Concierge medicine Worth It????

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johnrbain
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Re: Concierge medicine Worth It????

Post by johnrbain » Tue Dec 27, 2016 11:10 pm

Had the same thing happen to my wife and I last year.
Since we both used the same doctor the payment would have been $3300 (2x$1650)
We are both in our late 50's, in decent health other than weight, and take blood pressure medicine.
I paid for the first quarter and decided that the $3300 could be better spent elsewhere, so we found
another doctor. There are good doctors out there- you just have to look.
So if you're in a major metropolitan area and can find another doctor, the question is do you want to allocate
these dollars to that purpose or are they better spent elsewhere.
Just another perspective- that money can be used to supplement savings, help fund retirement, and so many other things.
Since my family is more middle income, in a high cost of living area (Washington DC) and we had no major medical issues
I felt the dollars were better spent elsewhere.

jasper
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Re: Concierge medicine Worth It????

Post by jasper » Wed Dec 28, 2016 12:44 am

robebibb wrote:
jasper wrote:
rgs92 wrote: (that's Physician Assistants, who seem to be able to do 90% of the regular doctor stuff and diagnosis quite well in my experience).
Umm. No. Just..., no.
I don't think I am a perfect physician or a medical genius.
But after doing this for close to 20 years this comment scares me the most.
This is what they (insurers and mid levels - or advanced practice providers as the new terminology reads) would like you to believe.
This is far, far from reality.
It would be unwise to paint all mid-level practitioners as equivalent.
True. Very true. But if we are generalizing on an Internet forum, I stand by this.
For the lay person I feel this is accurate. There are exceptions of course

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Wed Dec 28, 2016 10:56 am

johnrbain wrote:Had the same thing happen to my wife and I last year.
Since we both used the same doctor the payment would have been $3300 (2x$1650)
We are both in our late 50's, in decent health other than weight, and take blood pressure medicine.
I paid for the first quarter and decided that the $3300 could be better spent elsewhere, so we found
another doctor. There are good doctors out there- you just have to look.
So if you're in a major metropolitan area and can find another doctor, the question is do you want to allocate
these dollars to that purpose or are they better spent elsewhere.
Just another perspective- that money can be used to supplement savings, help fund retirement, and so many other things.
Since my family is more middle income, in a high cost of living area (Washington DC) and we had no major medical issues
I felt the dollars were better spent elsewhere.
I live in this area and am very pleased (over the years) with Kaiser. If that is an option for you, I suggest considering it.

vested1
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Re: Concierge medicine Worth It????

Post by vested1 » Wed Jan 25, 2017 11:25 am

I apologize for my absence, as I've been doing my writing on other sites concerning unrelated matters, and neglected this thread.

An Update, which is admittedly anecdotal:

I've spoken with friends who stayed with my original physician, paying the $1,800 extra a year each, and they are very dissatisfied. The wait times are even longer than before and the care is mediocre at best.
- One friend walked out after waiting an hour in the private patient room after complaining two times of the delay and listening to the doctor and staff laughing outside of the door. He was the only patient in the building. He has changed doctors for 2017.
- Another friend stayed along with her husband for a total of $3,600 a year. She complains about the care and the waits as well. At her last visit, she waited patiently in the private patient room for 45 minutes before complaining. She was the only patient in the building and first of the day at 8 am. The staff eventually realized that the doctor wasn't there, even though he is the only doctor in the practice, before they called him at home after she complained. He had forgotten that he had an appointment and told his staff to have her wait until he could get dressed and drive down to the office, which took another 30 minutes.
- This doctor has still not managed to retain 300 patients.

My last doctor who transitioned to MDVIP told me in my final visit that he regretted having to join MDVIP, but that he needed to do so to survive financially.

