benefits a national health information storage system will bring. I am delighted to find the post, “Health 2.0: Getting in PHR, Privacy and Deborah Peel issue off my chest,” written by Matthew Holt. He provided very sharp counter arguments to the allegations that such information would violate patient’s privacy. By separating myth from reality, he brings common sense back into discussion of such an important subject. According to Matthew, the real issue is not of violation of patient’s privacy, but is in the inefficient use of medical data that causes harm and wastage. I found another post, “Concierge Medicine from a Doctor’s Perspective” by David R. Donnersberger , MD, JD, very interesting. Though it is not a brand new topic, this business model appears to be gathering momentum. Under “boutique medicine” or “concierge care,” physicians ask patients to pay an annual retainer fee. In exchange, patients get greater access and personalized service. According to Darin Engelhardt, the Chief Financial Officer and General Counsel for MDVIP, a Florida based company that helps doctors transition to boutique practices, “95% of the company’s 40,000 patients renew their annual memberships each year. The business model appeals to over-worked and over-booked physicians. I wish to present my comments on these two posts for you below.

"HEALTH 2.0: Getting the PHR, Privacy and Deborah Peel issue off my chest"
Comment:
Thank you for drawing our attention to the right focus. As you wrote, “the biggest problem with the United State’s health care system and its use of technology is not privacy violations. It is the inefficient use of data causing harm (and costs and poor quality care).” You managed to introduce common sense back into the discussion; the setting up of national health care information adds no additional risk to patient’s privacy rights than what actually exists now. The information uploaded to the system is a mere copy, not the original. In fact, what is uploaded can be de-identified, thus offering patient privacy protection. Naturally, a well-designed system will preserve consumers’ right to decide who gets access to the data. Perhaps, consumers or patients may specifically block insurance companies, financial institutions, and employers from accessing the information. This will address the concern that these business entities may use the information to deny insurance coverage, loans, or employment, which creates whole new classes of people who are unemployable, uninsured, and dependent on the government, as Dr. Deborah Peel of Patient Privacy Right Foundation claimed. I believe consumers will appreciate that with Microsoft, Google, and Dossia getting into the business; the overall PHR industry privacy quality will improve. The Health Insurance Portability and Accountability Act, written before any PHR vendors came into business, is not updated but can be amended or modified to come up with a broader “covered party” definition, and to standardize patient privacy disclosure code for PHR vendors requiring the sale of data only in a de-identified format. We therefore should not use any loophole in HIPAA (logo shown to the left) to deny the value of a national health information system. A consumer will share personal information if there is a return or benefit. A borrower gives up his/her social security number in the loan application and allows a bank to access his/her credit report. We provide our medical history, together with the social security number and other personal data in the purchase of a health insurance policy. As a traveling person, I want my personal health information on a system that is secure, accurate, and readily available to those who need to take care of me, especially in times of an emergency. What good is my personal privacy will do for me if I no longer exist to give meaning to it.

"Concierge Medicine From A Doctor’s Perspective"
Comment:
Thank you for sharing this growing trend. I believe that our health care system is very vibrant, notwithstanding its shortcomings and challenges. Consumerism and capitalism play a big part in our health care system. Consumers want choices, and service-providers seek returns. Boutique medicine or concierge medicine (as shown in the image to the right) meets both expectations. I am not suggesting that financial reward is everything in our economic system, nor is the only deciding factor in a supply and demand equation. For a physician, a small client base means more time devoted to patient care and advocacy, along with continuing medical education and family life. While a care-giver may have to sacrifice financial gains, getting greater satisfaction from long-standing doctor-patient relationship offers a different kind of gratification, which an over-worked, over-booked physician will miss. A reduced patient load for physicians often translates into longer and same-day appointments, better coordination with specialists, and more emphasis on preventive care. Concierge care may potentially result in a two-tiered medical system based on wealth of the patients. Some decry concierge care as another step toward a medical system in which the rich get no-wait examinations and the poor sit for hours just to see a HMO doctor for 15 minutes. This is simply the nature of a free market. According to one comment on your blog, in Europe, where the universal health care system is long established, a significant percentage of people pay out-of-pocket to see specialists, avoid long waiting rooms, get MRIs, more appointments sooner, or see a doctor who is said to have better training or personality. While the concept sounds ideal, my concern is that physicians who choose to take part in this boutique medicine business model may not cancel all their contracts with third-party or government payers. As a result, doctors simply commercialize the doctor-patient relationship, and patients who pay the fixed annual fee in anticipation for premium services and attention will not get their bargains. Such business model is not widely available. According to the General Accounting Office, in 2004, there were just 146 concierge physicians in the U.S. My other concern is what will happen to the established doctor-patient relationship when one party has to relocate, especially for a patient who is very accustomed to a concierge care moves to a new region where such service is not available.