<p>How many of you subscribe to membership or cash only “concierge doctors”? How much is it costing you, and do you feel you’re getting your money’s worth? Is anyone bothered by the growing popularity of this brand of health care delivery? I have to say that I’ve got mixed feelings about it. I can certainly see why people who can afford it would take advantage of this option. But, the upward trend in popularity for this kind of service all the more urgently points to the inadequacy of contemporary PCP care in this country. It raises so many questions. What are the malpractice insurance needs for such a practice? Will it cause a shortage of insurance based doctors in the future? Will newly graduated medical students increasingly opt for this type of practice, if it means the ability to pay off medical debt sooner? It would appear that traditional insurance will remain an absolute necessity, even if one does employ a concierge physician, so the cost of health care will continue to rise ever more steeply. Where’s my silver bullet, darn it?!</p>
<p>We are swiftly heading toward a two-tier health care delivery system. The wealthy will always get what they need and the rest of us are falling further behind all the time, at an accelerating rate. This is just one more step along the path, and one more marker of our national deterioration. You’re right, it’s very sad.</p>
<p>We’ve always had a two-tier system. For example, someone gets an aggressive form of cancer. Those with means will often head to Johns Hopkins or MD Anderson to see ‘the best’, while those without a lot of money will have to settle for treatment at the local hospital, even though they have insurance because going far away for treatment includes the cost of transportation, taking a lot of time off of work, childcare, etc.</p>
<p>In my town, men who have the financial ability almost never get their prostatectomies here. They go to Duke, Johns Hopkins, etc. </p>
<p>The same holds true for those with and without insurance. Those with insurance are more likely to go to the doctors regularly, take their medications, get routine screenings. Those without insurance wait until they have a medical crisis before seeking care. Those with insurance are at a huge advantage when it comes to staying in good health. There is a strong correlation between how much money someone makes and their health status.</p>
<p>I find it depressing, as well. There was just an article in our local paper about the first concierge doc in our area. For a $1500 annual fee, he promises half-hour long appointments, same or next-day appointments with no waiting, and to be at the “constant beck and call” of his patients by email and cell phone. He plans to cut his current practice size from 2300 to 600 patients or less. Of course, the guy claims to be excited about the opportunity to practice better, more personalized medicine and dispense with some of the pressures brought about by the current health insurance situation. What about his poor, or poorer, patients? He’s kicking them out without any apparent concern.</p>
<p>My dh is an MD in a pediatric practice that includes many Medicaid and no-insurance patients. He and his partners work many hours and jump through many hoops to keep the practice going, and would never think of pulling a trick like this. He was disgusted and angry about the article. He’s been turned off by the way medicine has changed over the past 30 years but this one is an especially bitter pill for him to swallow. </p>
<p>And my regular internist, one of the few guys still in a solo practice, will see me on the same day if I’m sick. So it can be done without an annual bonus.</p>
<p>Agree completely ^^^. Spouse’s internist pulled this stunt a couple of years ago–spouse moved on to a different internist. Honestly, don’t know how much MORE office time we want. Mostly we just want a doc that will address the problem efficiently w/o a lot of extra time. In defense of the docs, however, I feel that insurance companies are a BIG part of the problem. Too many appear to be trying to practice medicine w/o a license. What is the solution? The whole system has become a real mess in my opinion.</p>
<p>It appears that the ordinary private or small group primary care practice is declining in favor of primary care practices in the concierge model (with membership fees and the like) or primary care physicians within large multi-specialty practices. Probably because primary care physicians bear the highest administrative costs dealing with insurance companies (lots of small claims, which is a really inefficient use of insurance).</p>
<p>$1,500 per year (I assume per person too) would be dirt cheap compared to what we (company + me) pay for healthcare. At 600 customers, that’s only $900K/year. How would that cover tests?</p>
<p>^ BC, I presume $1,500/year is the membership fee. Services would be billed separately in the customary manner … insurance, self-pay, whatever. Calculated that way, the doc is giving up 1,700 “less well insured” patients in exchange for the $900K.</p>
<p>These concierge practices seem to vary significantly. I think in many cases, these yearly “membership” fees are basically access fees, guaranteeing one more exclusive access to a physician (or physicians in a “holistic” practice), and “white glove” treatment. One must still pay office visit fees, lab fees, etc. And it’s still necessary to carry traditional medical insurance for many medical specialists, tests such as MRIs and CT scans, prescription drug costs, hospitalization, etc. Very few people are able to pay cash for all their medical costs.</p>
