<p>Have been reading about the spreading of “concierge medicine,” where you are asked to pay an extra annual fee of $1500-1800 so you can keep your doctor and have the ability to see him/her more quickly (or at all), possibly have email & other messages with him/her, and other benefits. This will pare down doc’s practices from their current 2500 or whatever it is to 500-700 patients, increasing shortages of healthcare professionals and squeezing pocketbooks in an already tough economy. It will also make it more difficult to access healthcare professional services, particularly in areas already experiencing shortages. It supposedly will focus more on preventative medicine. Companies like MDVIP are helping with this. The company gets 1/3 & the MD gets the other 2/3s, “focusing on quality rather than quantity.” The MD in our state who was interviewed about it says that more docs will go into primary care when they can get better compensated & that he currently nets under $100K before taxes, which was one of his motivations for switching to this.</p>
<p>Hard to see how this is allowed under Medicare & private insurance–perhaps they will not participate in those. I’m hoping my current docs don’t switch to this, as I really like them and would have a hard time replacing them. While I could afford the annual fee, I’m not sure I would pay it because it doesn’t seem right. The docs should be adequately compensated by the insurance we are paying so much for in premiums & decades of Medicare contributions.</p>
<p>My doctor did this. Insurance won’t pay the fee, but the regular services stay the same. I don’t like it, but I paid, because I like him and he’s been following me for a long time at this point. Although the promo materials claim this isn’t the case, I think part of this is a transitional phase so a doctor who is getting nearer to retirement age can reduce his workload while maintaining his income. It’s tough luck for the patients who can’t afford the fee.</p>
<p>I don’t have a problem with concierge medicine as long as there are adequate numbers and quality of providers for everyone else. In fact, if we do get universal health care in this country, I see this as one of the normal market answers to how wealthier people will get more convenient services. I don’t have a problem with people being able to buy a Lexus while most people can only afford a Ford—as long as Fords are available.</p>
<p>H’s former doc had a partner who has transitioned to a concierge practice. Something like $1300 a year + the cost of whatever isn’t paid by your insurer for office visits. He doesn’t seem to be doing fabulously with it.</p>
<p>Well, it still is a free country so good for them. They are sick of being bullied on all sides. Nobody can make them practice in a way they do not want to do.</p>
<p>It’s very tough out there from all sides, as you say, Barrons. I have relatives & friends who are docs & they are having a lot of expensive challenges transitioning to electronic medical records (which sound a lot more wonderful in theory than practice). I can definitely see the attraction to docs & patients in concierge medicine but also see that it can create and worsen shortages, especially in caring for older, sicker patients. It’s very challenging as it is around here to even get a good internist, much less keep one. Ours are slightly older than I am and slightly younger than H. We’re hoping they will keep going for a long while yet; since they just moved their practices to a gorgeous new building, it seems they plan to stick around awhile or they wouldn’t have bothered.</p>
<p>Compensation to docs have been decreasing while your insurance premiums are going up. Guess who are the beneficiaries?</p>
<p>Medicare is a pyramid scheme, your contributions have been supporting those who have used the services already. It’s not being adequately funded now with massive unemployment and less people are contributing. In addition,Medicare payments to doctors hardly cover the practice’s expenses and Congress wants to cut payments to doctors a further 25%. If it passes, many primary care doctors will not be accepting Medicare payments because they won’t be able to stay in business. In our town, many doctors are already restricting the number of Medicare patients and I know seniors who have moved here recently cannot find an internist who will take them.</p>
<p>Primary care physicians bear the brunt of low compensation because they don’t do procedures that are highly compensated and the procedures they perform are coded at a rate much lower than a specialist. For example, if you have a cyst frozen by an internist, it may cost you $100. If you have a dermatologist do the same procedure it may cost you $300.</p>
<p>At the practice where my wife works Medicare payments are considered OK. It is Medicaid and similar programs that is absolutely not worth the bother.</p>
<p>Last time I looked for a primary care doctor, they were most readily available at large multispecialty practices, where they share billing services and overhead with specialists, who get referrals in return.</p>
<p>Lots of people who get jobs in the billing bureaucracy at both the doctors’ offices and insurance companies.</p>
<p>One could argue that much of this is really wasted work that does not add much value overall in the scheme of medical care, but it is not an easy political hot button scapegoat.</p>
<p>We have concierge. I love it. I hated having my Doc’s dictated to by the insurance companies and told what they could and could not offer, though I was certainly always willing to pay out of pocket for any tests my DOCTOR thought necessary, sometimes they were reluctant to even suggest.</p>
<p>Now, my medical is between my Doc and me. She can suggest anything and I can do whatever, and the insurance company can pay what they will pay for without prohibitting me getting what I want and my doc thinks I need.</p>
<p>Win-win-win.</p>
<p>Insurance companies are the bane of this country, from nanny-state laws to healthcare, everywhere they go, they make our lives miserable with the laws they help to write.</p>
<p>I hadn’t heard about this. Our local clinic is replacing Drs who leave the practice with Physician’s Assistants and Nurse Practitioners. I absolutely love my PA! She spends much more time with me than my MD ever did and is much more thorough. I think this is the way we need to go with health care. That and getting rid of insurance companies.</p>
<p>A reason for this is that people expect every little medical expense to be paid for by “someone else”, instead of self-paying the small stuff and reserving insurance for catastrophic costs and losses the way insurance was meant to be used.</p>
<p>In other words, people want first dollar coverage from their employers or the government (Medicare) instead of a lower cost high deductible plan (with the savings paid to them in higher paychecks or a medical savings account or (in the government case) non-shaky government finances and possibly lower taxes). But they don’t realize that first dollar third party payment means that the third party becomes more intrusive since it does not want to be abused.</p>
<p>I’m not just talking about medical insurance. Insurance companies are creating a nanny state with their lobbied for laws and policies. Every time you lose freedom of choice in this country, be sure there is an insurance lobby behind it, making sure they won’t have to “pay” cuz you fell off the monkey bars.</p>
<p>My last two doctors have left to start concierge practices. I was never sent a letter to “invite” me to the practice. I don’t go to the doctor enough to justify the high cost, so maybe they only solicited patients they felt would be interested. Or else they just don’t like me. :(</p>
<p>^^Maybe since they “left” their old group, they weren’t allowed to solicit your patronage. A non-compete clause or something like that may have been in effect.</p>
<p>This was very popular in my area about 5 years ago. With the economic downturn, I have heard that it’s not working out too well for the doctors that tried it - at least around here.</p>