Concierge medicine Worth It????

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Rexindex
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Concierge medicine Worth It????

Post by Rexindex » Thu Mar 10, 2016 11:38 am

******Please do not give medical advice, I do not want this locked******

I was recently given notice by my primary care he is going "concierge". For $1650/pp my wife and I can stay with him as opposed to finding a new primary care doc.

We are both nearing 50 and aside from my being overweight, we are relatively healthy. We can afford to do this and feel our primary care has been wonderful over the last 20 years and want to stay with him.

I have been told by some who have more medical needs (heart/cancer) they feel the concierge medicine is well worth it. I am curious if anyone who fits into our category has found it worthwhile or not worthwhile financially and health wise.

The concierge is MDVIP
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afan
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Re: Concierge medicine Worth It????

Post by afan » Thu Mar 10, 2016 12:11 pm

Depends entirely on your alternatives. If there are other good docs available without the fee, then the fee is not worth it. If you NEED concierge services and cannot get them at lower cost, then not worth paying. If you actually need yhe service and this is the best price, then yes.

Vwry few people need this service, but many may find there are few alternatives for primary care docs. If you are in that situation, then consider whether you need a pcp at all.
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lthenderson
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Re: Concierge medicine Worth It????

Post by lthenderson » Thu Mar 10, 2016 12:20 pm

I live in a rural area that is the poorest county in our state. They can't pay doctors enough to come work out here so there is a shortage of doctors and long waits (sometimes 6 months) to be able to get in to see a primary care doctor. Much less if you want to see a nurse or PA. In this case, paying for concierge medicine is worth it if you can afford it. Instead of seeing 4000 patients a year, doctors will see 500 to 1000 because most living in our area can't afford to pay for it. You have their cell phone number and are encourage to call whenever you need. It essentially gives preference to those who can afford it. I don't pay for it now because other than a flu shot, I haven't talked to a doctor in over a decade. When I get closer to the age of needing more regular visits, I would certainly consider it depending on the price and services provided that are included in their fee structure.

123
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Re: Concierge medicine Worth It????

Post by 123 » Thu Mar 10, 2016 12:24 pm

Though I don't expect to be involved with one (too pricey for me) I've been curious about the business model for these concierge medical services. My understanding is that probably they don't take insurance so that the entry fee might be just the tip of the iceberg for medical expenses, if that's the case you would lose the bargaining power of the insurance company in establishing costs for services. Does the whole concierge system exist outside of the realm of insurance and negotiated prices? Would he only refer you to other "concierge" type providers? I assume you'd maintain your insurance anyway, just in case. What's his "rack" price for a routine appointment? How many times would you see him in a year? Will his involvement in concierge service take up all his time or will he actually be part of two difference practices, "classic service" and "concierge service" ?

Edited to add:

Could this change to concierge medicine be a pre-retirement move by your physician to cut back and work fewer hours? Maybe his priorities are shifting away from patient care to something else and where will that leave you? Perhaps you will be looking for a new primary care physician relatively soon anyway.
Last edited by 123 on Thu Mar 10, 2016 12:59 pm, edited 1 time in total.
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DTSC
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Re: Concierge medicine Worth It????

Post by DTSC » Thu Mar 10, 2016 12:45 pm

Disclosure: I am a primary care doctor and do not practice concierge medicine

I think it depends on how many medical conditions you have, and how often you have to see the doctor. If you only go a couple times per year, why do you need 24/7 access? Another consideration is need and access to sub-specialty care. Doctors are NOT allowed to pay or receive money for referrals, so even if you get to see the Concierge PCP the same day, who's to say that he can get you in to see the specialist in a timely fashion?

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queso
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Re: Concierge medicine Worth It????

Post by queso » Thu Mar 10, 2016 12:56 pm

We are considering this for a family member with an undiagnosed medical condition that we have had a lot of problems getting resolved. We have tried several primary care doctors and every specialist we have been referred to by those doctors, but we still haven't been able to obtain any relief or even a diagnosis for our family member. Our hope is that this will finally get us a dedicated primary care doctor who will act as a tireless project manager who will doggedly pursue a diagnosis and hopefully relief using whatever specialists he/she needs to get the job done. Normally we would never consider it, but our family member is quite young (mid-30s) and her condition is affecting her quality of life and career so we're desperate at this point.

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Re: Concierge medicine Worth It????

Post by NonnyGoGo » Thu Mar 10, 2016 1:00 pm

One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.

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Re: Concierge medicine Worth It????

Post by livesoft » Thu Mar 10, 2016 1:05 pm

When a physician I used for 15 years went "concierge", I switched to another doctor. I don't think it is worth it for me. My new physician will make all the referrals to the same specialists anyways.
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123
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Re: Concierge medicine Worth It????

Post by 123 » Thu Mar 10, 2016 1:08 pm

queso wrote:Our hope is that this will finally get us a dedicated primary care doctor who will act as a tireless project manager who will doggedly pursue a diagnosis and hopefully relief using whatever specialists he/she needs to get the job done.
In that kind of situation I think you best option is to get connected with a physician or clinic associated with nearby medical school. I think medical school environments can be much better for difficult cases. I don't think many doctors, even concierge physicians, want to act as a tireless project manager.
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queso
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Re: Concierge medicine Worth It????

Post by queso » Thu Mar 10, 2016 2:07 pm

123 wrote:
queso wrote:Our hope is that this will finally get us a dedicated primary care doctor who will act as a tireless project manager who will doggedly pursue a diagnosis and hopefully relief using whatever specialists he/she needs to get the job done.
In that kind of situation I think you best option is to get connected with a physician or clinic associated with nearby medical school. I think medical school environments can be much better for difficult cases. I don't think many doctors, even concierge physicians, want to act as a tireless project manager.
I get that impression as well. In my experience most of the providers we have seen want to get the patient out the door as fast as possible with a Z-pack and collect the copay or pass the problem off to a specialist (some of whom don't even make sense for this particular case at all). I may give your suggestion a shot.

