My father who is older has a concierge doc. Advantages include being seen quickly, speaking to the doctor directly on the phone, more time with the doctor and access to specialists. The paperwork is eating up doctors time due to the regulatory environment. Until the regulatory environment is eased we will see more of this. Furthermore, medicare patients are in many cases subsidized by their self pay and private insurance patients due to reimbursement schedules.
Yup, MDVIP works for the doctors who want to cut their load and spend more time with fewer patients while still having a solid income base, and for those patients who can absorb the additional cost. Himom explained the outcomes well in post #17. Those who do not join up when the doc switches to MDVIP generally (some docs may make exceptions for clergy, friends, etc.) need to find a new doc.
It is not a perfect solution, just as little else about the health care reimbursement system in our country is perfect.
I do feel uncomfortable that I am benefiting from a high-quality medical care option because I can afford it, while others can’t. (Others who could afford it simply don’t want to pay the extra cost, a matter of personal choice.)
P.S. My H’s MDVIP primary care doc uses a significant part of his annual vacation time to volunteer providing critically-needed medical care in Haiti. It is not all about the money for him, for sure.
I did it maybe 8-10 years ago in south Florida (still new back then?), and found that I didn’t have enough health issues to make it worth it. But now I’d definitely consider it. Unfortunately we do not have any options close to our new home.
While I wouldn’t do a complete concierge doc, Kiddo #1 sees a doc who doesn’t take insurance. It’sworked out really well. You pay an hourly rate to see her that makes a quick appointment less than the cost of going to the other kiddos’ pediatrician. When she refers for blood tests, etc., insurance kicks in. She has been great at answering questions over the phone, too. Guess not having to do insurance paperwork or hire people to do it has been freeing.
Our Primary care MDs went to the concierge model about 5-6 years ago. It was an extra $1,800/year at that time, and you still had the normal billing processes after that where it went through your insurance and you paid the balance. I could not see paying that kind of premium just for the ability to see a specific MD since we generally just go in to Primary care once a year for a physical. I can see the value however for someone who can afford it and has more complicated medical conditions that need supervision and coordination. Perhaps that premium makes up for the lower Medicare reimbursement rates? I am finding that our current MDs are billing at higher rates by using higher codes. A 5-10 minute office visit used to be a level 2 visit and now it is level 3 or level 4. Perhaps you avoid that by going concierge?
I assume the yearly fee is on top of the fee each time you need to see the doctor? Also, if your primary insurance is an HMO, can your doctor still give you the referrals you need? That would actually be the biggest concern of mine.
I don’t think anyone is arguing whether or not concierge medicine is “right,” just that it does exist and is a choice some folks are being forced to make—buy in or find a new MD.
If one chooses to find a new doc, the pool to find them among may be missing some very good MDs. The fact that folks may find this upsetting and/or offputting doesn’t change the fact that this is something that is growing.
Some of my friends and neighbors have switched to Kaiser HMO because they’re tired of having to search for MDs, some of whom move, retire, go to MDVIP etc.
Some of the patients I know aren’t thrilled with Kaiser HMO either as they sometimes hire a lot of temp MDs, so the patient may see a different temp MD every visit and have a tough time developing a relationship and evolving a good treatment plan, especially for specialists like lung docs. If you’re pretty healthy and don’t care which doc you see, it can work well.
Also my neighbor is singing it’s praises about the cancer care — no copays and Kaiser is paying their transportation and lodging to fly for stem cell treatment in connection with cancer treatment!
Also, all those in the Kaiser system can seamlessly read the medical records in the electronic medical records everywhere. This can be a great help. Yes, I can see pro and con but still prefer our BCBS PPO plan and providers.
Yes, the annual fee is on top of insurance premiums and copays and deductibles.
Our island with over a million people living on it has 8 mdvip internists. Clearly at this point there are still many non-concierge docs.
One other way MDs limit the # of patients they see is by doing research and taking on admin responsibilities. These are all important and part of the work life balance they have to juggle. There are pros and cons of whatever is chosen.
I’m surprised we don’t have many concierge practices in my community. What we do have is many MDs who no longer take insurance nor will they bill your insurance.
I just came from my dermatologist visit. I saw her in another practice when she took my insurance. I liked her and felt like she did a good job but was always rushed. She went out on her own and I’ve now seen her twice. The first time was when I had an unusual fast growing growth on my arm. The practice that took insurance could not get me in for 6 months. I called her and I was seen the next day. She spends a lot of time and she does a great skin check.She doesn’t have lasers and such so doesn’t push cosmetic procedures but will refer you out if it’s something you want. Today’s visit was a routine skin exam. The visit starts in her office where she asks questions , next exam and back into her office after for a follow up on what she found and recommendations. I had a number of things burned off. for up to 14 removals. The appointment lasted 30 minutes. I pay in full and they give me a generic completed insurance claim form to send to my insurance company. In contrast in January I decided to give her previous partner a chance as they still take insurance. My all over body check took all of 5 minutes if even that. She even had me leave my bra on. My appointment was 945 am by 10 am I was already at the Apple store replacing my phone battery. With a family history of melanoma and my own history of skin cancers I would rather pay for the Dr who is actually going to look thoroughly at my skin.
My internist is out of network for my insurance. I pay out of pocket because I like her and feel she takes time with her patients. I would pay $1500 to be able to continue to see her. As many have mentioned finding a good internist who is taking new patients is difficult.
Once you are on Medicare, the # of MDs accepting new patients shrinks even more, which is why I was so happy to get a great new internist before I’m on Medicare. She says she will even accept H since he’s my H, even tho he’s in Medicare, when his 68-year-old internist retires.