<p>My D studied this trend in classes (her degree is Medicine, Health, and Society). She thinks it sounds like a great deal IF you can afford it (and she has plenty to say about the lack of affordability of health care in this country). </p>
<p>AARP had a very interesting article last year about a similar model that is being piloted in rural areas. There is a health care team, and the patient has 24/7 access to someone who can answer his/her questions. The article seemed to show that this actually saves money in the long run. Of course, these are poor folks who don’t have health insurance to begin with … it’s not the type of concierge medicine referred to above. </p>
<p>I agree that those with money (who are willing to spend it on such things as health care, rather than cars, boats, vacations, fancy homes, etc) have always had access to better care. This is just an extension of that idea. Heck, the local dermatologist makes far more from folks who just can’t bear the thought of looking “old” than she does on checking a suspicious mole. Her practice is geared to those who are paying for stuff they don’t really need … and I felt hurried when I bothered her for something so mundane as a mole. (I switched doctors) </p>
<p>The point is, even health care providers respond to the demands of the market.</p>
<p>Insurance companies are awful. But most of your insurance companies base their policies right off of what the government does. Medicare has policies that make absolutely no sense-- except for them to find a loophole in a provider’s actions so they don’t have to pay the bill. And yes I would say they are one group that practice medicine without a license…</p>
You’re right, NewHope33. Sorry I didn’t make clear that the $1,500 annual fee is for the privilege of being a concierge-level patient only - everything else is paid through the usual channels.</p>
<p>What bothers me is that, prior to “managed care”, virtually all doctors were accessible to their patients. It was possible to reach them by phone after hours, they didn’t rush you out of the office after only five minutes in the examining room, and most of them maintained hospital privileges and oversaw the care of their hospitalized patients, instead of handing them off like footballs to various “hospitalists”. Doctors also use to be able to use their own best judgement when treating their patients, and didn’t have to submit to insurance company’s treatment guidelines and mandates. I guess I just don’t understand why that all had to change. Yes, my ignorance is showing.</p>
<p>^^^^Managed care changed things quite a bit. I ask myself everyday why things had to change… And I am a physician. I drive a VW Beetle (2003) and do not charge a concierge fee for the privilege of seeing me. Technology was part of the blame. Patients started researching their own problems, started requesting MRI’s when MRI’s were not needed… They did not always listen to the wisdom of their experienced physician. Then managed care took over. They managed the care, and the money. Insurance CEO’s make millions.</p>
<p>poetsheart: The entire system is being run by the private insurance companies, who have a fiduciary responsibility to their shareholders to maximize profits. Unfortunately, that fiduciary responsibility is in direct opposition to patient needs. The insurance companies charge ridiculous premiums, deny claims whenever possible, squeeze providers, rescind coverage for expensively ill subscribers (illegal, but still done) – all of which goes to boost investor dividends, pay obscene executive compensation, fund expensive advertising campaigns. The “free market” does not work for this particular sector. We need the public option.</p>
<p>I thought that one of the perks of practicing concierge medicine was to avoid insurance companies and all of that red tape and slow pay. I heard that some practices have gone back to having the patient pay the bill and have the insurance company reimburse the patient.</p>
<p>Yes. I haven’t seen a doc who would bill an insurance company in years. </p>
<p>We do the concierge thing. It’s probably a waste of money in our case, but H is always wanting things like that. I still see my old Ob/Gyn, though she is no longer OB, the insurance is too expensive. Of course, I don’t need Ob stuff anymore. She specializes in women who no longer want to have children. It’s a good practice, but she won’t deal with insurance companies. HATES them.</p>
<p>My husband would do the concierge thing in a heartbeat if and when it becomes available in our area. His beef with most physicians is they don’t keep their appointments on time and time is (his) money. Of course, that’s because they’re trying to squeeze in too many patients.</p>
<p>I see a doctor, on average, about once every three years. A concierge doctor would probably like that kind of client. I’m sure that my insurance company does.</p>
<p>With my dentist, I leave a credit balance of about $1,000 to cover what insurance doesn’t cover. He’s not in our plan and fairly expensive - he has to pay for all of his high-tech stuff.</p>