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

[Anonymous]

Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

[Anonymous]

Yea when you allow insurances to have so much control + you allow politicians to feed you feel good stories (by dems which floods the market with too many patients and incentivizes volume) = shit service. Docs are pushing back.

[Anonymous]

Anonymous wrote:Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

Sounds like we need more PCPs employed by health systems, then. The private practice system is broken.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

Sounds like we need more PCPs employed by health systems, then. The private practice system is broken.

Large health systems treat pcps like crap. They measure them on productivity and force them to see patients every 15 minutes (then patients complain they are being rushed) and will place random patients on their schedules. For some it’s either leave medicine or go concierge just to maintain some autonomy and dignity in the practice of medicine.

[Anonymous]

Anonymous wrote:Thank ACA.

How does insuring thousands more who previously had no way of affording health insurance have anything to do with low reimbursements to PCPs. That was happening long before ACA which is not related.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

Sounds like we need more PCPs employed by health systems, then. The private practice system is broken.

You should try it. You will get less than 15 min. Can’t get ahold of anyone. Docs are burning out and leaving. Mostly young docs or NPs and PAs who don’t really know how to practice medicine because they don’t have enough training.
But those attached to hospitals can charge a “facilities fee” which you may have seen on your EOB. That helps them pay all the administrators. It’s crazy. Hospitals with clinics make crazy $$$. Just not the doctors. They make nothing and work like hamsters on a wheel….lots of admin work. Very little quality time with patients. Not sustainable if you actually care about people.

[Anonymous]

Anonymous wrote:

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.

+1

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

Sounds like we need more PCPs employed by health systems, then. The private practice system is broken.

Large health systems treat pcps like crap. They measure them on productivity and force them to see patients every 15 minutes (then patients complain they are being rushed) and will place random patients on their schedules. For some it’s either leave medicine or go concierge just to maintain some autonomy and dignity in the practice of medicine.

I’m the PP who posted about her friend the internist who transitioned to concierge.

This PP is correct and clearly has some insider knowledge about how large health systems work. Hopkins, Inova, GW, and especially, especially MedStar. (I also work in healthcare but am not an MD in primary care) My friend used to work with one of the health systems I listed and grew depressed. Clinically, medicated depressed.

Patients SHOULD be angry about the state of affairs but I wish they would stop directing their ire at “docs”. (Side note: so disrespectful. Clearly a flex to take ‘em down a notch. Do you call your kids’ teachers “teach” ? Or your clergyman “hey preach” ? )

As PP says, the problem starts with Medicare and private insurance. If you dislike having 8 minute appointments during which ol’ Doc spends 7 minutes charting bullshit metrics for the feds instead of looking at you in the eye … blame Medicare regs and BCBS Aetna UHC and MedStar et al. Ol’ Doc hates it as much as you do, guaranteed.

[Anonymous]

Concierge gets me an email for urgent things even on weekends and an appointment in a day or so. Take insurance? 3 months.

[Anonymous]

Anonymous wrote:Concierge gets me an email for urgent things even on weekends and an appointment in a day or so. Take insurance? 3 months.

Most concierge doctors take insurance.

[Anonymous]

Anonymous wrote:

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.

That's when I went concierge -- when the first available physical with my doctor was 6 months out.

[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.

Interesting. My concierge doctor does not bill insurance, and she caps her practice at 400 or so. She spends about 30 mins with patients for follow ups. The physical was at least an hour and a half. She has a waiting list.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Private practice, especially with high overhead costs in this urban environment (rent, staff, etc), are not able to be sustainable if you take insurance.

Insurance only works for large corporations who use PCPs office to refer to the hospital and specialists that generate profits and so the PCPs are "loss leaders".

If you want to see a doc who takes insurance, they usually have a panel of 3,000! Concierge has about 500-600 and that is still a lot of work. But at least they can devote more time and brain power to you.

This country (Medicare, and thus insurance) doesn't value or reimburse primary care or preventative medicine. They pay for procedures and medications (some).

Sounds like we need more PCPs employed by health systems, then. The private practice system is broken.

Are you in the DMV? Most of them here already are. And workload is unsustainable for them and bad for patient care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

That's when I went concierge -- when the first available physical with my doctor was 6 months out.

Having recently moved, I was concerned about this, but was able to get an appointment quickly with an APN who is genuinely excellent, and seamlessly set up necessary referrals/labs.

There are challenges to this new approach (longer wait times), but I was very pleasantly surprised at the upsides. The staff is less stressed because the workload is more balanced and coordinated, having all of the info in one place is a safety and stress benefit for patients, and overall, the experience felt somewhat concierge-like, even in a huge health system.

Meanwhile, trying to coordinate dental health with several independent specialist providers has been much more stressful, with little to no electronic record management or autonomy on the patient side, occasionally very long wait times, and trying to discern what to do when the advice is conflicting (with second opinions often creating another round of the same process).

So while most providers have been excellent, the sense of continuity and oversight has been more notable in the larger system.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

That's when I went concierge -- when the first available physical with my doctor was 6 months out.

Having recently moved, I was concerned about this, but was able to get an appointment quickly with an APN who is genuinely excellent, and seamlessly set up necessary referrals/labs.

There are challenges to this new approach (longer wait times), but I was very pleasantly surprised at the upsides. The staff is less stressed because the workload is more balanced and coordinated, having all of the info in one place is a safety and stress benefit for patients, and overall, the experience felt somewhat concierge-like, even in a huge health system.

Meanwhile, trying to coordinate dental health with several independent specialist providers has been much more stressful, with little to no electronic record management or autonomy on the patient side, occasionally very long wait times, and trying to discern what to do when the advice is conflicting (with second opinions often creating another round of the same process).

So while most providers have been excellent, the sense of continuity and oversight has been more notable in the larger system.

I'm not seeing an APN for my pcp. For multiple reasons.