My new doctor, who I saw a couple of weeks ago asked me why I was changing doctors. When I told him that the last two had suddenly changed to MDVIP and that his own partner in the office had just announced that he also was going that route, my new doctor replied, "What, they don't make enough money already?" We had a good laugh before getting down to business.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Wed Jan 25, 2017 12:03 pm

vested1 wrote:I apologize for my absence, as I've been doing my writing on other sites concerning unrelated matters, and neglected this thread.
An Update, which is admittedly anecdotal:
I've spoken with friends who stayed with my original physician, paying the $1,800 extra a year each, and they are very dissatisfied. The wait times are even longer than before and the care is mediocre at best.
- One friend walked out after waiting an hour in the private patient room after complaining two times of the delay and listening to the doctor and staff laughing outside of the door. He was the only patient in the building. He has changed doctors for 2017.
- Another friend stayed along with her husband for a total of $3,600 a year. She complains about the care and the waits as well. At her last visit, she waited patiently in the private patient room for 45 minutes before complaining. She was the only patient in the building and first of the day at 8 am. The staff eventually realized that the doctor wasn't there, even though he is the only doctor in the practice, before they called him at home after she complained. He had forgotten that he had an appointment and told his staff to have her wait until he could get dressed and drive down to the office, which took another 30 minutes.
- This doctor has still not managed to retain 300 patients.
My last doctor who transitioned to MDVIP told me in my final visit that he regretted having to join MDVIP, but that he needed to do so to survive financially.
My new doctor, who I saw a couple of weeks ago asked me why I was changing doctors. When I told him that the last two had suddenly changed to MDVIP and that his own partner in the office had just announced that he also was going that route, my new doctor replied, "What, they don't make enough money already?" We had a good laugh before getting down to business.
[Almost] hard to believe.

Swansea
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Re: Concierge medicine Worth It????

Post by Swansea » Wed Jan 25, 2017 12:26 pm

My former primary care doc tried to go the concierge route, but could not get the necessary sign ups. Likewise, my friend's primary doc tried also, and failed. There are only so many folks willing and/or able to pay extra out-of-pocket.
P.S. I left the primary guy some years ago as he was far below my expectations.

tenkuky
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Re: Concierge medicine Worth It????

Post by tenkuky » Wed Jan 25, 2017 5:20 pm

dm200 wrote:
vested1 wrote:I apologize for my absence, as I've been doing my writing on other sites concerning unrelated matters, and neglected this thread.
An Update, which is admittedly anecdotal:
I've spoken with friends who stayed with my original physician, paying the $1,800 extra a year each, and they are very dissatisfied. The wait times are even longer than before and the care is mediocre at best.
- One friend walked out after waiting an hour in the private patient room after complaining two times of the delay and listening to the doctor and staff laughing outside of the door. He was the only patient in the building. He has changed doctors for 2017.
- Another friend stayed along with her husband for a total of $3,600 a year. She complains about the care and the waits as well. At her last visit, she waited patiently in the private patient room for 45 minutes before complaining. She was the only patient in the building and first of the day at 8 am. The staff eventually realized that the doctor wasn't there, even though he is the only doctor in the practice, before they called him at home after she complained. He had forgotten that he had an appointment and told his staff to have her wait until he could get dressed and drive down to the office, which took another 30 minutes.
- This doctor has still not managed to retain 300 patients.
My last doctor who transitioned to MDVIP told me in my final visit that he regretted having to join MDVIP, but that he needed to do so to survive financially.
My new doctor, who I saw a couple of weeks ago asked me why I was changing doctors. When I told him that the last two had suddenly changed to MDVIP and that his own partner in the office had just announced that he also was going that route, my new doctor replied, "What, they don't make enough money already?" We had a good laugh before getting down to business.
[Almost] hard to believe.
Not that hard to believe.
My former colleague went for her women's health appointment, the last visit of the day at a major medical center.
Gowned and ready for the physician.
And everybody left (incl nursing, front desk staff and physician) and turned the lights out! :oops:
Only when she got on her cell phone and made several calls did someone return and go "oh, we forgot you were here, let's get the doctor back".

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Wed Jan 25, 2017 7:09 pm

My former colleague went for her women's health appointment, the last visit of the day at a major medical center.
Gowned and ready for the physician.
And everybody left (incl nursing, front desk staff and physician) and turned the lights out! :oops:
Only when she got on her cell phone and made several calls did someone return and go "oh, we forgot you were here, let's get the doctor back".
And these things happen when you are awake - and can do something about it!! Who knows what might happen if you were sedated or under anesthesia - they "forget" you and you wake up (you hope) hours later -- with all your clothes, wallet, cell phone, ID locked in another room.

She could have been locked in all night (or all weekend).

You just can't make this stuff up.

