Doctor's office switching to "concierge" (additional cost outside of insurance)

[Anonymous]

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

I haven't read the whole thread, but I'm a private practice board certified pelvic PT/DPT and agree with this entirely and it's not just MDs doing this, it's also mental health care professions and PT/OT/SPTs. The bad/mediocre providers will still be in network, but those of us with lots of certifications, experience, education, and training will be concierge/cash based with superbills and the clients can fight it out with their insurers for reimbursement. Insurance does not reimburse us adequately for the care we need to provide to get clients better. United Healthcare is notorious for going back 2 years and trying to "claw back" reimbursements they paid to providers for treatments done 2 years ago - entire hospital systems are dropping UH this coming year.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Insurance premiums aren’t some magic fairy money that pays your docs. For the most part they (insurance cos) do their best to not pay or set the rates of services so low that docs are not being paid well - and sometimes not much at all beyond the copay. The concierge model helps the docs manage their practice in a way to be available to you more readily and not get completely hosed by the insurance company. If everyone took up the nonpayment more with their insurance companies instead of complaining to the doctors offices about this, it would have more traction. We all need to take more responsibility and understanding our benefits and how they work. The reason there are surprise bills are because the insurance company has a set point for your care. It’s your responsibility as a consumer to check in on your plan.

+1

Concierge docs are worth all the $$$ if you can afford it. You get 24 hour access for texting/Calling. They always have a "sick/same day consultation" available---may not be your doctor, but at least one in the practice will have space. They help arrange appointments/get you in earlier if you have issues and need more care. They coordinate care. They actually know you because most have 25-30% of the patients a typical doctor has, then they stop accepting new patients.

When I call the regular number for our concierge system, I always get a live person (or leave a message and get a response in an hour). no leaving a message and waiting until the next day for a response. The $200-300/month fee is to allow the doctor to see less patients. You get a 30-45 min appt most of the time, not 10 min.

My mom tried a concierge doctor - they eventually booted her because they said she wanted too many visits (she took up too much of their time). And frankly, they gave crappy service. I wasn't convinced they actually had her best interest at heart. All they wanted was healthy patients.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m surprised that you’re surprised by this. Over the past 5 years lots of PCPs have moved to a concierge model. My doctor explained that she would now be able to see 400 patients instead of the 2200 she was previously seeing. It’s up to you to decide whether the premium is worth it. My doctor still took my regular insurance so there were no surprises there.

I decided it wasn't worth it. I see several specialists for a complicated condition and a PCP doesn't add much value, especially for $2200. I'm not sure what they're going to do during the superduper annual check up. They certainly do not coordinate the specialists, and when I was diagnosed the PCP knew less about the condition than I did from Dr Google.

My suggestion would to find a PCP who uses the same portal as your specialist. Having them share records is the best care coordination for me.

2200 is dirt cheap to get (assuming you would) same day or next day care, extended time with doctor, and full annual more extensive visit.

Agree. My concierge practice charges 3200

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don't understand the argument for concierge, and the doctor's office certainly isn't helping.

Insurance doesn't pay enough? Doctor already charges more than insurance pays and doesn't post prices on their web site, so why can't they just charge more for services?

Is it something about being "in network" having hard price caps, vs out-of-network doctors who have reimbursements limits but unlimited prices?

That’s what they’re doing with concierge, genius.[b]

No, they are charging for a retainer, not for the medical services.

Depends on the practice. My doctor charged an annual fee and it covers all of the visits I need. No billing of insurance for visits.

[Anonymous]

Anonymous wrote:Concierge is a scourge.

It is ruining healthcare and making it so only rich people can afford medical care. USA is a third world S hole.

Concierge isn’t the scourge. Insurance companies + big pharma + private equity + Medicare legislation = the scourge. Concierge medicine is just a sign of it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thank ACA.

This isn’t an ACA thing. It’s a privat insurance thing.

I would MUCH rather have a government bureaucracy making decisions about my health coverage and claims than a private enterprise trying to meet quarterly earnings targets.

Oh my God. You have obviously never worked with the government.

My mom was a VA nurse for 38 years. You do NOT WANT THE GOVERNMENT MANAGING YOUR CARE. So many unnecessary deaths due to poor docs. There was one surgeon they called "Dr. Death" because he nicked organs like weekly, leading to people dying of sepsis unnecessarily. Did the VA stop him from operating? Nope. He continued on for 15 more years doing this until he retired.

So much misinformation. First, ACA isn’t govt run healthcare, it’s through private companies. Second, I’m sure the VA has problems but Medicare is govt run healthcare and seniors are overwhelmingly happy with original Medicare. There’s no reason that model couldn’t work for more people. Third, you have to talk about the impact private equity has had on practices.

Can we actually talk about this? It should be perfectly transparent when a practice is owned by PE. Because I would immediately walk.

There is no symbiosis to those sharks buying up practices (who is selling to them) and patient care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Concierge is a scourge.