Thanks

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Re: Concierge medicine Worth It????

Post by dm200 » Thu Mar 10, 2016 2:37 pm

Rexindex wrote:******Please do not give medical advice, I do not want this locked******
I was recently given notice by my primary care he is going "concierge". For $1650/pp my wife and I can stay with him as opposed to finding a new primary care doc.
We are both nearing 50 and aside from my being overweight, we are relatively healthy. We can afford to do this and feel our primary care has been wonderful over the last 20 years and want to stay with him.
I have been told by some who have more medical needs (heart/cancer) they feel the concierge medicine is well worth it. I am curious if anyone who fits into our category has found it worthwhile or not worthwhile financially and health wise.
The concierge is MDVIP
This is a very interesting and timely topic. I hope we can stay within the rules of discussion here. From what I understand (no first hand experience), there are many reasons and motivations for Physicians to move to this approach. Likewise, as I also understand, there are many different ways this is actually implemented.

On the one hand, this can appear (and may actually be) a way of providing medical care to "the rich" (or perhaps those of higher means). Viewed this way (which may or may not be the case), it certainly does not "look good" (whether or not it is). On the other hand, depending on the implementation, it may not (Net, bottom line) it may not actually be more expensive (or not that much more expensive).

Within the last week, I heard a radio show describing, at some length, one primary care physician's story of his moving to such a practice. he was very frustrated with the large number of patients he had to schedule each day to be able to have a positive financial "bottom line". He cited that he was scheduled/booked for about seven minutes per patient and that he had NO time or ability to properly deal with most of the medical/health issues he encountered. He said that it was not that he had to work hard, but that he was increasingly frustrated at the overall quality of services provided. I can't recall how much of a monthly or annual fee he charged when he moved to the "concierge" model, but I think it was in that range. I think he had a slightly higher monthly/annual charge for those ever 50.

I think he cut his total patient loan to about 1/3 or so of the previous number. He did charge for services/office visits, but was available to his patients by phone and email 7 days a week, 24 hours a day. He also said that his patients did NOT abuse this access with trivial or inconsequential calls. He also said that he was working just as "hard" as he worked before, but that his satisfaction level in this work was very high and very satisfying.

One thing was not clear to me is whether such office visits or procedures, etc. are (or can be) covered by insurance or Medicare? I did not think so, but the radio show seemed to imply that there could be insurance reimbursement.

I also considered and compared certain aspects of "Concierge medicine" to what my wife and I have with our HMO (Kaiser). I know my doctor (primary care) is schedule for 20 minute appointment times (3 per hour) and, of course, some things like annual physicals will take more time than a simple follow-up. In the current Kaiser "model" I only see my physician (Primary care) and no nurses or Nurse practitioners. I also can (and do) communicate regularly by email, have telephone advice nurse access 24 hours a day 7 days a week, can do "virtual house calls" (with a smart phone, or similar) nights, weekends, etc. with the on-duty physician, and in person urgent care (24 hours a day, 7 days a week) for almost anything I would otherwise go to an emergency room. Their "urgent care" is, in my opinion, about 99% as capable as a hospital emergency room for just about anything I believe I would encounter and, for me, it would only take 5-10 minutes more to get there.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Thu Mar 10, 2016 2:40 pm

NonnyGoGo wrote:One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.
Interesting possibility. I had not heard of this as a "motivation". Maybe some of the Physicians her can comment.

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Re: Concierge medicine Worth It????

Post by DTSC » Thu Mar 10, 2016 2:48 pm

dm200 wrote:
NonnyGoGo wrote:One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.
Interesting possibility. I had not heard of this as a "motivation". Maybe some of the Physicians her can comment.
The motivation is that you don't have to work as hard! You can see much fewer patients and make the same or even more money if you can find enough patients to pay the retainer. If you charge $1700 per patient, you need less than 300 patients to gross $0.5M. Assuming a 60% overhead, you make $200K, which is what many PCP's make, give or take 10%. This sure beats seeing 25 patients per day!

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Re: Concierge medicine Worth It????

Post by goodenyou » Thu Mar 10, 2016 3:19 pm

DTSC wrote:
dm200 wrote:
NonnyGoGo wrote:One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.
Interesting possibility. I had not heard of this as a "motivation". Maybe some of the Physicians her can comment.
The motivation is that you don't have to work as hard! You can see much fewer patients and make the same or even more money if you can find enough patients to pay the retainer. If you charge $1700 per patient, you need less than 300 patients to gross $0.5M. Assuming a 60% overhead, you make $200K, which is what many PCP's make, give or take 10%. This sure beats seeing 25 patients per day!

Hopefully the overhead is less than 60% without having to have coders, collectors, billing staff, pre-certifiers, appeals, and awful EMR. The appeal is not only on the clinical side, but, more importantly, on the administrative side. Now that ACA Plans are losing money, there is a push to cut fees to doctors even lower to make up for it. Only more patients and faster visits will make up for it. If you value your time, concierge may be the way to go.

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Re: Concierge medicine Worth It????

Post by Dutch » Thu Mar 10, 2016 3:31 pm

I can see the advantage for the provider, but not necessarily for you as a patient.

Unless you're a "frequent flyer" and access to care is a problem in your area, I would not do it.

Go to your health insurance website, look for the contracted providers in your area, and start making some calls.

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Re: Concierge medicine Worth It????

Post by Pdxnative » Thu Mar 10, 2016 3:37 pm

My pcp is part of such a program, though I only pay $500 pp annually for this. All the docs in the clinic are part of my insurance network, and everything works the same insurance-wise. I get better access, more time and attention, and quick response without hassle. More things are handled without an office visit, as I can email/call to speak with my pcp. Office visits are far less hurried, and I almost never wait (In fact, the clinic has only recently added a few chairs to the reception area).

I have been in this situation for 6-7 years and it is well worth it for me. Prior to making the move, I went through some years with complicated and extended health issues requiring quite a bit of primary care coordination. It was tough on my pcp and me, and the quality of care did suffer. When I made this switch, things became much more smooth. I don't blame my prior pcp. But he was always rushed, and every 'little' referral, rx refill, lab order added up to a mountain of uncompensated care that he was obliged to provide. Now, I am basically paying some of those carrying costs up front, and I do find that the approach is quite different.

I haven't had major health issues for 5+ years, but it is well worth it to me still. My family members are all very healthy (as am I) and we continue to happily pay the extra fee. Preventative care is an important component also, and I find a much greater emphasis there.

Plus, I know that serious medical issues can arise with little warning. I am relieved knowing that, if that happens, I have a team in place that I'm comfortable with.

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Re: Concierge medicine Worth It????

Post by NonnyGoGo » Thu Mar 10, 2016 3:42 pm

dm200 wrote:
NonnyGoGo wrote:One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.
Interesting possibility. I had not heard of this as a "motivation". Maybe some of the Physicians her can comment.
I thought it's a possibility since they've been seeing him for 20 years. I'm not a doctor.

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Re: Concierge medicine Worth It????

Post by midareff » Thu Mar 10, 2016 4:36 pm

I have about a twenty year relationship with my PCP. If I need him and I'm sick I leave a message he generally calls back within 20 minutes, never more than an hour, and presto magic I have an appointment to see him in an hour. If he went concierge I'd sign us right up.

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Re: Concierge medicine Worth It????

Post by desiderium » Thu Mar 10, 2016 4:42 pm

Medicine is a mess right now. Pcps are compelled by economics or corporate employers to see too many patients to manage thoughtfully, leading to excessive referrals and dyscoordinated care. Add pre authorizations for tests meds referrals electronic charting and more stuff to do, mostly uncompensated, and the doctor is there late every night and not feeling too good about her career choice.

The concierge fee shifts the economics to smaller panel size. Also, your insurance only pays for a face to face visit. Why do this if reassurance over the phone or by email is enough? The fee pays for all the non face time put into your care. Generally office visits, procedures etc are billed through normal insurance channels.

This can be a path to patient satisfaction and good care. Doctor has more time. Staff is more available and hopefully a little better paid. You have less hassle and more access. Is it worth it? As noted, if you need minimal health care maybe not. Also, just like conventional practices there are individual practitioner differences that can turn out ton be relevant to you

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Re: Concierge medicine Worth It????

Post by ourbrooks » Thu Mar 10, 2016 5:56 pm

One of the things to worry about is what happens if you need either a specialist or hospital care since your concierge relationship covers neither. Also, drugs would not typically be covered. You probably want to purchase health insurance in addition to the concierge coverage. One of the issues you will then have to face is how much of your concierge expenses can be claimed as deductible for the policy. Another issue is whether your concierge physician could still manage your care if you are admitted to a hospital and whether they would be willing to consider hospital care as part of the original concierge agreement.

The common situation which results in physicians being overscheduled is that they have become part of an organization which tries to maximum the medical care billed. Frequently, the physician is, in fact, one of the owners of the organization, as a partner. In exchange for a regular salary and other benefits. the physician agrees to generate a targeted amount of revenue.

Some physicians opt out of this situation without setting up a concierge practice by the simple approach of remaining in a private practice and seeing patients at whatever pace they desire and billing insurance companies for whatever care they provide. An alternative to a concierge contract is to find a primary care physician or practice who tolerates the non-medical work of running their own practice in exchange for greater flexibility.

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Re: Concierge medicine Worth It????

Post by jpa » Thu Mar 10, 2016 6:08 pm

I'm a medical student, and I am very interested in practicing "Direct Primary Care" (DPC), which is a 'concierge-lite' type of practice. I've heard of MDVIP, but don't know much about what services they provide for their fee.....are they charging you for each visit also? do you get discounted labs, imaging, medications? Can you pay for your yearly fees using HSA dollars? These are all questions you should ask your physician.

For those interested in DPC---I believe it is going to become much more popular in the near future. Some sources state that 4,000 physicians/yr are switching over. It's a subscription model---let me give some very popular examples: Children: $10/month, Adults 18-65: $50/month, seniors: $100/month. This includes 24/7 access to your physician via text, phone, twitter, fb, FaceTime, etc. Many even include house calls for free if you live nearby. It also covers routine ECGs, stitches, and any other in-office procedure. Many of these doctors have negotiated fantastic cash prices with companies such as LabCorp or Quest Diagnostics for labs. Most are 90-95% discounted what the hospital charges....why? Because the physician guarantees cash payment in full on the first of every month (cashflow is king!). Most radiology practices will provide MRI's and CT's for 60-70% off for the same reasons.

Most physicians have patient bases of 4,000-6,000 patients. DPC physicians keep it around 600-1000, with only a part time office assistant. Of course, you still want catastrophic insurance for major surgeries, life disasters, but don't most bogleheads have HDHP plans with an HSA as an investment tool, anyways? If you have any more questions, feel free to ask me. If you live in a big-city (where it's growing very rapidly), google "Direct Primary Care in _____) and see if there's anyone near you!

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Re: Concierge medicine Worth It????

Post by Pdxnative » Thu Mar 10, 2016 6:39 pm

ourbrooks wrote:One of the things to worry about is what happens if you need either a specialist or hospital care since your concierge relationship covers neither. Also, drugs would not typically be covered. You probably want to purchase health insurance in addition to the concierge coverage.
I think some people are confused about what the OP's PCP is doing. This is not a replacement for health insurance. It is more like an additional fee to remain part of the PCPs patient pool, and receive some additional benefits (NOT billable medical services, but better access, ease of scheduling, etc.). Assuming the PCP remains connected to the same insurance networks as currently (worth checking), the OP's insurance would operate the same way it does now.

There are other models that involve direct and discounted services, similar to a health plan. But that isn't what the OP is referring to, if I understand correctly.

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Re: Concierge medicine Worth It????

Post by LadyGeek » Thu Mar 10, 2016 7:23 pm

This thread is now in the Personal Consumer Issues forum (physician services). (This thread could also be in the Personal Finance forum, it's a mix. This forum allows a broader discussion, such as quality of care.)

Here's a link to the OP's plan: MDVIP

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Re: Concierge medicine Worth It????

Post by Lynette » Thu Mar 10, 2016 7:29 pm

.....
Last edited by Lynette on Wed Dec 06, 2017 12:44 pm, edited 1 time in total.

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Re: Concierge medicine Worth It????

Post by ourbrooks » Thu Mar 10, 2016 7:43 pm

Perhaps, I should have edited my post to say "you will certainly want to continue to purchase health insurance coverage in addition to the concierge coverage." Concierge coverage is a cost above and beyond the basic costs of health insurance. It's like purchasing an upgraded seat on an airline.

From the MDVIP website:
Most PPO, POS and HMO health insurance plans are compatible with your membership in an MDVIP-affiliated practice. We will be happy to discuss your specific health plan with you. Your annual fee is for a wellness program that is generally not covered by insurance. You will still need health insurance to cover all other healthcare visits unrelated to your wellness program, including office visits, hospital stays and visits to specialists

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Re: Concierge medicine Worth It????

Post by Impromptu » Thu Mar 10, 2016 8:50 pm

Rexindex wrote:We can afford to do this and feel our primary care has been wonderful over the last 20 years and want to stay with him.
Then stay with him. While doctors are all trained to high standards, they are not interchangeable. If you found someone you really enjoy working with, then stay with him.
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Re: Concierge medicine Worth It????

Post by malabargold » Thu Mar 10, 2016 8:52 pm

This is a business model, nothing else.

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Re: Concierge medicine Worth It????

Post by Swampy » Thu Mar 10, 2016 8:54 pm

Concierge medicine worth it????
In a word - NO.
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Re: Concierge medicine Worth It????

Post by Boglegrappler » Thu Mar 10, 2016 9:10 pm

dm200 wrote:
NonnyGoGo wrote:
One concern would be that this is your PCP's way of easing into retirement. It may not be easier to get an appointment if his availability goes down to two days a week.


Interesting possibility. I had not heard of this as a "motivation". Maybe some of the Physicians her can comment.


The motivation is that you don't have to work as hard! You can see much fewer patients and make the same or even more money if you can find enough patients to pay the retainer. If you charge $1700 per patient, you need less than 300 patients to gross $0.5M. Assuming a 60% overhead, you make $200K, which is what many PCP's make, give or take 10%. This sure beats seeing 25 patients per day!
I declined to go with my pcp when he went to concierge two years ago. But I completely understand the reasons for physicians doing it. Doctors need to be able to make a reasonable income reflecting the investment of time and money in their careers. BTW, on medicare rates, I'll bet that a physician needs to see in excess of 25 patients a day to make sense of his career.

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Re: Concierge medicine Worth It????

Post by SpaceCowboy » Fri Mar 11, 2016 1:25 am

In talking with physicians, they think it's a better way to manage their lifestyle and cut down their patient load. It does allow them to spend more time with each patient. To me concierge docs also get more selective about what insurance networks they join. Honestly though, if you can afford the concierge fee, the cost of office visits to the PCP aren't much of an add. You need insurance for the specialists, procedures, imagery, hospital etc.
My main reason for not joining a concierge practice, is that it is no guarantee that the quality of medical care is higher. Concierge docs are not necessarily any better. They just have a higher customer service model and a different business model. If there were truly a concierge network comprised of the top 10% measured in some meaningful way, which no doubt would be up for debate, I'd strongly consider it.

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Re: Concierge medicine Worth It????

Post by HIinvestor » Fri Mar 11, 2016 2:03 am

It depends a great deal on the patient and the practice. Several docs around our state are switching to this for lower patient loads, but this increases the loads on the physicians who are NOT switching. My docs so far have not opted for this and if they did, we'd have to carefully consider it. I am considered a complicated patient and see my internist at least 3-4x/year, plus sometimes need to consult him between visits. I also have an allergist and a pulmonologist. H also see his internist about 3-4x/year plus if he has any infections or problems between visits.

It would be important to see what is and is not covered with the fee, how often it has to be paid, and how everything works with insurance and any Medicare. Several of my friends have opted for concierge medicine because they liked the internist and she switched to it and said she'd be cutting her patient load down to about 500 patients, the first ones who signed up instead of the 2000 she was carrying. She wanted my allergist to give a free allergy clinic to her patients, but my allergist declined since she felt she was getting more much work and no benefit from the other MD dropping patients who didn't want to pay the extra fee. She's already terribly over-worked as it is!

I don't know the answer, but having a good MD that you can work closely with is important, especially if you have complicated chronic health issues. If you are basically healthy and only see the doc about once/year, it may not be as important.

I also agree that for most MDs, they will NOT be in charge of coordinating care. I am the manager of my care and keep my healthcare providers informed about the diagnoses and opinions and medications that I'm getting from each of them. I ask them when we should add a new specialist and let them know what each other is saying. Coordinating care is a big challenge, but very important. You CAN hire someone to help with this, but so far, I have done it for myself and both of my children--we all have some chronic health issues. As was said above, referrals and whether you will get in to be seen promptly for your referrals is another matter entirely, which can be an important issue if you have more complicated health issues.

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Re: Concierge medicine Worth It????

Post by 2comma » Fri Mar 11, 2016 3:16 am

123 wrote:
queso wrote:Our hope is that this will finally get us a dedicated primary care doctor who will act as a tireless project manager who will doggedly pursue a diagnosis and hopefully relief using whatever specialists he/she needs to get the job done.
In that kind of situation I think you best option is to get connected with a physician or clinic associated with nearby medical school. I think medical school environments can be much better for difficult cases. I don't think many doctors, even concierge physicians, want to act as a tireless project manager.
I had a friend that had a hard time getting a diagnosis locally (large regional medical community). After a few years attempting she eventually resorted to going to one of the "world class" diagnostic clinics - they only diagnose, they do not treat. She had to pay "out of pocket" but said she had spent more over 3 years bouncing between different specialists who never came to a conclusion. She is a process/procedure type person (perfectionists) and was very impressed that she was assigned a team of specialists and a schedule of tests to be performed with a date when the final diagnosis would be given by her "panel of experts". Since I heard her story I always thought that if I or a loved one had a difficult condition to diagnose I would pay for the services of the "best of the best" in diagnostic capabilities and yes they are associated with/part of large medical universities.
If I am stupid I will pay.

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Re: Concierge medicine Worth It????

Post by UADM » Fri Mar 11, 2016 5:38 am

Swampy wrote:
Concierge medicine worth it????
In a word - NO.
Maybe not for your specific needs, but you don't speak for everyone. My experience has been amazing.

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Re: Concierge medicine Worth It????

Post by sumi » Fri Mar 11, 2016 5:55 am

I work in a doctor's office and I see the amount of paperwork insurance companies have us do everyday. More than 50% of the doctor's time goes in filling prior authorization for medications our patients need. Every procedure, every referral, every medication nowadays generate more paperwork for the doctors and the doctors do not get paid for it.In their effort to save money, doctors are being squeezed by insurance companies, needing to explain every decision. On top of that most days doctors are explaining to nurses and not their peers as to why they made such decision for prior approval. It is not easy being a doctor. On one side patients demand service and on the other side the insurance companies question everything. Oh, and then there are the audits. After years of education and loans that they have to pay off, most doctors are forced to do as per insurance dictates. Nobody sees this side of medicine.


I feel if the doctor is charging $1600 for 24/7 care, it is true patient care and not care dictated by insurance companies.As long as the doctor is good and has been taking care of you well it may be worth it.

It is not working hard that is a problem.Most doctor's do. It is working hard and not being able to deliver proper care due to the paperwork that bogs one down is the doctor's problem. Many doctors will take this route just to escape the demands of the insurance companies.

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Re: Concierge medicine Worth It????

Post by Swansea » Fri Mar 11, 2016 6:00 am

In my part of the country (Maryland), the only docs going concierge I know of are primary care. Since there is a shortage of pc docs, some of this move may be driven by supply and demand.
Has anyone notice a significant number of specialists going this route?

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Re: Concierge medicine Worth It????

Post by SleepKing » Fri Mar 11, 2016 7:40 am

sumi wrote:I work in a doctor's office and I see the amount of paperwork insurance companies have us do everyday. More than 50% of the doctor's time goes in filling prior authorization for medications our patients need. Every procedure, every referral, every medication nowadays generate more paperwork for the doctors and the doctors do not get paid for it.In their effort to save money, doctors are being squeezed by insurance companies, needing to explain every decision. On top of that most days doctors are explaining to nurses and not their peers as to why they made such decision for prior approval. It is not easy being a doctor. On one side patients demand service and on the other side the insurance companies question everything. Oh, and then there are the audits. After years of education and loans that they have to pay off, most doctors are forced to do as per insurance dictates. Nobody sees this side of medicine.


I feel if the doctor is charging $1600 for 24/7 care, it is true patient care and not care dictated by insurance companies.As long as the doctor is good and has been taking care of you well it may be worth it.

It is not working hard that is a problem.Most doctor's do. It is working hard and not being able to deliver proper care due to the paperwork that bogs one down is the doctor's problem. Many doctors will take this route just to escape the demands of the insurance companies.
Great summary.

We are at the point where doctor's do not run medicine, or practically their own patients, anymore. Insurance companies, administrators, and bureaucrats do. Concierge medicine seems to re-empower the patient-physician relationship. This how many patients learned to trust their doctors since the time they were a child, only to see this relationship disappear due to aforementioned reasons, over the past few decades. Also a main reason most physicians went into medicine. Seems to me like a re-balancing of the force.

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Re: Concierge medicine Worth It????

Post by Rexindex » Fri Mar 11, 2016 8:02 am

To clarify, my PCP is 68, in great shape and plans on practicing another 5 or so years.

He does not need the money but I am absolutely sure the quality of life for him will be much improved. HE has cited numerous times he is tired of getting 5 minutes to talk about 2 problems when the patient has 5 problems.

It is a tough choice because he is a great doc but since we are relatively healthy it is hard to justify the cost. At our age we are interested in giving it a year and seeing what the benefits are.
“Attention is the rarest and purest form of generosity.” | — Simone Weil

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Re: Concierge medicine Worth It????

Post by queso » Fri Mar 11, 2016 8:46 am

2comma wrote:
123 wrote:
queso wrote:Our hope is that this will finally get us a dedicated primary care doctor who will act as a tireless project manager who will doggedly pursue a diagnosis and hopefully relief using whatever specialists he/she needs to get the job done.
In that kind of situation I think you best option is to get connected with a physician or clinic associated with nearby medical school. I think medical school environments can be much better for difficult cases. I don't think many doctors, even concierge physicians, want to act as a tireless project manager.
I had a friend that had a hard time getting a diagnosis locally (large regional medical community). After a few years attempting she eventually resorted to going to one of the "world class" diagnostic clinics - they only diagnose, they do not treat. She had to pay "out of pocket" but said she had spent more over 3 years bouncing between different specialists who never came to a conclusion. She is a process/procedure type person (perfectionists) and was very impressed that she was assigned a team of specialists and a schedule of tests to be performed with a date when the final diagnosis would be given by her "panel of experts". Since I heard her story I always thought that if I or a loved one had a difficult condition to diagnose I would pay for the services of the "best of the best" in diagnostic capabilities and yes they are associated with/part of large medical universities.
We are considering Mayo or Hopkins, but would be all ears if you have any other recommendations based on your experience. Thanks!

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Re: Concierge medicine Worth It????

Post by john94549 » Fri Mar 11, 2016 9:56 am

My wife is with MDVIP and loves it (feel free to PM). My wife and I are 68, pushing 69. I am already signed up with Kaiser Senior Advantage (I really like Kaiser). My wife is still working and under her employer-provided insurance. However, as she will be retiring (eventually), she looked around for a PCP and found none to her liking willing to accept new Medicare patients. On a recommendation from her current PCP (who is retiring), she connected with MDVIP. Her new PCP with MDVIP will take her Medicare (when she transitions), and she really likes him. I have posted on another thread the "extras" he and his nurse have already provided, at no additional charge above the concierge fee.

Funny story: I was at Kaiser last week, and chatted briefly with my PCP (an internist) about why he chose to work at Kaiser rather than be in private practice. He rolled his eyes, smiled, and said: "Medicare".

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Re: Concierge medicine Worth It????

Post by dm200 » Fri Mar 11, 2016 11:59 am

john94549 wrote:My wife is with MDVIP and loves it (feel free to PM). My wife and I are 68, pushing 69. I am already signed up with Kaiser Senior Advantage (I really like Kaiser). My wife is still working and under her employer-provided insurance. However, as she will be retiring (eventually), she looked around for a PCP and found none to her liking willing to accept new Medicare patients. On a recommendation from her current PCP (who is retiring), she connected with MDVIP. Her new PCP with MDVIP will take her Medicare (when she transitions), and she really likes him. I have posted on another thread the "extras" he and his nurse have already provided, at no additional charge above the concierge fee.
Funny story: I was at Kaiser last week, and chatted briefly with my PCP (an internist) about why he chose to work at Kaiser rather than be in private practice. He rolled his eyes, smiled, and said: "Medicare".
I looked at the MDVIP web site and searched this area. There are a lot of area Physicians in it. The physicians seem to be a varied group, male and female, older and not so old.

Do such Physicians go to all "Concierge" or can the (or do they) have some "regular" patients and some "Concierge" patients?

How (if at all) do or can an MDVIP Physician have Medicare patients?

In a given area, are the Physicians in MDVIP completely independent of each other or is there any "relationship"? For example, I was previously a patient of a PCP (Internal medicine) in a practice with three other Internists. One benefit of this was that if my PCP were not available for some period of time (extended vacation, maternity leave, etc.), I could be seen by another Physician in the practice. How does that work with a "Concierge" practice and/or with MDVIP.

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Re: Concierge medicine Worth It????

Post by dm200 » Fri Mar 11, 2016 12:16 pm

Code: Select all

Funny story: I was at Kaiser last week, and chatted briefly with my PCP (an internist) about why he chose to work at Kaiser rather than be in private practice. He rolled his eyes, smiled, and said: "Medicare".
My experience with Kaiser Medicare (Medicare 'Cost" in Washington DC area) is excellent. While copay amounts, charges for various products/services/etc. and other "rules" must be generally followed (just as with the many different plans Kaiser offers), I have not experienced ANY skimping on such services because I am on Medicare. My experience and perception is that the Physicians (Primary care and specialists) do not treat me any differently because I am on a Medicare plan. When scheduling the annual physical/health assessment, and the disclosure that there is no copay - Kaiser does state that if a new condition is brought up, the visit will (or may) incur a charge. Over the years, however, Kaiser does not seem to charge even when I have brought up new conditions. Last year, for some reason, I did get a bill for the copay amount, but I called and it was reversed. One of the things my PCP recommended (and I did receive it) was an additional (and ifferent) Pneumonia vaccine.

Two or three years ago, there was something "curious" about my annual Health assessment appointment, both scheduling and the appintment itself. I make almost all appointments with my Kaiser PCP online. That year, when selecting the type of appointment, there was a distinction of Medicare Health assessment and just Health assessment. Since I was on Medicare, I scheduled the Medicare Health assessment. When I arrived at Kaiser for the appointment, they gave me some information to read and there was some kind of "secret word" (or phrase) that I was supposed to remember. Then, during the physical/health assessment the Physician would ask me for this "secret word" (or phrase) as a "test" of memory.

Then, the next year - this Medicare Health assessment choice went away, as did the "memory test" with the secret word.

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Re: Concierge medicine Worth It????

Post by dm200 » Fri Mar 11, 2016 12:31 pm

UADM wrote:
Swampy wrote:
Concierge medicine worth it????
In a word - NO.
Maybe not for your specific needs, but you don't speak for everyone. My experience has been amazing.
In quantifying whether this is (or might be) "worth it", I see some parallels (or possible ones) with my experience with Kaiser. One (of many possible) issue or question is whether this enhanced availability of Physician access reduces charges for office visits of other, perhaps costly, services? For example, if you have after hours telephone access to your "Concierge Physician" and you encounter an "issue" at 9 am on a Saturday, and have a telephone conversation about the "issue", might that result in a lower (or much lower) incurred cost than an alternative of an emergency room or standalone urgent care visit?

I will say that when I first heard of the "Concierge medicine" movement, I had a very negative reaction - that this was better healthcare and access for the "rich". Based on some of the details that I am hearing and reading about, my attitude may be changing. While numbers like $1,000 - $2,000 per month may seem like a lot, just ONE, even modest, hospitalization for a few days along with some tests, procedures, surgery, etc. can easily cost this much or more. Suppose such enhanced access could prevent or minimize this?

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Re: Concierge medicine Worth It????

Post by john94549 » Fri Mar 11, 2016 12:41 pm

dm200, I don't know whether my wife's PCP has any other patients "outside" MDVIP. He assures her he will take her Medicare, when she transitions into it, as a MDVIP patient. I suspect the MDVIP annual fee offsets his angst. Finally, MDVIP has physicians all over the Bay Area. In a pinch, she has been assured that a local MDVIP physician-participant can assist her (i.e., she wouldn't have to drive all the way to Palo Alto from Lafayette).

Her "circle" of physicians has always been in Palo Alto, even though we moved to Lafayette in 1978.

PS: the MDVIP fee is per year, not per month. I think my wife pays $2000/yr, or thereabouts.

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Re: Concierge medicine Worth It????

Post by dm200 » Fri Mar 11, 2016 2:04 pm

john94549 wrote:dm200, I don't know whether my wife's PCP has any other patients "outside" MDVIP. He assures her he will take her Medicare, when she transitions into it, as a MDVIP patient. I suspect the MDVIP annual fee offsets his angst. Finally, MDVIP has physicians all over the Bay Area. In a pinch, she has been assured that a local MDVIP physician-participant can assist her (i.e., she wouldn't have to drive all the way to Palo Alto from Lafayette).
Her "circle" of physicians has always been in Palo Alto, even though we moved to Lafayette in 1978.
PS: the MDVIP fee is per year, not per month. I think my wife pays $2000/yr, or thereabouts.
That is interesting about MDVIP and Medicare. While I cannot cite chapter and verse, I did not believe a Medicare provider could charge Medicare patients beyond the Medicare schedule amounts.

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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Mar 12, 2016 1:01 pm

dm200 wrote:
john94549 wrote:dm200, I don't know whether my wife's PCP has any other patients "outside" MDVIP. He assures her he will take her Medicare, when she transitions into it, as a MDVIP patient. I suspect the MDVIP annual fee offsets his angst. Finally, MDVIP has physicians all over the Bay Area. In a pinch, she has been assured that a local MDVIP physician-participant can assist her (i.e., she wouldn't have to drive all the way to Palo Alto from Lafayette).
Her "circle" of physicians has always been in Palo Alto, even though we moved to Lafayette in 1978.
PS: the MDVIP fee is per year, not per month. I think my wife pays $2000/yr, or thereabouts.
That is interesting about MDVIP and Medicare. While I cannot cite chapter and verse, I did not believe a Medicare provider could charge Medicare patients beyond the Medicare schedule amounts.
I was thinking the same thing. It makes it difficult to find an easy answer since there are 4 different classifications of in-network and out-of-network physicians when it comes to Medicare.

I found this on Google and it's confusing as heck, just like everything else related to Medicare:

http://cahealthadvocates.org/_pdf/webin ... -notes.pdf

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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Mar 12, 2016 3:17 pm

We are seeing the finalization of the 2-tier healthcare system that has been in progress for years. The future will be 2 different healthcare settings: one where patients are shuffled through as quickly as possible like cattle to maximize the number of patients seen while providing the minimal standard of care. There are longer waits to get tests, imaging, and appointments. Strangely, this is not necessarily cheaper. The other (Concierge or DPC) is a setting where you will get more personalized care by the same doctor every time with minimal waiting and you will have someone to take extra steps to get tests done quickly, coordinate outside care, and you will not be rushed out the door after 7 minutes of doctor time. Yes this about money. Just like other industries, if you pay for the upgrades you will get a better product. Nothing wrong with that. While you don't always get what you pay for, you will NEVER get what you DON'T pay for. This is not offering care just to the "rich" since there are not enough rich people out there...some of the concierge fees are a similar amount that many women spend on their hair per year. Many people will be happy with the cattle call sitting in economy class, while others will find value and pay for the upgraded 1st class airline seat. Both will get you to your destination.

Concierge doctors generally do not make more money. Concierge medicine is about simplifying things to get rid of the inefficiencies and time constraints to offer better care. The doctor's time can be focused on being a doctor instead of a secretary. The doctor's office can be reimbursed for things that insurance companies don't pay for such as phone/email availability and after hours care. Everyone assumes quality for some reason. It also involves working smarter instead of harder. Who here would prefer to work harder instead of smarter? In medicine, working harder does NOT mean getting paid more. Insurance is a race to the bottom where yearly paycuts dominate since physicians are forbidden from collective bargaining and therefore have no negotiating power with insurance companies. These rules do not apply to hospitals which are able to negotiate their fees and they can also charge facility fees separately. This increases the cost to patients and they don't even know it.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Mar 12, 2016 3:28 pm