Often people are a bit surprised (and tell me I worry too much) when I relate that I always (either by looking at theirID badge) or asking (very pleasantly and politely) not only who they are (name, for example) but the "category" of health provider (surgeon, MD, DO, RN, NP, Licensed practical nurse, Physicians assistant, maid, IT consultant, coroner, etc.)

tenkuky
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Re: Concierge medicine Worth It????

Post by tenkuky » Wed Jan 25, 2017 7:39 pm

dm200 wrote:
My former colleague went for her women's health appointment, the last visit of the day at a major medical center.
Gowned and ready for the physician.
And everybody left (incl nursing, front desk staff and physician) and turned the lights out! :oops:
Only when she got on her cell phone and made several calls did someone return and go "oh, we forgot you were here, let's get the doctor back".
And these things happen when you are awake - and can do something about it!! Who knows what might happen if you were sedated or under anesthesia - they "forget" you and you wake up (you hope) hours later -- with all your clothes, wallet, cell phone, ID locked in another room.

She could have been locked in all night (or all weekend).

You just can't make this stuff up.

Often people are a bit surprised (and tell me I worry too much) when I relate that I always (either by looking at theirID badge) or asking (very pleasantly and politely) not only who they are (name, for example) but the "category" of health provider (surgeon, MD, DO, RN, NP, Licensed practical nurse, Physicians assistant, maid, IT consultant, coroner, etc.)
And how exactly do you "look at" or "ask" the coroner?! :shock:
By then, I think it would be a moot point.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Thu Jan 26, 2017 12:20 am

Interesting update. I can't imagine this guy being in business too long. I am not a "concierge" doc but I am a specialist who is not in-network with any medical insurance. You better believe my "customer service" is above and beyond because I no longer have the steady stream of insurance patients to rely on. In the insurance world, docs don't fear the upset patient because the insurance company has a long list of patients waiting to take that spot. This is why insurance patients tend to greatly overestimate their value to a practice.

vested1
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Re: Concierge medicine Worth It????

Post by vested1 » Thu Jan 26, 2017 8:12 am

toofache32 wrote:Interesting update. I can't imagine this guy being in business too long. I am not a "concierge" doc but I am a specialist who is not in-network with any medical insurance. You better believe my "customer service" is above and beyond because I no longer have the steady stream of insurance patients to rely on. In the insurance world, docs don't fear the upset patient because the insurance company has a long list of patients waiting to take that spot. This is why insurance patients tend to greatly overestimate their value to a practice.
This post illustrates the deep divide that now exists between too many doctors and patients, brought on IMHO by our health care system which inserts insurance companies into the mix to add a profit incentive where none should exist. Not getting political, just stating a fact. In my HCOL scenic location, which has contiguous small towns who's borders run into each other in a relatively small geographic area, the combined 100,000 permanent residents don't have an HMO hospital and no doctors are members of an insurance plan. Everything is out of network, which increases co-pays and deductibles. The nearest HMO hospital is in a different county, an hours drive one way with no traffic (Kaiser). Very few doctors accept Medicare or Obamacare, and all but a couple of care homes are private pay and don't accept Medicaid.

You would think I was talking about a rural area, but that's not the case. During frequent events that occur all year long here the population swells by up to 40,000 additional people , as the climate is temperate and it never freezes or snows. Doctors charge what they want to because they are the only game in town. Luckily, our only hospital is one of the best in the State, but you certainly pay a price for its services.

And yet, the waiting rooms of those doctors who have transitioned to concierge care here are virtual ghost towns. The result of the spiraling cost for basic care has led many to avoid health care entirely unless an emergency arises. I truly believe that the recent trend of declining life expectancy is largely due to this reality. There can be no justification for this from a layman's perspective, regardless of profit/loss considerations. Everyone should be allowed to pursue success, but our health should not be the price. It's not hyperbole to say that if this trend continues, visiting tourists would be advised to bring along a face mask.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Thu Jan 26, 2017 11:05 am

And how exactly do you "look at" or "ask" the coroner?! :shock:
By then, I think it would be a moot point.
:sharebeer

oxothuk
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Re: Concierge medicine Worth It????

Post by oxothuk » Thu Jan 26, 2017 5:14 pm

vested1 wrote:This post illustrates the deep divide that now exists between too many doctors and patients, brought on IMHO by our health care system which inserts insurance companies into the mix to add a profit incentive where none should exist.
Unless we go back to paying doctors in the same manner we do plumbers, you're going to need somebody in the middle to spread the risk and to say "no" when necessary. That can be insurance companies or the government, but in either case they will be widely hated for the necessary role they play.