It is ruining healthcare and making it so only rich people can afford medical care. USA is a third world S hole.

Concierge isn’t the scourge. Insurance companies + big pharma + private equity + Medicare legislation = the scourge. Concierge medicine is just a sign of it.

The US system is broken, mainly due to profit motives throughout the entire process.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

I haven't read the whole thread, but I'm a private practice board certified pelvic PT/DPT and agree with this entirely and it's not just MDs doing this, it's also mental health care professions and PT/OT/SPTs. The bad/mediocre providers will still be in network, but those of us with lots of certifications, experience, education, and training will be concierge/cash based with superbills and the clients can fight it out with their insurers for reimbursement. Insurance does not reimburse us adequately for the care we need to provide to get clients better. United Healthcare is notorious for going back 2 years and trying to "claw back" reimbursements they paid to providers for treatments done 2 years ago - entire hospital systems are dropping UH this coming year.

Fortunately for patients, study after study has shown how terrible patients are at determining good vs bad doctors. The better salesmen will end up being concierge, but that doesn't equate to better outcomes. My hope is that enough PCPS go concierge that they higher level of service becomes the standard of care. That will force insurance company's hands

[Anonymous]

Anonymous wrote:

Anonymous wrote:Concierge is a scourge.

It is ruining healthcare and making it so only rich people can afford medical care. USA is a third world S hole.

Concierge isn’t the scourge. Insurance companies + big pharma + private equity + Medicare legislation = the scourge. Concierge medicine is just a sign of it.

ACA also.

[Anonymous]

The scourge is drug companies and hospitals having free reign in pricing and the artificial limitations the number of doctors creating artificial shortages. In both cases, markets are being distorted leading to consumers having to pay more

[Anonymous]

Anonymous wrote:Get rid of the artificial cap on medical school grads and residents. That solves 40% of the problem there.

But of course docs and the AMA will stomp their feet because they might only have to make $200k per year rsther than $500k-$1M per year.

This ship has sailed. Private equity does not want more MDs in the mix. They want them replaced by NPs and PAs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Concierge is a scourge.

It is ruining healthcare and making it so only rich people can afford medical care. USA is a third world S hole.

Concierge isn’t the scourge. Insurance companies + big pharma + private equity + Medicare legislation = the scourge. Concierge medicine is just a sign of it.

ACA also.

ACA is really just a subset of “insurance companies” here.

[Anonymous]

Health insurance eventually is going to be only for catastrophic coverage like hospital stays, surgeries and $$$$ treatments. Regular care is moving gradually towards private practice and out of pocket costs and will be regulated by market (supply/demand) much like cosmetic procedures today. It's ironic how much cheaper plastic surgery is in overall cost compared with the surgery of similar complexity (that's not for vanity reasons) performed at a regular hospital if you look at these bills hospital submits to insurance companies. Something is messed up there and costs inflated.

One of the reasons healthcare is such a mess and insurance premiums, crazy deductibles, and insane bills exist is because it's tied to the employment and people think they get it for free or highly discounted rate as long as they are willing/able to work full time for a business with 50+ employees for a salary. Honestly, if everyone had to purchases their own plan and employer plans were to go away something would change drastically. There are many ways employment tied health coverage hurts us, not just in terms of costs but in terms of who can and cannot participate in the workforce and how we participate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

You don't understand the difference between how much the patient pays at point of service vs how much the provider receives.

And you don’t understand how terrible the U.S. is. The Japanese have a similar level of taxation as we do, yet somehow they manage to have pretty much universal access to affordable medicine. In fact, the Japanese government mandates that everyone get a free comprehensive physical every year after a certain age. Healthcare is affordable and accessible there that they got to the doctor like 9-12 times per year, on average. Each time might only cost them $20 or less out of pocket.


Meanwhile, in the U.S. we shell out hundreds per month for insurance that many places no longer even take only to have to pay even more exorbitant fees at the offices. And that’s only if you’re lucky enough to get access to a doctor. Everything about US healthcare blows. It is massively overpriced too.

Because doctors (and drug/insurance execs) expect to be rich.

For all of their complaining, do you have one doctor friend:relative who is not well off? They live in nice houses, send kids to private school, go on fancy vacations.

Lately, some don’t even work five days a week.

If you can afford that lifestyle, while working part-time, you are over charging your patients.

And of course some of that expectation comes because the training is so onerous and the costs of becoming a doctor were so high. I think the barriers to entry should be high in terms of academic qualifications but if med school
Was more affordable and residency paid a little better and wasn’t such a nightmare in terms of hours maybe doctors would have slightly less expectation of huge salaries.

It’s a complicated issue and obviously as others have noted others system s have their problems also. Nothing is perfect but it just seems crazy to me that in our system insurance companies take in huge profits acting as middlemen when they essentially serve no necessary function.

[Anonymous]

I left my doctor of 10 years when they tried to go this route. Completely up to them and assume they figured losing some patients into the decision. I'm just not up for the additional cost and additional paperwork that I assumed would inevitably be involved.