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VIP patients: how does your program deal?
- Thread starter tyrionlannister00
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The "VIP patient" thing happens everywhere - and chances are good that your attendings also are feeling pressured to make sure the VIP is happy.
Some have argued that "VIPs" actually end up getting worse care because the things we do or don't do for them aren't always actually the best standard of care. I mean, just look at what happened to Michael Jackson. Maybe MJ would still be alive if he wasn't Michael Jackson and had doctors who told him "no" instead of giving him everything he wanted.
I have been a patient being treated by people who didn't know me professionally, and I have definitely noticed a difference in how I am treated when the doctor and nurses know that I am a physician vs. when I don't draw attention to that fact , even though I never ask for or demand special treatment (I usually don't bring up that I am a doc unless I'm asked what I do for a living just because I'd actually prefer to be treated normally by people who treat all their patients well).
I do think this is a valid ethical concern, but unfortunately with the way the world is I'm not sure what can really be done about it.
Some have argued that "VIPs" actually end up getting worse care because the things we do or don't do for them aren't always actually the best standard of care. I mean, just look at what happened to Michael Jackson. Maybe MJ would still be alive if he wasn't Michael Jackson and had doctors who told him "no" instead of giving him everything he wanted.
I have been a patient being treated by people who didn't know me professionally, and I have definitely noticed a difference in how I am treated when the doctor and nurses know that I am a physician vs. when I don't draw attention to that fact , even though I never ask for or demand special treatment (I usually don't bring up that I am a doc unless I'm asked what I do for a living just because I'd actually prefer to be treated normally by people who treat all their patients well).
I do think this is a valid ethical concern, but unfortunately with the way the world is I'm not sure what can really be done about it.
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Most hospitals live by the Golden Rule….those who have the gold make the rules. As for if it is fair…look at it this way…if a donor gave $10m to expand an existing program, their "net" contribution is far more than whatever extra perk here or there they may get if they are in the hospital. Some of the other patients on the floor may not have been able to be on the unit if they didn't expand the program.
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I haven't run into this issue on psych, but we do have a med/surg floor of one of the hospitals that is for VIP's. There's less nursing staff, their single rooms often stay closed, trainees aren't usually posted on the floor (although do round there). These things actually lead to worse care IMO.
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VIPs at our shop generally go to the "nice" floor if they are psych inpatients, that has lovely common areas, a good view, and is ostensibly focused on trauma-informed care and for those of a more delicate disposition. We have a lot of very specialized units, but in contrast the gen pop adult psych floor is sometimes referred to as Thunderdome.
It is also the floor our frequent fliers always specifically request. They almost never get it. I have had people in an emergency context before who I would have wanted to admit if and only if beds were available on the "nice" floor, but was pretty sure would not benefit from being elsewhere in our hospital.
So OP, other people definitely face this challenge as well.
It is also the floor our frequent fliers always specifically request. They almost never get it. I have had people in an emergency context before who I would have wanted to admit if and only if beds were available on the "nice" floor, but was pretty sure would not benefit from being elsewhere in our hospital.
So OP, other people definitely face this challenge as well.
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Your "nice" floor sounds delightful and immediately went to the top of my list for when I self-present to the ED with my first psychotic break because I am far too miserly to pay for Sheppard Pratt's Retreat. Upon reading further however due to my lack of delicateness I have accepted that I'd probably be a better fit for the "Thunderdome". 🙂
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The question is not whether a certain patient gets better than the average treatment, it is whether the standard of care for the average patient is acceptable. Only in the liberal socialist fantasy world does it make sense to lower the standards for the wealthy to make up for crappy treatment of the poor.
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My old hospital actually had special VIP rooms that you could pay extra for. The VIP patients had a hand-selected staff (you didn't even know you were on the staff until you were informed of it, to avoid people asking you about VIP guests), premium accommodations, and food served on a- I **** you not- silver platter. The hospital was trying to set itself up as a destination center for certain treatments and procedures, and was trying to use such facilities to lure in extremely high net worth and famous clients to build their reputation.
They obviously got to skip any lines or waiting, and had their team at their beck and call for any possible needs.
They obviously got to skip any lines or waiting, and had their team at their beck and call for any possible needs.
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Ah, psychosis wins you a trip to one of our several dedicated psychosis units, so no glassy atriums for you I'm afraid.
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deleted480308
I'm cool with that if they are footing the bill for it out of their pocket...
I'm confused by OP seeming to be cool with special treatment for staff family/friends but not for someone that wrote a $1mil check to the hospital.
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I didn't really have a problem with it either. The fee, however, was actually quite minimal for the level of service offered (I believe an extra $140/day), and the rooms were really only made public to people "deserving" of such treatment. I think it should have been more expensive, if anything, but hey, that's a loss leader for you.