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burt
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Re: Concierge medicine Worth It????

Post by burt » Thu Jan 26, 2017 8:05 pm

Recently, after moving to a small mid-west town I started calling for a new primary care physician, who was willing to accept new patients.
After 15 calls I finally found one who could see me.... 3 months later.

The medical system is broken.


burt

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Thu Jan 26, 2017 8:39 pm

burt wrote:Recently, after moving to a small mid-west town I started calling for a new primary care physician, who was willing to accept new patients.
After 15 calls I finally found one who could see me.... 3 months later.

The medical system is broken.


burt
Not enough info for anyone to agree or disagree. Discount plan or cash? if it's a discount plan then I'm not sure what you expected.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Fri Jan 27, 2017 10:34 am

burt wrote:Recently, after moving to a small mid-west town I started calling for a new primary care physician, who was willing to accept new patients.
After 15 calls I finally found one who could see me.... 3 months later.
The medical system is broken.
burt
Was this in general "no new patients" OR would not accept new patients based on details of health insurance?

vested1
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Re: Concierge medicine Worth It????

Post by vested1 » Fri Jan 27, 2017 12:11 pm

oxothuk wrote:
vested1 wrote:This post illustrates the deep divide that now exists between too many doctors and patients, brought on IMHO by our health care system which inserts insurance companies into the mix to add a profit incentive where none should exist.
Unless we go back to paying doctors in the same manner we do plumbers, you're going to need somebody in the middle to spread the risk and to say "no" when necessary. That can be insurance companies or the government, but in either case they will be widely hated for the necessary role they play.
I don't remember hearing of any middle man in Canada, and despite targeted disinformation, they seem to like it pretty well. A friend of mine while visiting Canada recently had to go to the emergency room and wanted to pay for the service, but was told that there was no structure or system in place to allow for that. What would have cost tens of thousands here was free.

I will not however get into a political debate about something so basic as the right to get medical treatment while not going bankrupt.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Fri Jan 27, 2017 1:43 pm

I don't remember hearing of any middle man in Canada, and despite targeted disinformation, they seem to like it pretty well. A friend of mine while visiting Canada recently had to go to the emergency room and wanted to pay for the service, but was told that there was no structure or system in place to allow for that. What would have cost tens of thousands here was free.
I will not however get into a political debate about something so basic as the right to get medical treatment while not going bankrupt.
That was EXACTLY the experience of an acquaintance who was injured ( pedestrian hit by car) while traveling in Canada (Province of Quebec). The Canadian physicians/hospital provided excellent information for the followup treatment needed when he was able to return to the US (he was enrolled in Kaiser Permanante). He was pleasantly surprised. His only difficulty/complication was not medical, but dealing with the auto insurance liability payments, etc. related to the driver who hit him.

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burt
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Re: Concierge medicine Worth It????

Post by burt » Fri Jan 27, 2017 7:00 pm

dm200 wrote:
burt wrote:Recently, after moving to a small mid-west town I started calling for a new primary care physician, who was willing to accept new patients.
After 15 calls I finally found one who could see me.... 3 months later.
The medical system is broken.
burt
Was this in general "no new patients" OR would not accept new patients based on details of health insurance?
I need to clarify.
7 of 15 calls were bogus because of a bad insurance company database.
5 calls indicated they were not accepting new patients with no information provided regarding insurance, health, etc.
2 of 15 calls required filling out a "new patient form" for review by doctors before acceptance.
1 of 15 calls accepted me, with an appointment set for 3 months later.

I have retiree medical insurance with one of the top 5 insurance companies.
Myself and previous employer pay approximately $1200/mo for high deductible insurance.

As I said before - The medical system is broken.

burt

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Re: Concierge medicine Worth It????

