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

[Anonymous]

Anonymous wrote:Email:


Dear {insert patient name},
[sic. That's what the email said]


We are writing to announce an important practice change. We will convert to a concierge/personalized care practice model.

Unfortunately, in recent years the healthcare environment has made it almost unsustainable to practice medicine as independent physicians due to the mandated constraints placed on doctors.

Continuity of care and personalized communication have become more difficult. This is not the way we want to practice medicine.


As a member, you will enjoy phones answered live by caring staff, scheduling appointments quickly and at your convenience, having extended unhurried visits, receiving dedicated follow-up between visits, and directly communicating with us after hours for urgent issues.


In order to realize these goals, our practice size will be limited and there will be an annual membership fee
------

Fee amount not announced yet.

Thoughts?

Sounds like a lot of words to say "we need more profit per patient."

So now we get a guaranteed fixe price to pay PLUS still get surprise bills for treatment.

A new way to screw patients. I had a practice that did this and it made it far more difficult to actually see a M.D.as first patient had to talk to "nurse(?)" who would insist that I see PA, who would assess my complaint and determine whether I actually needed to see the doctor. I found a new doctor immediately. Maybe your doctor's will be different.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What are they doing extra for $2200 a year if you still have to pay for appointments and your insurance is billed? That's what almost $200 a month, and for that I'd expect one charge appointment at least monthly.

Seeing far fewer patients and spending more time with them.

People seem to be misunderstanding the concept of what you are paying for. Any doctor’s office has to pay for the office space and the salaries & healthcare of all of their employees. They either rely on insurance payments and book 5 patients an hour, 8 hours a day. Or they go concierge and see 4-6 patients per day and spend 1 hour with them. I view paying for concierge more as insurance (easy access when I need it) than fee-for-service. YMMV

+1000
That is exactly what you are paying for! My physical was 1.25 hours last week. I scheduled it 2 weeks before.
When I need to see a doctor, I always get in that day (it may be a different doc in the concierge practice but I get to see a concierge doc that day) and the "sick" appt is 20-30 mins, no rushing me out to see another 4 patients in the hour.
If I have a major concern at 10pm or 2am, I can text the doc on call and get a call back within 5 mins or less. They will sit on the phone to schedule appointments (so I dont' have to waste 20 mins doing it). For $200/month, it's worth it to our family.

Also, in our area many family/internal med docs are just quitting. There are not enough so you can be 3-5 months out scheduling a physical or appt with your normal doctor. I prefer to have easy access so will happily pay for it. That's worth me not getting Starbucks daily or the equivalent.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Doctors deserve to get paid. The end. If insurance won’t reimburse at rates that allow doctors to stay in business they have no choice but to do this. They could just start doing cosmetic stuff instead?

Doctors DO deserve to get paid. Maybe med school shouldn't cost so much.

+1 Yes but new Range Rover second home private for four kids paid?

Most internal medicine doctors are NOT making that much. That's only high level specialists like neurology surgeons, cardiac surgeons, and anesthesiologists, etc. And yes they deserve that much. I want a top skilled doc working on me in those situations, not the one who graduated with Cs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Blame the insurance companies.

Or rather insurance CEOs who need another yacht.

Or rather government that won't regulate this abuse

Or rather Republicans who oppose single payer

Blame the venture capital vultures who buy up practices. THEY force the excess patient load and create a set of frazzled, overworked salaried providers.

This. PE has ruined healthcare and we will soon have a 2-tiered healthcare system: knowledgeable MDs for wealthy people who can pay $$$ out of pocket and poorly-trained NP/PA "providers" for everyone else on terrible insurance-provided care. Doctors want to spend time and take care of their patients, but their corporate overlords require otherwise.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Blame the insurance companies.

Or rather insurance CEOs who need another yacht.

Or rather government that won't regulate this abuse

Or rather Republicans who oppose single payer

Blame the venture capital vultures who buy up practices. THEY force the excess patient load and create a set of frazzled, overworked salaried providers.

This. PE has ruined healthcare and we will soon have a 2-tiered healthcare system: knowledgeable MDs for wealthy people who can pay $$$ out of pocket and poorly-trained NP/PA "providers" for everyone else on terrible insurance-provided care. Doctors want to spend time and take care of their patients, but their corporate overlords require otherwise.

Most conceirge patients use insurance too. So there is still that barricade

[Anonymous]

I switched to a high deductible plan and went with a concierge doc I used previously. Being female, I appreciate that my doctor is not reporting my visits to anyone - ie if I am pregnant and need intervention, there’s no insurance coding that tells anyone I ever was. Crazy to have to think about that, but that’s the world we live in.

[Anonymous]

Anonymous wrote:I switched to a high deductible plan and went with a concierge doc I used previously. Being female, I appreciate that my doctor is not reporting my visits to anyone - ie if I am pregnant and need intervention, there’s no insurance coding that tells anyone I ever was. Crazy to have to think about that, but that’s the world we live in.

I think about this as well.

[Anonymous]

My friend is an internist whose practice transitioned to concierge over a 18 month period. I'm sure they sent out a letter like the one in OP. As well, she would have a conversation with every patient at each appointment about the upcoming changes and invited MOST* of them to continue as her patient by paying $2000 annually.

