Concierge Medicine

[Anonymous]

Any recommendations for a Primary Care/concierge doctor in the NW DC area?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:When people here say their concierge doc "coordinates care," what does that actually mean? Serious question.

I have been in the traditional system, and if I need to go to a specialist, my pcp gives me a rec. for a provider/practice. I then go to said specialist and either tell my pcp how it went at my next appointment with her, or the specialist sends the results/lab work directly to my pcp. Sometimes both occur.

What more does concierge do? Drive you there, lol

Better specialist recs sometimes instead of just a referral to a deparment. Sometimes an in with specialists who aren't taking new pts.

My mother, for example, has 8+ specialists and multiple chronic health conditions that impact other conditions and about 15 medications. Her concierge doctor manages all of that, as in, when a health issue arises, she is the first person I call bc she is trained better than I am to determine what is cardiology/nephrology/endocrinology/medication interaction etc. further, for ER visits, she calls ahead and gives full medical background and recommendations on what might be needed. She handles follow-up afterwards. She also gets specialists on the phone for consult much faster than we can as the patient and w/o our having to go in for unnecessary office visit. We get same day lab results. Calls back on weekends. Email/text answers within hours. I could go on but this is what managing care looks like.

It makes sense for a complicated patient like this. It might not be as necessary for someone who doesn't have to go to a lot of specialists.

[Anonymous]

Anonymous wrote:I’d do it if I had medical issues that required frequent visits and medication titrations. Modern corporate health is just ridiculous. I say this as a doctor who can’t get my patients follow ups because my system shoves new patients in my schedule to make more money. When I’m older and need it, I’ll 100% pay for what I need health wise- without health what are we?

Well of course, you’re a dr who doesn’t have any financial concerns whatsoever. Most people have to think about money.

[Anonymous]

I am in a concierge practice. It was a traditional practice until about five years ago. While my frugal side does not like paying a few thousand a year, it is definitely worth it.

The service is improved, not because it was bad before, but because the practice is no longer a volume business the doctor is able to give you the time to really understand your medical issues and plan solutions.

More importantly, getting referrals, which insurance companies require, is much easier. In a sense, the referrals pay for the concierge fee.

Finally, it is much easier to reach doctor and see doctor when necessary.

In an ideal world all would have this type of access without concierge fees. Absent that medical nirvana, I would recommend concierge medicine with a good GP. Health, like anything else, is something in which one must invest.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am so opposed to this trend.

They are charging you a retainer to be their patient.

Trying to work less and make more.

Cutting out all but wealthy patients..

Reeks of greed, but around here they can get away with it.

I'm OP and the thing is, I'm not wealthy. This would be a big financial sacrifice.

Doctor here. I am not a concierge doctor but it makes a lot of sense to me. The fee covers all the work doctors have historically been unfairly asked to do for free (and for which other professions, like lawyers, charge by the hour and much more): phone calls, talking to pharmacies, arguing with your insurer, completing disability and other forms, consulting other doctors we know, and more. In addition these are some diseases and some patients that require a lot of hand holding and are very labor intensive. There are still others who are entitled and expect to be treated as the exception and like VIPs. For all these people, concierge medicine is appropriate. And frankly, knowing what goes on behind the scenes, and how difficult access is right now PSLF-COVID, $2K annually is a bargain in these times.

+1

Would much rather skip eating out 3-4 times per month and pay the $250 for better service/care and a doctor who is not rushed and overworked. We think it is worth the cost and realize that insurance sucks and doctors do not get paid much relatively speaking, hence the 5-6 appts per hour.

When my kids were little (15 years ago), the Ped would charge $120 for a well baby visit, and our insurance would pay $35--the negotiated rate. So $35*4=$140. $140/hour for the nurse responsible for you, the front desk staff, the IT staff, the office costs and HVAC/utilities, and the doctor and their malpractice insurance, etc. In the grand scheme they are NOT making very much for their education levels.

Except many concierge practices do not do these things. I've been a patient at Foxhall Internists, and I can guarantee you they are not calling pharmacies or arguing with insurers. Most concierge docs like FH won't even take insurance or even Medicare. So, you are paying out of pocket AND paying a yearly retainer.

As far as "coordination," my experience has been that when something is hard, they give you a referral to a specialist just like any other doctor would give you. I have filled out so many hipaa forms but my concierge doc has never actually picked up the phone to discuss my condition, disease, etc. with another provider (even when she said she would because it was so serious). The more money they make, the less they work for you. Concierge is like an income floor that is super high-takes away any incentive.

Would not pay if my CM doc did not do those things. As stated, we are part of a "hospital system", so they organize everything (within the system). Our CM docs will even go with you to a specialist appt if you have a very serious condition and want them to (I've never needed it but they would if needed or would zoom in for the appt). So it depends upon the plan. For ours we get a lot of benefits.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Okay continue to expect that your doctor will do more and more for no compensation and get back to use on your satisfaction with the care you’re receiving.