Post by drawpoker » Fri Jun 15, 2018 8:25 pm

*** B U M P ***

Bringing this thread back up because yesterday received doc's letter informing me she has joined MDVip. Cost will be $1,650 a year, have until Sept 27 to make up my mind. Also contained the dire-sounding warning that this is being done first-come, first served, once she reaches "capacity" the unlucky ones go on "waiting list".
After getting over the initial shock (this is a very, very small town, pop less than 6,000, so this quite radical for our area) am very puzzled over some aspects of this.
Big Part of the MDVip requirements is that the practice agrees to a limit of 600 patients. Frankly, I cannot imagine that she has more than 600 patients right now. Or close to it. Altho a small town, we are the county seat, there is a small local hospital still operating (albeit with limited inpatient services, no maternity, no pediatrics, some other stuff not offered) so by my count, there are about 10 to 12 other docs, either internists or family practice, with offices right here all within one square mile, competing with her for patients.
If you take the whole county, not just the town, as the potential customer base for these doctors, that is just 20,000 people, according to the last census. Also, our county has been flat-lining for years, there has been no population growth. Nor is any expected, that would create a draw for doctors and other professionals. It's not likely neighboring counties will be a big source of patients. In fact, if you start going out-of-county to the west, you aren't far from Annapolis with its renowned Anne Arundel Medical Center complex. Which everyone would love to have for their own doctors, both PCP and specialists.
Is it realistic, given our demographics and the amount of competition already, for an PCP/internist to expect to be able to snare 600 people willing to pony up the concierge fee, every year, under these circumstances? Hope some of the docs who have been in this thread might return and share more of their thoughts on this.
Or, is this a trial balloon she is sending up, if she doesn't get the 600, she will just go ahead and retire early? She is 62 and has been practicing for 28 years. Burnout, maybe? A factor in this?
(She is not in solo, has another doc in partnership, but I looked it up, and this guy is also joining up with MDVip :oops: )

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Fri Jun 15, 2018 9:28 pm

Interesting. I grew up in a town this size and I cannot imagine this model being able to survive in a rural area where there tends to be high numbers of medicaid. I hope she proves me wrong.

Doroghazi
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Re: Concierge medicine Worth It????

Post by Doroghazi » Sat Jun 16, 2018 8:32 am

I guess the 2 main factors are 1) What is your state of health? If you have multiple medical problems, and need to see the doctor frequently, then I would sign up. If you see the MD just once a year for a routine check, then no. 2) If you do not sign with this person, what are your options?

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 10:02 am

As I follow the whole "Concierge medicine" movement and discussion - the pros and cons, etc. - I conclude that our current Kaiser plan offers a great many of the same or similar benefits.

We choose a Primary care Physician who coordinates our care. My wife, if she chooses, can also have an OB/Gyn in additon. Care is available by phone and in person (urgent care) 24x7. The only medical professional we see at Primary care appointments is out PCP. About half of needs can be done by email or telephone appt (no charge). Appointments are available quickly.

I wonder if there are other similar alternatives to Concierge medicine withut the added cost?

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 10:05 am

drawpoker wrote:
Fri Jun 15, 2018 8:25 pm
*** B U M P ***

Bringing this thread back up because yesterday received doc's letter informing me she has joined MDVip. Cost will be $1,650 a year, have until Sept 27 to make up my mind. Also contained the dire-sounding warning that this is being done first-come, first served, once she reaches "capacity" the unlucky ones go on "waiting list".
After getting over the initial shock (this is a very, very small town, pop less than 6,000, so this quite radical for our area) am very puzzled over some aspects of this.
Big Part of the MDVip requirements is that the practice agrees to a limit of 600 patients. Frankly, I cannot imagine that she has more than 600 patients right now. Or close to it. Altho a small town, we are the county seat, there is a small local hospital still operating (albeit with limited inpatient services, no maternity, no pediatrics, some other stuff not offered) so by my count, there are about 10 to 12 other docs, either internists or family practice, with offices right here all within one square mile, competing with her for patients.
If you take the whole county, not just the town, as the potential customer base for these doctors, that is just 20,000 people, according to the last census. Also, our county has been flat-lining for years, there has been no population growth. Nor is any expected, that would create a draw for doctors and other professionals. It's not likely neighboring counties will be a big source of patients. In fact, if you start going out-of-county to the west, you aren't far from Annapolis with its renowned Anne Arundel Medical Center complex. Which everyone would love to have for their own doctors, both PCP and specialists.
Is it realistic, given our demographics and the amount of competition already, for an PCP/internist to expect to be able to snare 600 people willing to pony up the concierge fee, every year, under these circumstances? Hope some of the docs who have been in this thread might return and share more of their thoughts on this.
Or, is this a trial balloon she is sending up, if she doesn't get the 600, she will just go ahead and retire early? She is 62 and has been practicing for 28 years. Burnout, maybe? A factor in this?
(She is not in solo, has another doc in partnership, but I looked it up, and this guy is also joining up with MDVip :oops: )
Sounds like my hometown - moved away 50+ years ago. Are there any financial savings to offset the $1,650 charge?