Her business model was that she needed to sign up 150 patients in the concierge practice to be comfortable ($300k before liability ins. and overhead) and the optimal number in their model was 200 patients ($400k annual). Note that they DO get payment from insurance as well -- not sure where people are getting that "concierge" = "doesn't accept insurance." Most do.

My friend used this transition as an opportunity to drop patients who were notably annoying. Not notably sick -- she actually LIKES sick or complex people and sees them as a challenge to help and solve. She wants to spend much more time with complex, appropriate demeanor patients and oversee and coordinate all their care.

OTOH, she was excited to kick out the bad personalities and get them off the rolls. Entitled, demanding DC people who typically tried to treat her as just another service person with no particular expertise. Kind of like the guy you hire to shovel snow.

She sees about 4-6 patients a day now and spends an hour or so at each appointment. She loves it. Writes really long notes, texts and takes calls into the evening IF WARRANTED. Works on Saturday and Sunday morning writing follow ups. Rounds on people in hospitals if they're admitted. She's very happy and makes a lot more money than when she had to see 20 people a day for 10 minute appointments and depend on insurance payouts exclusively.

[Anonymous]

PCPs could be replaced with AI and there would be a massive improvement in service.

[Anonymous]

Anonymous wrote:My friend is an internist whose practice transitioned to concierge over a 18 month period. I'm sure they sent out a letter like the one in OP. As well, she would have a conversation with every patient at each appointment about the upcoming changes and invited MOST* of them to continue as her patient by paying $2000 annually.

Her business model was that she needed to sign up 150 patients in the concierge practice to be comfortable ($300k before liability ins. and overhead) and the optimal number in their model was 200 patients ($400k annual). Note that they DO get payment from insurance as well -- not sure where people are getting that "concierge" = "doesn't accept insurance." Most do.

My friend used this transition as an opportunity to drop patients who were notably annoying. Not notably sick -- she actually LIKES sick or complex people and sees them as a challenge to help and solve. She wants to spend much more time with complex, appropriate demeanor patients and oversee and coordinate all their care.

OTOH, she was excited to kick out the bad personalities and get them off the rolls. Entitled, demanding DC people who typically tried to treat her as just another service person with no particular expertise. Kind of like the guy you hire to shovel snow.

She sees about 4-6 patients a day now and spends an hour or so at each appointment. She loves it. Writes really long notes, texts and takes calls into the evening IF WARRANTED. Works on Saturday and Sunday morning writing follow ups. Rounds on people in hospitals if they're admitted. She's very happy and makes a lot more money than when she had to see 20 people a day for 10 minute appointments and depend on insurance payouts exclusively.

Exactly!! Our concierge docs seem very happy, much less stressed than when they were in regular practice (Same hospital system, just the really good docs get invited to join concierge)
Mine has it even better---she shares the role with one other female doctor (both have kids in the ES/early MS age). So you do you well visits with your doctor. But if you need a same day appt, you might end up with the other (I'm fine with that, the sharing doctor is equally amazing). Actually all of the doctors we have seen (between my spouse and our college kid and me) have been great.
Who wouldn't be happier when you see 4-6 patients a day, get time to actually write notes and followup with patients. Yes, you are on call for after hours calls/text from your patients. But with only 200 patients, it is not that frequently. Also, you are not on call every evening (10pm-8am) or weekends---that alternates with the other 4-6 doctors in the office. So you get a weekend every 4-6 weeks and the week nights maybe one per week (I suspect they do a full week or several evening at a time you are on call, but dont know never needed to call then).
This is how medicine should be practiced---your doctor(s) should know you and your health history, not because you tell them it each time, but because they remember and/or read up on you before the appt (because they have 30 min between appts to finish up and prep for the next).

[Anonymous]

Anonymous wrote:PCPs could be replaced with AI and there would be a massive improvement in service.

Fabulous! Maybe you'll get extra fingers out of it, too. Exciting.

[Anonymous]

This is very much a DC area phenomenon. My friends and family in the midwest and south don't have this issue where every doctor they see and like ends up going concierge. I'm on my 5th doctor in the past 10 years.

[Anonymous]

Anonymous wrote:Blame the insurance companies.

Or rather insurance CEOs who need another yacht.

Or rather government that won't regulate this abuse

Or rather Republicans who oppose single payer

lol.

Single payer would bring this about in spades. See NHS.

What foolishness.

[Anonymous]

Anonymous wrote:I switched to a high deductible plan and went with a concierge doc I used previously. Being female, I appreciate that my doctor is not reporting my visits to anyone - ie if I am pregnant and need intervention, there’s no insurance coding that tells anyone I ever was. Crazy to have to think about that, but that’s the world we live in.

As you get older, it's a complete pain to have records in different places on different portals or in different offices, risking uncoordinated care or repeat tests.

[Anonymous]

Anonymous wrote:This is very much a DC area phenomenon. My friends and family in the midwest and south don't have this issue where every doctor they see and like ends up going concierge. I'm on my 5th doctor in the past 10 years.

100 percent a thing in Chicago (with pediatricians too).