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deleted480308
the capitalist in me flinches at the notion of a "cool kids" list that can access the rooms, I also don't like the notion of the elite rooms not being profitable for the extra service...it ends up with the other "normal" rooms subsidizing them that way
but you charge enough for the extra services to make a profit or break even and anyone is allowed to buy in? I'm in love with it
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My primary care office joined up with a company called n1 to offer concierge level care. I think it was about $6,000 per year in addition to your regular co-pays.
When I looked at what they offered, it was all the stuff they're already supposed to do: Return phone calls, fit you into the schedule when you're sick, etc.
It's kind of like skip-the-line passes at amusement parks in that only so many people can sign up. I had a feeling they would regret me as a member even with all the extra money. I got the impression they were hoping elderly people would sign up and not use it that much.
It does raise real ethical concerns. It means that doctors are allocating more time to certain patients based on their willingness to pay over their their need (because in this case the doctors continued to provide care in the traditional office and the concierge office, but obviously had less time available to their existing patients who didn't move over to the concierge practice). The doctors were already overbooked, overworked, and had too many patients. So it doesn't solve for the original problem, except for those willing to pay more (but even then as I said, when I started asking questions about how much you could be seen, etc., they started getting hesitant).
Of course, those ethical concerns are already sitting on top of a huge mountain of existing concerns—the people who can't afford to get into the theme park at all, let alone afford the fast-pass.
If you include concierge service, we have an entirely new tier of healthcare (not in any order): 1) No insurance with ability to pay 2) No insurance with inability to pay 3) Public insurance 4) Bad private insurance 5) Good private insurance 6) Good private insurance plus the fast-lane pass
Good and bad private insurance should also have subcategories of percentage of income they take up, as it is indicative of your tendency to slide from good to bad to none.
EDIT: Apparently they closed in my area. Maybe they would have liked me as a patient after all.
When I looked at what they offered, it was all the stuff they're already supposed to do: Return phone calls, fit you into the schedule when you're sick, etc.
It's kind of like skip-the-line passes at amusement parks in that only so many people can sign up. I had a feeling they would regret me as a member even with all the extra money. I got the impression they were hoping elderly people would sign up and not use it that much.
It does raise real ethical concerns. It means that doctors are allocating more time to certain patients based on their willingness to pay over their their need (because in this case the doctors continued to provide care in the traditional office and the concierge office, but obviously had less time available to their existing patients who didn't move over to the concierge practice). The doctors were already overbooked, overworked, and had too many patients. So it doesn't solve for the original problem, except for those willing to pay more (but even then as I said, when I started asking questions about how much you could be seen, etc., they started getting hesitant).
Of course, those ethical concerns are already sitting on top of a huge mountain of existing concerns—the people who can't afford to get into the theme park at all, let alone afford the fast-pass.
If you include concierge service, we have an entirely new tier of healthcare (not in any order): 1) No insurance with ability to pay 2) No insurance with inability to pay 3) Public insurance 4) Bad private insurance 5) Good private insurance 6) Good private insurance plus the fast-lane pass
Good and bad private insurance should also have subcategories of percentage of income they take up, as it is indicative of your tendency to slide from good to bad to none.
EDIT: Apparently they closed in my area. Maybe they would have liked me as a patient after all.
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deleted480308
The only ethical thing you mentioned in there was the accusation that docs took more patients than they could properly treat. Charging more for a "fast pass" isn't an ethical issue at all. They are just monetizing the opportunity cost of convenience.
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Its a big potential problem. If you can prove that the non-concierge patients are getting less of the usual care than the concierge ones. Its why most docs are advised to go either all or none for concierge/DPC.
Treating some of your patients differently from others based on a retainer is dangerous.
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deleted480308
I agree with you from a legal standpoint because our world is silly right now. I disagree from an ethical standpoint.
But it's all part of why, if I go primary care, I will either go full employee of a group/hospital or full dpc owner/partner. Halfway is too hard for people to wrap their minds around even if I know I could do it honestly
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Well it also depends on exactly what benefits your concierge patients get. If its the usual e-mail access, same day appointments, house calls type thing that's fine. But if, and this seems likely, the benefits run the risk of treating your regular patients significantly different it can run into an ethics area. For example, if your special patients get 30 minute appointments and your regular ones get 5 minutes it wouldn't be hard to argue that the 5 minute patients are getting substandard care. That's when you hit ethical dilemma land.
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deleted480308
Only if every doc in town with 5 minute appts gets brought up on charges too. Different and inadequate are not the same thing.....but again, i'm speaking philosophically about what should happen and that often has nothing to do with how courts feel
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Sign me up for that (if I sm ever in need of a hospital stay).
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All or nothing is definitely the way to go. "Standard of Care" would be of all docs in that area and not limited to just your services, correct?
I've talked w a few judges over the years about standard of care issues and they all had a similiar bar....and it was very hard to lose bc most courts gave a wide birth. All anecdotal, but still interesting for me.