I tend to agree with you that this environment does not sound like this will work for him/her.

vested1
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Re: Concierge medicine Worth It????

Post by vested1 » Sat Jun 16, 2018 10:24 am

drawpoker wrote:
Fri Jun 15, 2018 8:25 pm
*** B U M P ***

Bringing this thread back up because yesterday received doc's letter informing me she has joined MDVip. Cost will be $1,650 a year, have until Sept 27 to make up my mind. Also contained the dire-sounding warning that this is being done first-come, first served, once she reaches "capacity" the unlucky ones go on "waiting list".
After getting over the initial shock (this is a very, very small town, pop less than 6,000, so this quite radical for our area) am very puzzled over some aspects of this.
Big Part of the MDVip requirements is that the practice agrees to a limit of 600 patients. Frankly, I cannot imagine that she has more than 600 patients right now. Or close to it. Altho a small town, we are the county seat, there is a small local hospital still operating (albeit with limited inpatient services, no maternity, no pediatrics, some other stuff not offered) so by my count, there are about 10 to 12 other docs, either internists or family practice, with offices right here all within one square mile, competing with her for patients.
If you take the whole county, not just the town, as the potential customer base for these doctors, that is just 20,000 people, according to the last census. Also, our county has been flat-lining for years, there has been no population growth. Nor is any expected, that would create a draw for doctors and other professionals. It's not likely neighboring counties will be a big source of patients. In fact, if you start going out-of-county to the west, you aren't far from Annapolis with its renowned Anne Arundel Medical Center complex. Which everyone would love to have for their own doctors, both PCP and specialists.
Is it realistic, given our demographics and the amount of competition already, for an PCP/internist to expect to be able to snare 600 people willing to pony up the concierge fee, every year, under these circumstances? Hope some of the docs who have been in this thread might return and share more of their thoughts on this.
Or, is this a trial balloon she is sending up, if she doesn't get the 600, she will just go ahead and retire early? She is 62 and has been practicing for 28 years. Burnout, maybe? A factor in this?
(She is not in solo, has another doc in partnership, but I looked it up, and this guy is also joining up with MDVip :oops: )
The next communication you will receive will contain a lowering of the 600 patient limit to 400, then to 300, which hopefully will never be reached. She may also use the oft quoted figure of having 2,000 current patients and that by slashing that number she will be better able to serve her remaining patients. While this could possibly be true, it would seem a variation of this canned spiel might be in order, one that I heard verbatim at the various doctors I abandoned for adopting this practice. Curious that they should all have exactly 2,000 patients.

I suppose we expect too much of our physicians, and assign to them an outdated concept of sacrifice due to a romantic concept of the Hippocratic oath. They are, after all, in business to make a profit. I wonder, however, how they would feel if the shoe was on the other foot? Can you imagine the outcry if every service that they (or anyone else) required had an annual fee for participation? If you want groceries it will require a yearly fee of $1,650 per shopper for membership only (think Costco) . Want your car fixed? Another $1,650 per mechanic's membership only please. Everyone needs water, how about a $1,650 annual membership fee for every user if they want to turn on the tap?

We recognize it when advisory firms take advantage with high AUM fees, and those in the know avoid those ridiculous charges. As with investment firms, doctors who chose to participate in the MDVip program will either flourish or fail. I can hopefully be excused for my vote in that regard.

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Re: Concierge medicine Worth It????