The reason my two lung docs out of state can give me 1 hour concierge appointments is that they are major medical research teaching hospitals and my docs have the seniority that they can arrange their duties between the research trials, admin and other duties as well as patient care as they prefer. My local docs are stuck with seeing 4 patients an hour (or more if they can squeeze them in).
@mom60 what you describe sounds like the way insurance was handled 30 years ago (and I think it sounds great because the consumer is a active participant in the billing process!)
Our family doctor just went MDVIP At $1400 per person @ 8 people, there’s no way we could stay with her.
Fortunately, DH’s employer offers a sort of concierge-hybrid situation. They fund a clinic (jointly with another company) that only serves employees and their families. The employer provides insurance at excellent rates which is all that the clinic accepts. There is no fee whatsoever for any visit. They guarantee next-day appointments, but I have never had a problem with getting one the same day I call. I never wait more than 10 min. to put my eyes on an MD or NP. The clinic keeps a fully stocked dispensary, so all but the most rare or expensive prescriptions are free and immediately available. They have after work hours on weekdays and are open half-days on Saturdays. It has made life so much easier since I and a couple of my kids have ongoing health issues.
I do have a provider who has equipment I like that get prescriptions filled at. They give me the paperwork and it’s up to me to file a claim with my insurance if I choose to do so. I have filed some claims for some of the equipment I’ve gotten from them and received appropriate reimbursement for a portion from insurer and just not bothered filing for other equipment. It saves costs for the companies not having to have staff to deal with the insurance claims and denials and having to handle the mountains of paperwork and changing regulations.
I have spent an inordinate amount of time this month getting insurance claims re-processed and appealing denials. It is really a drain for the providers to have to deal with this stuff, as it is for the patients. It’s sadly in the interests of insurers to deny as much as possible and figure that most patients will just accept it and not bother appealing. It takes a LOT of time and energy to appeal. One of my equipment providers has a staff person out of state totally dedicated to dealing with insurance problems. It’s one of the reasons insurance costs and medical care is so expensive.
This is NOT concierge medicine because there is no extra charge up front paid by patients for going to doctors who are not “in network.” This is just another variation for providers who are fed up with having to deal with insurers and the low reimbursement rates.
I am still going back and forth. I have some moonier health issues that I would like to know more about and be proactive on. And the MDVIP will also be able to do some hearing screenings, plus the other cardiac screenings.
I was not aware that it is getting so hard to find an internist that takes new patients. Perhaps I ought to look around and see if there is someone I would switch to in case that helps my decision.
My internist went concierge a few years ago, so I switched to another internist. Insurance wouldn’t cover the retainer fee, and all the other expenses were still there. So as far as I could tell I was paying a lot of money out of pocket upfront solely for the privilege of having the doctor’s attention. He was a good doctor, but so is my new one.
I agree availability of good internists accepting new patients is something that varies greatly by where you live/are searching. It’s worthwhile searching about to see what highly recommended internists you may have access to.
As I wrote on another thread, I was increasingly concerned about my recent internist that I’ve had for decades as he is now 68, his twin brother (radiologist) is retired, and he’s made some questionable medical decisions lately, plus has been having his personal health issues.
I finally asked my new lung doc if he had an internist he worked well with that he could refer me to and he referred me to his internist. Though her practice is full, she agreed to add me as a new patient. I get along great with her and have her cell number. Both of these new docs are accessible via the electronic health records system at their med center (they’re both in same system). I got the new lung doc as a referral from my allergist who treated me for over a decade and was unhappy that my old lung doc would try to defer to internist when I had a lung infection instead of taking the lead. 
Another friend gave me the name and contact info of another internist that she and her partner switched to that they like but I like that this internist can easily share electronic records with my lung doc.
I still like having my mainland lung doc(s) as well. They help when I have big issues that stump my local docs (eg we don’t have many infectious disease docs in our state).
My dad (91 years old) started with a concierge physician last October, after struggling with an extremely busy PCP who could not see him as his needs increased with age. Further, last month, the busy PCP closed the local office and called saying all patients was welcome to drive 35 miles to his other office. My guess is that closing the local office accomplished a reduction in patients for him. We are so happy we switched before the busy PCP closed. Further, the physician has built a real relationship (warm, caring, friendly, honest) with my dad.
My husband and I have not joined, but might do so later, depending on costs.
My spouses doctor of 25 years went concierge about 5 years ago. The fee was $6,500 per year or 10K per family ( family did not include kids). We didn’t do it. Then mine went concierge shortly after. I called to get info and was told about the costs ( don’t remember but I think 4K ish). I do remember one of the benefits was being able to get early appointments ( before 10) and having the doctor come to you if needed and Skype discussions. I don’t have any long term issues so didn’t see the value. My spouse wanted to do it but the cost was prohibitive.
This reminds me of the conversations surrounding financial aid at selective colleges. I wonder how many self-described donut hole families who believe everyone should have access to an elite education regardless of their ability to pay are members of this premium medical service which is accessible only to those who can afford to pay for it.
The services described in some of these posts are services my primary physician has been providing to my family for over 2 decades at no additional cost. She’s very committed to providing equal access to quality medical care to all of her patients regardless of their income, and she’s actively searched out partners who share her philosophy. If our doctors aren’t going to fight against the bureaucracy for us, then who will?
if my PCP were charing $4k+ for concierge service, I’d have to think REALLY hard and long about it. That is a significant chunk of change for us. I know my DH would not spend that for himself.