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« Houses, cheap! | Main | Alpha parents »

Nov 24, 2009


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Are this and/or all of a sudden "mamagrams arent really that reliable or important until your 50" connected with possible gubmint medicine? I aint payin $1500 bucks a year for the "privilege" of seeing a doctor. Unless I have to of course.

Joe Guarino

Ed, I think this is a legitimate practice model. There are a fair number of problems for patients and physicians associated with "insurance medicine"-- which is what most of us have to practice; and this is an alternative to that status quo. (BTW, it is my understanding that Dr. Vaughn is the first to have attempted this particular new model in Greensboro).

I have had companies require that I sign an annual service agreement, for instance, for maintenance and troubleshooting of my computer hardware and software in my office. That is associated, of course, with a fee. That fee guarantees they will be there for you when they need you. This is a similar model. Retainer agreements, for instance with an attorney, operate under the same principle. This approach is non-traditional for medicine, but it exists in other fields.

I think many patients who can afford it would like this particular model. Many patients have numerous, complex medical problems that require active, ongoing management.

I don't know how many physicians operating under this model will be supported by any given local market, however.

Ed Cone

Thanks for the perspective, Joe -- good to hear from an MD.

Ian obviously feels left behind by his doc. That doesn't mean there's not a place for different approaches in the marketplace.


And thus we see a preview of one of the many unintended consequencs that health care "reform" will produce.

Dave Dobson

Um, like, how can healthcare reform that hasn't happened yet be causing something now? It seems like this is evidence for how current healthcare is broken, and why it needs reform.


Many patients have numerous, complex medical problems that require active, ongoing management.

Maybe it's just me, but this is not an intuitive connotation of "VIP."


"Um, like, how can healthcare reform that hasn't happened yet be causing something now?"

Um, it's called contingency planning, but the model works fine under current assumptions.

And they didn't even have to gin up the models to get the desired results, as is commonly done in a certain pseudo science industry.

greensboro transplant


how is this evidence that "healthcare" is broken? what reform would you suggest to remedy this?


Um, it might be called, like, being proactive and such. I, like, hear businesses and such,like, operate that way.


This model was being discussed several years ago, before hcr became a campaign issue.


What about the mamagram issues?

Ed Cone

Mick, I don't see a connection between the mammogram guidelines are unrelated to health reform.

Ian McDowell

Joe, this isn't an alternative to "Insurance Medicine." Dr. Kindl's patients, like all those who sign with an MDVIP provider, will still be expected to have their usual insurance, and all usual rates and fees will apply. Were I to continue using him, I'd be paying the same thing for Bluecross as I currently am, PLUS another $125 a month for the "right" to see him (in some cities, the "membership fee" is as much as $5,000 annually).

As for "contingency planning," a casual googling shows that MDVIP was being touted as the "future of medicine" as far back as 2004, and that by 2005 one out of every four doctors in Boca Raton, where they started, had signed with them. They've been growing by leaps and bounds ever since, at a steady rate that suggests they would have regardless of who won the last election.

Proctor and Gamble's affiliation with MDVIP is also a cause for concern.


"Contingency planning" works both ways.

With the growth of consumers "entering" the health care arena under new mandates, medical practices will take steps to control the size of their practice to insulate from the necessity to deal with an ever more invasive bureaucracy and mindset brought to bear from further government intrusion.For a consumer not willing or able to enter into a provider relationship like this, the alternative is subjecting oneself to the indignities and outrages inflicted by the government controlled system.

If the worst parts of health care "reform" become a reality, you the consumer may find it wise to enter into a relationship with a caregiver who has a program like that mentioned above before the practices stop accepting new patients.

On the other hand, the idea may turn out to be irrelevant. As well we know from the words of certain of the Drumbeaters, the current health care "reform" is just a building block toward the requisite deprivation and lower quality of service found in government mandated control, and such practices as described above will likely find themselves outlawed.

Never under-estimate the power and ability of bureaucrats, do-gooders, "regressives", and politicians from screwing things up when given a chance like this one presents.

Joe Guarino

Ian, it IS, in fact, an alternative to insurance medicine, both for the patient and the physician.


The physician is not submitting a claim to the insurance company for his services, and is not bound by what the insurance company will pay him. He is therefore freed from the necessity to see high volumes of patients and generate high numbers of procedures to survive economically. That is the legacy of insurance medicine, and explains the sometimes unhappy state in which physicians and patients often find themselves.

For the patient, it offers the possibility of a higher quality experience, quicker access to their own physician, and a more comprehensive approach to their problems. For instance, managing diabetes-- when handled correctly-- is an extremely complex endeavor.

This is not necessarily a "good buy", from a consumeristic standpoint, for the patient is usually healthy, of limited means. But it can be for those who can afford it, or who have lots of problems.

I happen to think that it is inappropriate for insurance to pay for routine physician visits. It is part of the reason we have had such atrocious health care inflation. Insurance ought only to kick in after a certain amount of out-of-pocket expense has been generated-- after a significant deductible has been satisfied.


As we are possibly staring in the face of government health care of some sort all of a sudden we dont really need mammograms as early as we thought.

Ian McDowell

Joe, if you go to Dr. Kindl's MDVIP website and click on "Join Now," you will find a window asking for your insurance carrier:

And on his FAQs page, he says:

"You will still need health insurance to cover your healthcare visits that are unrelated to the comprehensive, annual preventive care examination, including office visits, hospital stays and visits to specialists."

That does not sound like an "alternative" to insurance to me. As I said, if I sign with him, I would be keeping exactly the same insurance plan as I have now and be paying exactly the same insurance premium, PLUS an additional $1,500 a year or $125 a month.


So go check out an HSA 100 policy with a deductible that fits your needs, and can help you cover the physician's costs.

Here's the advantages: You make a pre tax deduction out of your physician's fees, you're likely to have little or no deductible for hospitalization should it be needed, and your monthly insurance premium is likely to come down significantly.

Joe Guarino

I stand corrected on that point, Ian. This is a bit different than the typical concierge medicine model I have seen, which usually forsakes insurance involvement completely. But most of the other points I made remain valid in terms of explaining the other benefits of the concept Kindl is advancing.

I am not sure to what extent insurance contracts for physicians will permit what you are describing-- remaining mindful that some private insurance and even Medicare cover some preventive services. Physicians typically are not permitted to go outside the insurance contract when they "participate" with a given insurer. I wonder if the model here is to refrain from participating with insurance contracts, but to file claims anyway-- and then bill the patient for any unpaid amounts.

I do not argue that this is a good value for everyone. But I think it is a stretch to claim that anyone is "entitled" not to have to be a part of whatever Kindl is trying to do with his practice. It is, after all, his practice. We should have a free market in health care, which means patients and physicians should be able to make their own choices with respect to the conditions under which they are willing to see each other. It is the same as choosing the Fresh Market over Food Lion, Lexus over Ford.

Of course, depending on how things go, that may be all gone in a few years anyway.

Ed Cone

Mick, I understood the question. I'm saying I don't think there is a connection.


Hmmmm, $1500 times 600 patients, that’s $900,000/year before taking care of anything not related to “wellness”. Sounds like a sweet deal for SOMEONE, I suspect most of all the corporate entity that has seduced these doctors and also,....does what again?

“MDVIP provides the services required to assist your doctor in providing a focus on preventive care and personalized service that is not possible in a traditional primary care practice. Your doctor owns and manages the practice, and MDVIP has absolutely no involvement in any medical decisions. MDVIP's job is to simply remove all obstacles that exist in the delivery of the highest level of care.”

Repeat: ".....MDVIP has absolutely no involvement in any medical decisions. MDVIP's job is to simply remove all obstacles that exist in the delivery of the highest level of care.”

So the obstacles to the delivery of the best level of care have nothing to do with medical decisions? Would anyone like to take a crack at explaining that one to me?


Gotcha. My mistake.
Im not sure there is either but the timing seems odd.

"Who are the PR wizards who came up with that" (using Seinfeld voice)

Charles Crabtree

After 10 years of yearly physicals and maybe two or three visits for other minor problems I am not paying $1500 for the privilage of seeing this doctor if I have other choices, which I do...

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