Post by mouses » Sat Jun 16, 2018 10:33 am

Single payer is really the only way to go. Sure, it has its problems, but they are dwarfed by the enormous waste of money that winds up in the pockets of the insurance and pharmaceutical companies with the current system. Concierge vs. non-concierge is just trying to put a bandaid on a fracture.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 10:37 am

The next communication you will receive will contain a lowering of the 600 patient limit to 400, then to 300, which hopefully will never be reached. She may also use the oft quoted figure of having 2,000 current patients and that by slashing that number she will be better able to serve her remaining patients. While this could possibly be true, it would seem a variation of this canned spiel might be in order, one that I heard verbatim at the various doctors I abandoned for adopting this practice. Curious that they should all have exactly 2,000 patients.
I suppose we expect too much of our physicians, and assign to them an outdated concept of sacrifice due to a romantic concept of the Hippocratic oath. They are, after all, in business to make a profit. I wonder, however, how they would feel if the shoe was on the other foot? Can you imagine the outcry if every service that they (or anyone else) required had an annual fee for participation? If you want groceries it will require a yearly fee of $1,650 per shopper for membership only (think Costco) . Want your car fixed? Another $1,650 per mechanic's membership only please. Everyone needs water, how about a $1,650 annual membership fee for every user if they want to turn on the tap?
We recognize it when advisory firms take advantage with high AUM fees, and those in the know avoid those ridiculous charges. As with investment firms, doctors who chose to participate in the MDVip program will either flourish or fail. I can hopefully be excused for my vote in that regard.
One, big (in my opinion) challenge of good health and healthcare is proper compensation for providers. Such "providers" almost exclusively get paid for "doing things" - and not for keeping patients healthy. The "least profitable" (financially) patients are the healthy ones.

Pills are covered by insurance - as are office visits to monitor them. Insurance does not pay for broccoli and blueberries.

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Re: Concierge medicine Worth It????

Post by vested1 » Sat Jun 16, 2018 12:01 pm

dm200 wrote:
Sat Jun 16, 2018 10:37 am


One, big (in my opinion) challenge of good health and healthcare is proper compensation for providers. Such "providers" almost exclusively get paid for "doing things" - and not for keeping patients healthy. The "least profitable" (financially) patients are the healthy ones.

Pills are covered by insurance - as are office visits to monitor them. Insurance does not pay for broccoli and blueberries.
As evidenced by the methods of my newest PCP, whose partner is on MDVip, while he is not. He compensates by trying to up-sell me regular testosterone implants, which I don't need and which are very expensive. He also called for a blood test, which I thought normal since I get tested every year. I found it odd that they took my blood in his office however, as it is usually done at one of several local clinics. I finally understood when I got the bill for over $5,000 after he sent my blood to a private clinic in Boston (I live on the west coast). The brochure that came with the bill was perhaps 20 pages long with glossy pictures and a detailed analysis of my blood, with a recommendation that I join their program for additional benefits.

Not only did I decline, but I didn't pay the bill, which had no consequence as this is the normal reaction according to another patient I know who also didn't pay the nasty surprise he got in his mailbox, and from the receptionist who verified that fact. I offered to pay the contracted price of a blood test, but it was written off.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 12:28 pm

vested1 wrote:
Sat Jun 16, 2018 12:01 pm
dm200 wrote:
Sat Jun 16, 2018 10:37 am
One, big (in my opinion) challenge of good health and healthcare is proper compensation for providers. Such "providers" almost exclusively get paid for "doing things" - and not for keeping patients healthy. The "least profitable" (financially) patients are the healthy ones.
Pills are covered by insurance - as are office visits to monitor them. Insurance does not pay for broccoli and blueberries.
As evidenced by the methods of my newest PCP, whose partner is on MDVip, while he is not. He compensates by trying to up-sell me regular testosterone implants, which I don't need and which are very expensive. He also called for a blood test, which I thought normal since I get tested every year. I found it odd that they took my blood in his office however, as it is usually done at one of several local clinics. I finally understood when I got the bill for over $5,000 after he sent my blood to a private clinic in Boston (I live on the west coast). The brochure that came with the bill was perhaps 20 pages long with glossy pictures and a detailed analysis of my blood, with a recommendation that I join their program for additional benefits.
Not only did I decline, but I didn't pay the bill, which had no consequence as this is the normal reaction according to another patient I know who also didn't pay the nasty surprise he got in his mailbox, and from the receptionist who verified that fact. I offered to pay the contracted price of a blood test, but it was written off.
Amazing!! [or maybe not ;( ]

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 12:29 pm

I wonder if anyone who has signed up for "concierge medicine" has been able to offset any of the annual fee with other savings?

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Re: Concierge medicine Worth It????

Post by ResearchMed » Sat Jun 16, 2018 12:49 pm

vested1 wrote:
Sat Jun 16, 2018 12:01 pm
dm200 wrote:
Sat Jun 16, 2018 10:37 am


One, big (in my opinion) challenge of good health and healthcare is proper compensation for providers. Such "providers" almost exclusively get paid for "doing things" - and not for keeping patients healthy. The "least profitable" (financially) patients are the healthy ones.

Pills are covered by insurance - as are office visits to monitor them. Insurance does not pay for broccoli and blueberries.
As evidenced by the methods of my newest PCP, whose partner is on MDVip, while he is not. He compensates by trying to up-sell me regular testosterone implants, which I don't need and which are very expensive. He also called for a blood test, which I thought normal since I get tested every year. I found it odd that they took my blood in his office however, as it is usually done at one of several local clinics. I finally understood when I got the bill for over $5,000 after he sent my blood to a private clinic in Boston (I live on the west coast). The brochure that came with the bill was perhaps 20 pages long with glossy pictures and a detailed analysis of my blood, with a recommendation that I join their program for additional benefits.

Not only did I decline, but I didn't pay the bill, which had no consequence as this is the normal reaction according to another patient I know who also didn't pay the nasty surprise he got in his mailbox, and from the receptionist who verified that fact. I offered to pay the contracted price of a blood test, but it was written off.
Yikes. :annoyed

Are you now with another PCP?

Separate question: How does it work for a regular PCP to "partner" with one on MDVip?

RM
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Re: Concierge medicine Worth It????

Post by boglesmind » Sat Jun 16, 2018 1:07 pm

dm200 wrote:
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?
+1000
Some independent practitioners conveniently omit the "HMO" model when projecting future developments.
We've been with Kaiser for over 10 years and not a single complaint. We get all the benefits of so-called "concierge" primary care physician access, specialist referrals if needed, quick appointments and have been very happy. Excellent care and zero unpleasant surprises in terms of "out of network costs" or balance billing junk. Our colleague at work had a quadruple by-pass surgery + valve replacement a year ago at Kaiser (Medicare Advantage or some such, and he is working past 65) and the most he paid was his annual maximum --a couple of thousand dollars and is very happy about the treatment. I heard that Kaiser has over 60% of the insurable market in Norther California (correct me if this is wrong) and is growing still, opening more offices in more locations. Never say never but we don't plan on leaving Kaiser any time soon.

Boglesmind

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Re: Concierge medicine Worth It????

Post by drawpoker » Sat Jun 16, 2018 1:18 pm

dm200 wrote:
Sat Jun 16, 2018 12:29 pm
I wonder if anyone who has signed up for "concierge medicine" has been able to offset any of the annual fee with other savings?
Interesting you ask that! Yes, I might benefit.

Maryland is one of the states that removed all means testing for food stamps, they go strictly by monthly income. People over 60 get way more because that age bracket is allowed medical deductions that the younger folks don't get.

So, according to my caseworker, if my monthly medical costs suddenly jump by $137.50 (one-twelfth of $1,650), my FS allotment will go up by $62, from $120 to $182.

But - the catch is - she is not certain if this concierge fee actually is a "qualified medical expense". She cannot say after researching her manual, will check with state supervisory office on Monday. The problem seems to be it is not technically health insurance, or a co-pay bill for a medical exam or procedure. It is not anywhere on the list they use of allowable deductions. She gets it that the I.R.S. treats it as such, and it is permitted as any other medical expense that is deductible for 1040 itemizers.

But, the state doesn't always follow the logic of the I.R.S. Or anyone else. She hinted that the bureaucrats could take the position that this is a discretionary expense, something that is not necessary, and people can just switch doctors to avoid it.

Hope that turns out to just be a false alarm and this will get green-lighted by next week. Will post back went I get the answer.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 2:06 pm

Some independent practitioners conveniently omit the "HMO" model when projecting future developments.
We've been with Kaiser for over 10 years and not a single complaint. We get all the benefits of so-called "concierge" primary care physician access, specialist referrals if needed, quick appointments and have been very happy. Excellent care and zero unpleasant surprises in terms of "out of network costs" or balance billing junk. Our colleague at work had a quadruple by-pass surgery + valve replacement a year ago at Kaiser (Medicare Advantage or some such, and he is working past 65) and the most he paid was his annual maximum --a couple of thousand dollars and is very happy about the treatment. I heard that Kaiser has over 60% of the insurable market in Northern California (correct me if this is wrong) and is growing still, opening more offices in more locations. