Concierge Medicine

[Anonymous]

PP : I understand your empathy for the Dr. However, I am the patient. As far as I am concerned, I am paying more for less. I do not want any of the perks afforded me for paying a retainer to my Dr. I can't help but thing that the Dr needs to look at lowering their overhead. There are many ways to do this. I think a company like Privia markets Dr's and they see potential less work and more money. However, it just may be Privia (not sure if i have the name correct) that is getting rich.

Obamacare plus dr's who are not business savvy = unhappy patients and dr's who add another expense to their overhead (Privia).

My concierge dr. has more people working for her than I can count. Actually, maybe she could hire me.....I would not have to work so hard.

[Anonymous]

My wife is a family practice physician and I am a RN. She currently has around 2300 active patients and is very busy. In order to make her production numbers and earn around 200,000 per year she must see around 30 patients per day. Now the national average for family practice visits is 8 minutes per vissit. How can a physician manage a patient with multiple problems in 8 minutes? Patients hardly get a chance to talk with their doctor. My wife likes to sit down and talk with her patients and give them a plan with goals. She rarely hits her numbers and usually sees 20-22 patients per day. The result is her income is reduced by the hospital because she has lower production numbers. All that said physicians and patients are being short changed in my opinion. We have discussed starting a private practice but with medicare reinbursements going down by 22% next year it is scary. The retainer practice model interests us because it bennifits the patients and the physician. Our plan would be to charge 1500 per year and include unlimmited vissits with little or no wait, same day appointments, executive type physical yearly, visits that last 30-60 minutes and longer, the patients would have her cell number to call, and patients would be limmited to 500. We wouldn't bill or collect anything else from the patient or insurance company. I think the docs that are doing this model and continue to charge the patients or insurance companys for visits are greedy. The loosers in all of this are the patients that can't afford 1500 per year. My take on this is if you care about your health and are tired of long waits and short visits from your physician then this alternative may just work for both the patient and the physician. We will continue to evaluate this type of practice. Do you think the model I decribed is fair?

[Anonymous]

A few years ago my MD began an MDVIP practice. He's a truly excellent physician, and I'd had a lot of bad ones. My previous internist and my GYN had both retired early, primarily for the reasons 16.26 outlines.

After considerable thought I signed up, and I've been very pleased. Some of the benefits: Same or next day appts for illness; phone calls and emails quickly returned; no long waits while you sit in the office, no being rushed during appointments, a feeling that you're really being listened to - I could go on. In short it's like the medical office of 40 years ago.

The cost is high: $1650 per person per year I think. You do continue to pay copays etc (though not on the annual physical). However, the practice participates with all the major insurance plans including Medicare. Meanwhile in DC many practices won't take new Medicare patients or are even firing present patients when they turn 65.

For a person who has ongoing medical issues I think it's well worth it.

I feel about "concierge" medicine the way I feel about private schools: I'm a strong believer in the alternative, but when it comes to my kids or my health I'm ready to sign up.

[Anonymous]

Anonymous wrote:Why shouldn't a doctor offer higher quality care to someone who pays for it? What did you think was going to happen when Obamacare got into the system. Please don't go on and on about the hippocratic oath. Doctors need to get paid for their services and more and more are being squeezed. This is a way for them to even the playing field.

I know this isn't the political board but even as a Rebublican I don't agree with concierge practices. Probably because I doctor I know has one but also has a car covered with Obama stickers. I just can't believe the hypocrisy. I for one am totally offended.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why shouldn't a doctor offer higher quality care to someone who pays for it? What did you think was going to happen when Obamacare got into the system. Please don't go on and on about the hippocratic oath. Doctors need to get paid for their services and more and more are being squeezed. This is a way for them to even the playing field.

I know this isn't the political board but even as a Rebublican I don't agree with concierge practices. Probably because I doctor I know has one but also has a car covered with Obama stickers. I just can't believe the hypocrisy. I for one am totally offended.

That is unbelieveable!

[Anonymous]

Anonymous wrote:My Dr. does not get paid any more or less since Obamacare. Even if I was able to pay a dr. a retainer fee. it is simply not a good idea to have one person overseeing your medical decisions. Concierge medicine is managed care wrapped up in a big bow. It waters down an individual's access to diversified opinions. It uses physician extenders (a "Mayo Clinic" nurse to ask questions to). I can't see how the dr. makes more money (the goal) and I don't see the patient getting better care. No one wins. The jury is out.

This makes no sense. As a patient in a concierge practice I can still see any doctor I want, and my insurance will cover it. My MD makes referrals to other MD's (specialists) all the time.

