Paying a yearly fee to see your Doctor through an MDVIP plan

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Paying a yearly fee to see your Doctor through an MDVIP plan

Postby DiscoBunny1979 » Sun Jan 30, 2011 1:48 pm

I recently have been informed that one of my Doctors is changing their practice to be affiliated with MDVIP - which lowers their patient load to no more than 600 in order provide a Wellness Program and to satisfy the need to provide better individualized service.

My question for folks here is whether they have encountered such a switch from any of their Doctors, and if so, how do they feel about services through an MDVIP affiliated practice in which the standard yearly fee (above and beyond the charges for office visits and tests/procedures) costs $1,800.

Does paying the yearly fee actually amount to better service, or is it a marketing gimmick to make the patient feel good so that the Doctor's income can be subsidized more by the patient, rather than solely by the Medicare system or the patient's insurance?

Assuming a Doctor currently has 2,000 patients and collecting about $180 per visit and the patient sees that doctor on average 4 times a year . . . that's $720 per patient. $720 x 2,000 = $1,440,000. But by switching to a limit of 600 patients . . . 600 x $720 = $432,000 plus 600 x $1800 = $1,080,000 or $1,512,000. IF the Doctor can get 600 people to join the plan it appears as though they will make as much money as they did before, but with fewer patients. Less work for the Doctor, but paid for by each patient.
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Postby Nowizard » Sun Jan 30, 2011 2:20 pm

Memphis paper recently had an article on a physician who did this, charging $1,500 annually for 600 patients. Quite a firestorm of letters on both sides. One, laughable one, from a physician stated that the extra fees are only sufficient to cover office expenses, with insurance payments representing income. Several stated they had sufficient time with their current doctors, which is my case. Others pointed out that some doing this also had gone to night coverage by groups in business to cover at night and most were using hospitalists when hospitalization was required. Whether this was representative, I do not know, but no night or hospital coverage and the same income as previously earned with fewer patients sounds like a business decision. As with everything else, there will always be people who want what appears to be the Cadillac option, however.

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MDVIP

Postby Macmungo » Sun Jan 30, 2011 2:40 pm

DVIP
My wife's and my family physician and his partner switched to an MDVIP plan three years ago. Although we had been satisfied with his service we decided to try the new plan (for $1500 dollars, not $1800).
We have been more than satisfied with the new plan. Earlier our MD had been overwhelmed with patients; now we receive highly individualized care. Examples:
The annual examination (all charges included in the $1500) is extremely thorough, usually lasting about 2 hours. He explains bloodwork and everhting else in detail and provides a complete printout of results and recommendations.
We have obtained same-day appointments on several occasions, and they too have not been rushed.
We have reached him at home on a Sunday with no sense of his being rushed or annoyed.
We were notified and given appointments as soon as flu vaccine became available.
When I required an emergency hospitalization last year I received desultory and impersonal treatment from the hospital until I called my MD. He was immediately in touch with the hospital and my treatment improved 100% within one hour.
Our MD says this is the way he had always wanted to practice medicine. It is more than worth the extra money to us.
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Re: Paying a yearly fee to see your Doctor through an MDVIP

Postby joppy » Sun Jan 30, 2011 5:50 pm

DiscoBunny1979 wrote:I recently have been informed that one of my Doctors is changing their practice to be affiliated with MDVIP - which lowers their patient load to no more than 600 in order provide a Wellness Program and to satisfy the need to provide better individualized service.


It also depends on the type of insurance you have, and the copays, and how much your time is worth vs money. It also depends on whether you feel your doctor isn't giving you enough time at present. If so, it may help to have a frank conversation with your doctor about how much time is available to spend with you per visit, and how you can work around those limitations. For particularly complicated issues, tell the doctor you would like to split a consultation across multiple visits on two separate days -- so they can get paid for their time, and you can get the time you need without the doctor being rushed.

For example, if you have 5 items to discuss, that you can't cover in one 15 minute visit, you can schedule 2 appointments with the doctor 2 days apart. Go over the first 3 items in the first visit, and the last 2 items in the second visit. Yes, you (or your insurance) will pay $180 times 2 plus the cost of your time to go for a second visit to the doctor. But if there really are 5 issues to discuss and you only get through 3, and end up in the emergency room, or having to see a specialist or have a procedure, because the last 2 issues weren't addressed in a timely fashion -- that ends up being more costly for you (or the insurance company) anyway. So you/insurance are better off paying the extra $180 for the extra visit. And obviously don't do this frivolously -- you won't anyway, because you value your time and money going to the second visit.

But realistically, it won't be more than once a year that you feel the need to do this. For the other common visits, e.g. earache, stomach upset, sprained ankle, etc., a 15 minute appointment is quite sufficient.

On the other hand, if your time is really valuable compared to the $1800 per year -- you don't want to waste time on multiple visits, or waiting in the waiting room -- then go for the MD-VIP service.