toofache32 wrote:We are seeing the finalization of the 2-tier healthcare system that has been in progress for years. The future will be 2 different healthcare settings: one where patients are shuffled through as quickly as possible like cattle to maximize the number of patients seen while providing the minimal standard of care. There are longer waits to get tests, imaging, and appointments. Strangely, this is not necessarily cheaper. The other (Concierge or DPC) is a setting where you will get more personalized care by the same doctor every time with minimal waiting and you will have someone to take extra steps to get tests done quickly, coordinate outside care, and you will not be rushed out the door after 7 minutes of doctor time. Yes this about money. Just like other industries, if you pay for the upgrades you will get a better product. Nothing wrong with that. While you don't always get what you pay for, you will NEVER get what you DON'T pay for. This is not offering care just to the "rich" since there are not enough rich people out there...some of the concierge fees are a similar amount that many women spend on their hair per year. Many people will be happy with the cattle call sitting in economy class, while others will find value and pay for the upgraded 1st class airline seat. Both will get you to your destination.
Concierge doctors generally do not make more money. Concierge medicine is about simplifying things to get rid of the inefficiencies and time constraints to offer better care. The doctor's time can be focused on being a doctor instead of a secretary. The doctor's office can be reimbursed for things that insurance companies don't pay for such as phone/email availability and after hours care. Everyone assumes quality for some reason. It also involves working smarter instead of harder. Who here would prefer to work harder instead of smarter? In medicine, working harder does NOT mean getting paid more. Insurance is a race to the bottom where yearly paycuts dominate since physicians are forbidden from collective bargaining and therefore have no negotiating power with insurance companies. These rules do not apply to hospitals which are able to negotiate their fees and they can also charge facility fees separately. This increases the cost to patients and they don't even know it.
While I do not disagree with many of your points, I also think there are some other "models" of healthcare. The system my wife and I are enrolled in (Kaiser Medicare 'Cost' plan) provides many of the above cited benefits of personalized care. It may not always be with or from the same actual "Physician", but with coordinated care and consultation of multiple professionals - all with full access to all records. For example, is it really important if I have a condition of great concern on a weekend and this condition is addressed by a Physician (not my Primary care) using a virtual housecall on my Smartphone?

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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Mar 12, 2016 3:56 pm

dm200 wrote:While I do not disagree with many of your points, I also think there are some other "models" of healthcare. The system my wife and I are enrolled in (Kaiser Medicare 'Cost' plan) provides many of the above cited benefits of personalized care. It may not always be with or from the same actual "Physician", but with coordinated care and consultation of multiple professionals - all with full access to all records. For example, is it really important if I have a condition of great concern on a weekend and this condition is addressed by a Physician (not my Primary care) using a virtual housecall on my Smartphone?
Although none of us knows the financial ins and outs of the Kaiser system, I have to think this is still a more expensive model since they will charge extensive facility fees and HCPCS codes that private practice docs are not allowed to charge for the same services. Not all of these fees are cost-shared by patients which means patients are rarely concerned with the increased costs. They only care about their own wallets. This is how a corporate model can afford to hire doctors as employees. About 5 years ago only about 30% of doctors were employed by hospital/corporate groups. Now it's about 66% if I remember correctly. My prediction is that this will increase as much as possible until the insurance industry "owns" at least 80% of the doctors. Then they will make the most drastic pay cuts ever since the doctors will have no choice. That will complete our transition into a 2-tier healthcare system which we never really planned on.

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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Mar 12, 2016 3:57 pm

I am a surgical specialist with 2 separate jobs. One is an insurance-based job where I am an employee (not a doctor, only a provider), and the other is my own private practice which is mostly cash although there is some insurance which I am slowly weeding out. Although I don't consider my private practice concierge, it's a similar concept since it's cash based. You can still use you insurance for hospital fees, imaging fees, and everything else. It's just the surgeon's fee that changes here which most people think will be 5-20x higher than the fees we quote them. There are no surprises and you know all costs up front. I do my own H&Ps, take out my own sutures, do my own wound care. I see the patients every visit and don't turf them off to nurses. I round on these patients in the hospital instead of turfing them to a nurse. Every patient get the same cell number my wife calls me on, not a call center or nurse they have never met. Appointments are available within 24 hours and I will come in to my office after hours to keep you out of the ER. I can afford to provide treatment at a low and reasonable rate because the middle man is removed which only increases healthcare costs. Yes, insurance increases healthcare costs. I know I am getting paid every time since I don't have to worry about insurance denials. Patients are given walkout statements so they can file their own claim if they want to. Many have lots of trouble with the claims process and quickly understand why we are leaving the insurance world. I stay plenty busy treating patients out-of-network and the patients are happy and keep coming back. Not many Medicare/Medicaid patients though since they are the most entitled and balk at paying for anything.

One of the biggest unsung problems with insurance in my practice is that it treats every case the same. There is no recognition of the extra time, expertise, and resources required for more difficult cases. I am not compensated for taking on sicker patients that will require more time and have more complications (that I am also not paid for dealing with). Therefore, in my office insurance is only for slam dunk cases since we must work at a discount. For very complex cases that require extensive extra time, expertise, and resources....those are not discount cases and I'm not interested in getting involved. Most insurance patients don't realize that insurance takes away the doctor's incentive to compete with other doctors by providing better service and make sure the patient is happy and stays in their practice. If the patient is unhappy and leaves, the insurance company has 10 more patients waiting to fill their spot. Insurance patients tend to greatly overestimate their value to a practice. About once a week a patient tells me "I have GREAT insurance!!" as if they actually know what that means. There is actually no longer such a thing as great insurance.

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Re: Concierge medicine Worth It????

Post by CedarWaxWing » Sat Mar 12, 2016 4:10 pm

Rexindex wrote:To clarify, my PCP is 68, in great shape and plans on practicing another 5 or so years.

He does not need the money but I am absolutely sure the quality of life for him will be much improved. HE has cited numerous times he is tired of getting 5 minutes to talk about 2 problems when the patient has 5 problems.

It is a tough choice because he is a great doc but since we are relatively healthy it is hard to justify the cost. At our age we are interested in giving it a year and seeing what the benefits are.
This is one of the problems with concierge medicine... the healthy paitients will pay much more than they would otherwise.... and it would presumably be good for both those patients and that md to continue the doctor patient relationship... but the law does not allow to give a different annual fee to you (or me) simply because he knows you will not need or use the "extra service" such as 24 hour access, or long appointment times, etc.

(Although for a pt who is not able to afford the fee he may be able to waive that fee totally or in part for economic distress.)

m

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