Doctors get paid plenty.

Actually that's the point, a PCP really does NOT get paid much, considering their education. When a reg PCP has 4-5 appts per hour and insurance reimburses ~$35-45 per appt. Let's say $40*5=$200.
Out of that the doc has to pay rent, utilities, malpractice insurance, the nurse/med assistant, front desk, billing, cost of equipment (X-rays, blood draws), cleaning staff, all the one time use things to keep the office safe/clean, etc...and also their own salary. Now consider that at the end of the day or lunch break, the doc is spending another 2 hours to document the rest of the appt for the day information, because 12-13 mins per patient is not enough time to see the patient and fully document the appt. IN reality, for someone who spent $200K+ for med school and is so highly educated, a general PCP might only make $150K/year, maybe $200K in a HCOL area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am so opposed to this trend.

They are charging you a retainer to be their patient.

Trying to work less and make more.

Cutting out all but wealthy patients..

Reeks of greed, but around here they can get away with it.

I don't agree. On a lot of fronts.

First not just here but it is everywhere and it is the future. I think it will not be too long before other practices require 500 to join.

Doctors are not trying to make more. In most cases they make less. But they can spend more time with patients.

It's about quality of their day. Our CM doc has at most 300 patients vs the 2500+ most regular PCP have. All appointments are at least 30 mins, many 1 hour. When I have an issue and doing lab work/radiology/various testing, my CM doc actually calls me with the results and is not rushed, we can talk for 10-15 mins or as long as needed to evaluate and make a plan. And the call is typically the same day the results come back, usually within a few hours (I mean they do have appts, so it's typically at the lunch break or end of day if they have a full day of actual appts). It's the doc that calls, not the front desk/nurse assistant. It's not just an email. It's direct doc to me contact. And that is wonderful when you have issues, and can get your questions answered promptly.
So they are not as rushed thru the day. They seem happier and more relaxed than when they were not CM (I followed my fav doc into the CM practice). Previously when she would attempt to spend extra time with a patient, you know that 45 mins she spent with me would then push the rest of her day way off schedule (as appt was only a 15 min appt). Now she can listen, spend time helping patients and still be on schedule.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They keep using the excuse of insurance companies but many providers refuse to deal with them even before going concierge (i.e., they make the patient pay in full at time of service, and have to hound the company for reimbursement). So, that is BS.

I have a bunch of doctors and have never even heard of this -- you must be out of network for your insurance.

Some doctors simply don't do insurance. My Functional Medicine MD (not naturopath, but full MD) does not do insurance. They never did, but now recently switched to a CM approach, where you must pay for the full year of access. (with levels of 2, 3, or 4 visits per year). I happily pay for it. Means when I have issues I also have full access to my Func med doc. This past month had an issue and spent at least 1.5 hours of the docs time communicating with me as well as the team finding a solution to my issue and finding the right supplements/meds that I'm not allergic to. All part of what I pay $1500/year for. 3 visits and unlimited access to the doc via email/consulting.

They dropped insurance years ago, because they do 1 hour appts and insurance reimburses $35 if they cover it. My doc used to charge $250 for the appt. They can because there are not many functional medicine doctors out there so you have no choice. I prefer the concierge approach, as it will help keep my doc in business and it's an essential part of my health plan---cant' live well without it.

[Anonymous]

Anonymous wrote:Any recommendations for a Primary Care/concierge doctor in the NW DC area?

My husband and I love and have been seeing Ida Bergstrom, MD downtown for years. It sounds like they have new openings, but her practice used to be closed before the pandemic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’d do it if I had medical issues that required frequent visits and medication titrations. Modern corporate health is just ridiculous. I say this as a doctor who can’t get my patients follow ups because my system shoves new patients in my schedule to make more money. When I’m older and need it, I’ll 100% pay for what I need health wise- without health what are we?

Well of course, you’re a dr who doesn’t have any financial concerns whatsoever. Most people have to think about money.

It's about choices. My own parents were LMC or poor...I ate free lunch for at least 3 years while in ES/MS. They never made more than $40K/year between the two of them. Very frugal, but have chronic health issues so happily find the way to pay $200/month even while retired to keep their doc once he went concierge. It's a luxury they are willing to pay for. (these are people who did not have Color tv until 2000 and never have had cable or any pay service for watching tv. They drive for 90% of their vacations. They live extremely frugally and go out to eat maybe once every 2 weeks. They were in their 50s before they had AC in a car or home.

So people who think about money can still make this choice---you just have to give up something else.

[Anonymous]

Anonymous wrote:I have various issues and thought going to an academic health center would be my best bet, figuring the doctors would all coordinate and talk to one another.

They simply do not.

I don’t know if One Medical is right for me, but it is disappointing that all the specialists operate in silos while babbling “holistic health care” and “whole patient blah blah”

Kaiser does what you want. "Whole patient" is corporate speak for making you see your GP a bunch before you can get a referral. "Doctors talking to each other" usually results in them concluding you need less care.

[Anonymous]

Anonymous wrote:When people here say their concierge doc "coordinates care," what does that actually mean? Serious question.

I have been in the traditional system, and if I need to go to a specialist, my pcp gives me a rec. for a provider/practice. I then go to said specialist and either tell my pcp how it went at my next appointment with her, or the specialist sends the results/lab work directly to my pcp. Sometimes both occur.

What more does concierge do? Drive you there, lol

Our CM doc is part of a "hospital system". So if I need a specialist, they recommend who to see within that hospital system and the CM office books the appointment/coordinates everything. I don't have to spend 30 mins on the phone booking the appt--just give the CM office my availability/times. If I had major health issues, my doc would even actually go to the appt with the specialist with me/family members. They also are able to get me appointments "sooner" than I might get if I called myself---they can access those that are held available for "urgent needs" and/or get me squeezed in at the end of the day if needed. The specialist will communicate with me and my CM doctor about the results.
So yes, I could do all this myself, but I enjoy not having to waste 30-45 mins when I need an appt. And if I ever have a real health scare I'm comforted in knowing that someone else will do the grunt work to get everything going in a timely efficient manner.

[Anonymous]

Anonymous wrote:

Anonymous wrote:When people here say their concierge doc "coordinates care," what does that actually mean? Serious question.

I have been in the traditional system, and if I need to go to a specialist, my pcp gives me a rec. for a provider/practice. I then go to said specialist and either tell my pcp how it went at my next appointment with her, or the specialist sends the results/lab work directly to my pcp. Sometimes both occur.

What more does concierge do? Drive you there, lol

Better specialist recs sometimes instead of just a referral to a deparment. Sometimes an in with specialists who aren't taking new pts.

+1000

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:When people here say their concierge doc "coordinates care," what does that actually mean? Serious question.

I have been in the traditional system, and if I need to go to a specialist, my pcp gives me a rec. for a provider/practice. I then go to said specialist and either tell my pcp how it went at my next appointment with her, or the specialist sends the results/lab work directly to my pcp. Sometimes both occur.

What more does concierge do? Drive you there, lol

Better specialist recs sometimes instead of just a referral to a deparment. Sometimes an in with specialists who aren't taking new pts.

My mother, for example, has 8+ specialists and multiple chronic health conditions that impact other conditions and about 15 medications. Her concierge doctor manages all of that, as in, when a health issue arises, she is the first person I call bc she is trained better than I am to determine what is cardiology/nephrology/endocrinology/medication interaction etc. further, for ER visits, she calls ahead and gives full medical background and recommendations on what might be needed. She handles follow-up afterwards. She also gets specialists on the phone for consult much faster than we can as the patient and w/o our having to go in for unnecessary office visit. We get same day lab results. Calls back on weekends. Email/text answers within hours. I could go on but this is what managing care looks like.

+1000

It's the care we all deserve and envision getting. So if you can afford it, it is worth every penny, even if you don't have urgent health issues now. As we age, you never know when it will start. I even put my 18yo on CM when a minor health issue arose. They help coordinate the care we need while my kid is away at college, even with a different "medical system". They answer texts/calls/emails within 2-3 hours.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:When people here say their concierge doc "coordinates care," what does that actually mean? Serious question.

I have been in the traditional system, and if I need to go to a specialist, my pcp gives me a rec. for a provider/practice. I then go to said specialist and either tell my pcp how it went at my next appointment with her, or the specialist sends the results/lab work directly to my pcp. Sometimes both occur.

What more does concierge do? Drive you there, lol

Better specialist recs sometimes instead of just a referral to a deparment. Sometimes an in with specialists who aren't taking new pts.

My mother, for example, has 8+ specialists and multiple chronic health conditions that impact other conditions and about 15 medications. Her concierge doctor manages all of that, as in, when a health issue arises, she is the first person I call bc she is trained better than I am to determine what is cardiology/nephrology/endocrinology/medication interaction etc. further, for ER visits, she calls ahead and gives full medical background and recommendations on what might be needed. She handles follow-up afterwards. She also gets specialists on the phone for consult much faster than we can as the patient and w/o our having to go in for unnecessary office visit. We get same day lab results. Calls back on weekends. Email/text answers within hours. I could go on but this is what managing care looks like.

It makes sense for a complicated patient like this. It might not be as necessary for someone who doesn't have to go to a lot of specialists.

You never know when you might need that. And it can take a few months to join a practice/find a concierge doc that is taking new patients. So sure, your 25 yo self may not need it but once you hit 45/50, it can be extremely nice to have in place, so if any issues arise you are taken care of promptly.