I've talked w a few judges over the years about standard of care issues and they all had a similiar bar....and it was very hard to lose bc most courts gave a wide birth. All anecdotal, but still interesting for me.
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I know, right? It's Holiday Inn Express pricing for Waldorf-Astoria level amenities.
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I know a good deal when I see one! It's why I'll stay at a Waldorf-Astoria/Four Seasons level hotel instead of a Marriott because for not a ton more money the experience is far far better.
Frankly, I'm very supportive of the concierge model because we are being forced into having insurance, so I'd rather have more options for my care. Some people don't see the value in it (or do and can't afford it), but I'd much rather have the market dictate what can be a workable model. It's been a few years but from some of the articles I've read, the clinician burden (ratio of patients, # of appts, etc) are greatly improved, which I think is a win/win for the patient and the provider. There have always been different levels of care available based on the individual's funding, so I don't care that this would create another layer. Good for the people who can afford it.
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I get that, I just think its a bad idea for almost every angle to have separate classes of patients within the same provider's practice. And you might be able to not have such a setup affect how you treat patients, but that would be the exception - like how there are doctors who didn't ***** themselves out to drug companies in the 90s, but the evidence says they were very much the exception.
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deleted480308
I should be clearer for fairness sake (and again, i agree a mixed model is problematic). If I ran a mixed model they would absolutely be treated differently. That's what the upper tier paid for. A diner has no moral claim against a restaurant for getting the hamburger and diet coke at thr advertised $15 just because the table across the room paid the advertised $65 for steak and wine.
But you lose soooooo many of the joys of DPC if you go mixed model and I can't understand why anyone would choose that
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Even if you can ensure that your non paying patients are still getting care that's within the norm for the area, I think once the patients find out about the "fast pass" option many of them will resent it.
It could very easily look to the non-paying patients as though you could be spending more time with them but you're choosing not to because you care about money more than you care about the patient. The last thing we need is to encourage resentment against "those greedy rich doctors".
Of course, if enough doctors drop all their insurance patients and switch to concierge practice, then that brings up new issues. If enough doctors drop out of the conventional system, I won't be at all surprised if we see a legislative push to either shut down concierge docs or at least require concierge docs to see a certain amount of Medicare/Medicaid patients due to concerns about "provider access".
It could very easily look to the non-paying patients as though you could be spending more time with them but you're choosing not to because you care about money more than you care about the patient. The last thing we need is to encourage resentment against "those greedy rich doctors".
Of course, if enough doctors drop all their insurance patients and switch to concierge practice, then that brings up new issues. If enough doctors drop out of the conventional system, I won't be at all surprised if we see a legislative push to either shut down concierge docs or at least require concierge docs to see a certain amount of Medicare/Medicaid patients due to concerns about "provider access".
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deleted480308
You don't owe access to anyone. Forced acceptance is oppressive and unnacceptable
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I agree wholeheartedly. I just have a feeling that the public and our legislators may start pushing things in that direction.
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All true, and its treated differently in what way that matters. Most of the regular FPs I know are pretty lose with things like antibiotics for the sniffles and imaging for back pain. Technically we're told that's wrong, but I know of almost no one who actually adheres to the IDSA or CDC recommendations for antibiotic use or the Choosely Wisely for back pain because its easier at the moment and prevents call backs from patients (which are a time suck).
Most DPC docs, on the other hand, since we have time to actually explain why we're NOT doing the things that patients have come to expect seem to do less of those things.
You're not going to get sued or lose your license for either approach, but the latter is definitely better care 99% of the time.
If you can medically treat patients the same on a mixed model and not fall into the "I only have 10 minutes and giving them that z-pack is easier than explaining why I'm not going to" for your non-concierge patients, then you're better than most of us.
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True, but several states are trying it. After all, a medical license is a privilege...
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deleted480308
Ugh, i hate that mindset from govt like they are so generous by allowing me to work. Which states are trying that?
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deleted480308
I have trouble convincing my wife of that in an hour when she's mad at her doc. Likely I wouldn't give then the zpac and they quit my practice 😉
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Mass. and Hawaii thought about it, pretty sure it never made it far but that's how these things start...
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Not sure about the potential screaming fans, big league level of VIP patients, but I've been in the waiting/recovery area of a day surgery ward and seen a stalwart of Australian TV being looked after post whatever surgery she'd had (I'm pretty sure she's retired now, but she had a career going back 40+ years, and had appeared in lead character roles on almost every major Australian soap there was in that time). There was a few quick glances and smiles amongst the other patients when we recognised who it was, but after that we just went back to whatever it was we were doing at the time; nobody made a big deal out of it. What were we supposed to do otherwise, fire up a conversation, ask for an autograph, whip out our phones and start snapping selfies with her? The poor woman was quite obviously coming out of general anaesthesia and in some discomfort, I think of all the times someone would need their privacy respected that would have to be right up there.