So the decision tree isn't "money vs. quality of care" at least in the PPO world. It is pick two of "time, money, quality of care".

But also, make sure you remember that "quality of care" isn't the same thing as "quantity of care". Make sure that you don't get unnecessary "quantity of care" because you are a "VIP patient" who wants the "best treatment".

- Joppy
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Postby fishnskiguy » Sun Jan 30, 2011 6:02 pm

Interesting thread. Our PCP is shifting to an MDVIP plan starting Tuesday. He is limiting his practice to 400 patients. The base plan is $1,500 annually per person for up to five visits per year.

My wife really likes the guy, so we will give it a try for a year and see how it goes.

He gives a 5% discount for a lump sum up front, and I can pay by credit card for another 1% off. How bogleheadish is that? :lol:

Chris
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Postby DTSC » Sun Jan 30, 2011 6:08 pm

As a PCP who does not practice "concierge" medicine, I think it depends on what acute and chronic health problems you are prone to having.

Just because you paid $1500 and got to see the doctor the day the problem developed is no guarantee that you'll get to see the needed subspecialist expediently. In fact, many subspecialist see patients based on how well they get along with the referring PCP. Often, this is based on volume - they see a particular doctor's patients sooner to keep the pipeline flowing. Conversely, as a referring doctor, I use subspecialists who will see my patients in a timely fashion.

So having a concierge doctor might actually work against you - how many patients will your doctor send to the cardiologist if he has a panel of only 500 patients, versus a PCP who has 3000 patients? Who will the cardiologist want to keep happy first?

Don't think that your doctor will pass on some of the $1500 to the subspecialist to get you in sooner - it is illegal.
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Postby Radiohead » Sun Jan 30, 2011 6:12 pm

I know a few family/internal med docs who have switched to a concierge type practice (a single all inclusive fee for the year). Both patients and physicians tend to love it. The patients get all the time and special attention they need, and the physician gets to practice medicine the way it is meant to be done all while eliminating the headaches of dealing with government/insurance.

Oh, and the majority of office visits are a coded as a level 3 (99213) which Medicare reimburses ~$67http://www.aafp.org/online/etc/medialib/aafp_org/documents/prac_mgt/medicare-options/medicarefeeschedule2010.Par.0001.File.dat/MFS2006-2011.pdf. After that assume 90% net collections and 50% overhead. In general private insurance will pay a little more and Medicaid a little less. If there is a field that gets $180/visit and can have 8000 visits a year....sign me up! :-)
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Postby semperlux » Sun Jan 30, 2011 6:44 pm

It's a good option if you have multiple complicated medical problems requiring lots of attention and coordination and are at risk for decompensation (eg congestive heart failure, COPD, unstable angina, heart attack, stroke, transient ischemic attack (TIA), diabetics, etc).

If you are young, healthy, with no health problems, not on any medications, and only need to see the doctor once a year for a physical, then you probably don't require the amount of attention a concierge doctor offers.

I think their services are extremely valuable to those who need it, but it is definitely not necessary for everyone. The old adage applies, "You get what you pay for."

To add to Radiohead's info, medicaid/medi-Cal only pays $30 for an average 99213 office visit, so a doctor actually loses money and is doing charity work seeing people on those insurances.
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Re: MDVIP

Postby soaring » Sun Jan 30, 2011 7:10 pm

Macmungo wrote:He explains bloodwork and everhting else in detail and provides a complete printout of results and recommendations.

We have obtained same-day appointments on several occasions, and they too have not been rushed.
We have reached him at home on a Sunday with no sense of his being rushed or annoyed.


I suspose if one needs at home contact with a doctor, same day appts, and more personalized care then maybe it makes sense for those folks.

However, my doctor gives me copies of lab work, explains results, but yes he is rushed and I can't call him at home.

But for me it would not make sense. My total medical costs last year including medicare advantage pmt, meds, lab work and doctor visits totaled less than $400. But I realize some can't get serviced this inexpensive.
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Postby Grandpaboys » Mon Jan 31, 2011 8:24 am

Souring

I am also on Medicare. My costs are Medicare $96/month
plus Med-Gap & $146/month, plus Plan D $30/month equals $272/month. Deductibles of $162 on Medicare and $150 on Plan D equal another $26/month for a total cost of $298/month just for Insurance. Don't believe your $400/year.
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Postby fredflinstone » Mon Jan 31, 2011 8:28 am

semperlux wrote:It's a good option if you have multiple complicated medical problems requiring lots of attention and coordination and are at risk for decompensation (eg congestive heart failure, COPD, unstable angina, heart attack, stroke, transient ischemic attack (TIA), diabetics, etc).

If you are young, healthy, with no health problems, not on any medications, and only need to see the doctor once a year for a physical, then you probably don't require the amount of attention a concierge doctor offers.


I agree.
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