I consider it a benefit to have one person "overseeing" my medical care (not my decisions). If you've ever had responsibility for an elderly person's care, you know how nuts it gets. My mother had three different doctors prescribing a total of 12 medications that interacted with one another. Each medication helped one condition but worsened another etc. etc. It was impossible to get the drs to communicate regularly, and that likely hastened my mother's death.

My MD doesn't use "physician extenders" unless you count the people who draw blood, do EKG's etc. If you have a question the MD answers that same day, by phone or email.

To the PP who says she opposes concierge medicine "even though she's a Republican," how about opposing the present system in which very many people have no medical care at all? I'd be happy to pay the taxes necessary to ensure that everyone has access to decent medical care. Once we get that in place come back and we'll talk about inequality in respect to concierge medicine.

[Anonymous]

I think a lot of people didn't realize that when we add more and more people into gov programs that the service is affected for those people who have been resposible enough to have insurance. Yes I say responsible because I always made sure I had insurance even when I had jobs that didn't offer it..of course I waited on buying a new car, buying a house, buying new clothes..but I digress. So doctors are pushed and they should be allowed to make a lot of money. They have gone to school for years, many have taken on considerable debt so yes I could see a doc saying..geez I want to find a way to make more money and service my patients better. This concierge med interests me because I have taken to using urgent care for random stuff so would probably fare better with a yearly doc fee.

[Anonymous]

Just for a little perspective, I'm married to a physician, and I worked as a medical support staff person in a private practice with for years. In Maine we have government supported plans like medicare and Maine Care that reimburse very little. In 2007 is reimbursed around $50 for the average office visit. Maine Care only reimbursed about $30. When you have to pay your staff, your utilities, your lease, your insurance, and your billing specialist, it doesn't go far if the majority of your patients are on these plans. The overhead incurred with waiting for reimbursement tends to make things costlier.

I think too many doctors are being shown as the bad guy here. First, they've worked very hard to become physicians and have likely taken out $250,000.00 in debt to do it. They have their bills to pay, more than many in the case of student loans. The lengthy wait for reimbursement is tough on smaller practices who want to have more time to spend with fewer patients. I don't think requesting a reasonable payment up front is a bad thing. You can still submit it to your insurance company for your own reimbursement. Or if you don't have insurance, you won't have to wait in an emergency room for an ear infection.

My husband is looking at going into private practice and charging around $25 for a 15-minute visit for established patients or $1000.00 for a yearly fee which includes house calls and 24-hour access. I don't think that it is particularly unreasonable.

[Anonymous]

Anonymous wrote:

Just for a little perspective, I'm married to a physician, and I worked as a medical support staff person in a private practice with for years. In Maine we have government supported plans like medicare and Maine Care that reimburse very little. In 2007 is reimbursed around $50 for the average office visit. Maine Care only reimbursed about $30. When you have to pay your staff, your utilities, your lease, your insurance, and your billing specialist, it doesn't go far if the majority of your patients are on these plans. The overhead incurred with waiting for reimbursement tends to make things costlier.

I think too many doctors are being shown as the bad guy here. First, they've worked very hard to become physicians and have likely taken out $250,000.00 in debt to do it. They have their bills to pay, more than many in the case of student loans. The lengthy wait for reimbursement is tough on smaller practices who want to have more time to spend with fewer patients. I don't think requesting a reasonable payment up front is a bad thing. You can still submit it to your insurance company for your own reimbursement. Or if you don't have insurance, you won't have to wait in an emergency room for an ear infection.

My husband is looking at going into private practice and charging around $25 for a 15-minute visit for established patients or $1000.00 for a yearly fee which includes house calls and 24-hour access. I don't think that it is particularly unreasonable.

$25 for 15 minutes in Maine? Not relevant to DC.

And I'm pretty tired of hearing about how much debt they've taken out--not everyone falls into this category, and it is a personal choice.

[Anonymous]

And I'm pretty tired of hearing about how much debt they've taken out--not everyone falls into this category, and it is a personal choice.

It is a personal choice, yes. Just like it is a personal choice whether physicians enter into concierge practice or charing add'l fees to patients to counteract low reimbursement. You might be tired of hearing about the debt but the truth of the matter is if doctors can't pay their bills then our healthcare system is doomed. Not to mention the lack of incentive for entering medical students - who wants to be in school for 12 years only to stuggle to have a successful business?

[Anonymous]

My former doctor moved to a concierge-style practice years ago, during Bush II's presidency. So this trend started way before Obama was in office.

Free market. I didn't follow her, but could see why others did.

[Anonymous]

One thing that greatly concerns me about Privia is that these 24/7 "Personal Health Advisers" are telecommuting positions - meaning someone working from home anywhere in the USA has access to your personal health record. No joke...check out the careers page at Privia Health!

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