Concierge Medicine: a New System to Get the Best Healthcare.
Article Type: Book review
Subject: Books (Book reviews)
Author: Orient, Jane M.
Pub Date: 12/22/2008
Publication: Name: Journal of American Physicians and Surgeons Publisher: Association of American Physicians and Surgeons, Inc. Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2008 Association of American Physicians and Surgeons, Inc. ISSN: 1543-4826
Issue: Date: Winter, 2008 Source Volume: 13 Source Issue: 4
Topic: NamedWork: Concierge Medicine: a New System to Get the Best Healthcare (Nonfiction work)
Persons: Reviewee: Knope, Steven D.
Accession Number: 190198295
Full Text: Concierge Medicine: a New System to Get the Best Healthcare, by Steven D. Knope, M.D., 178 pp, hardback, $34.95, ISBN 978-0-313-35477-9, Westport, Conn., Praeger, 2008.

Dr. Steven Knope opened one of the first concierge practices in 2000, after a year in a group of five internists and 6 years of solo practice in Tucson, Arizona--"Ground Zero for the HMO movement."

"I did not like the pressures exerted on me by my employers to accept the new world order. I did not like being a cog in the wheel," he writes of his decision to leave the safety of the group.

His colleagues warned that he would "soon be eaten by the corporate predators." Other doctors were forming larger and larger groups in an effort to gain more clout at the bargaining table. But being the "doc in the box" at a large clinic just wasn't appealing. The system was killing Dr. Marcus Welby.

Knope describes two basic models of concierge medicine--a term he actually likes, not because it accurately describes the practice, but because he thinks it will stimulate an honest debate. His own model is a "hybrid." Besides his concierge patients, who pay a relatively high annual fee that includes a full gym and two sessions with a certified personal trainer, he takes on charity patients with complex problems, partly to help keep his skills sharp.

The book is designed more for patients than physicians. It offers much advice about managing and growing your health assets. There's an entire chapter on "Your Exercise Portfolio"--Knope himself has completed four Ironman triathalons, and one on "A Lifelong Nutritional Strategy."

Knope contrasts the schedule and approach of the busy primary-care physician in an ordinary practice with that of the concierge physician, and explains to patients how to get the best out of their physicians, as well as how to evaluate their current care. He provides a concise explanation of health savings accounts, and of the advantages of owning your own insurance.

Of greatest interest to physicians is Knope's experience with HMOs when he was chairman of internal medicine and later chief of medicine at his hospital--and his efforts to do something about the rationing and poor quality of care. He formed a group called the Tucson Alliance for Medical Excellence. He created and performed a scientific survey on HMOs that got prominent media coverage. But nothing changed. He filed a complaint with the licensure board about medical directors who denied care. The complaint was dismissed; the lead examiner had a serious conflict of interest. This was exposed in a front-page newspaper story. Still, nothing changed.

That's when Knope dropped all of his HMOs, which were responsible for 55 percent of his income. Despite the ridicule and predictions of ignominious failure, he did not go out of business, and missed not a single payroll. When the Office of Inspector General issued an alert about potential violations of Medicare rules by concierge physicians, Knope found that no one could explain what the rules meant. Rather than hiring a staff of high-priced lawyers, he opted out.

Along with much valuable practical advice, Knope offers "life's real lesson": Don't waste time fighting the system. Create!

Jane M. Orient, M.D.

Tucson, Ariz.
Gale Copyright: Copyright 2008 Gale, Cengage Learning. All rights reserved.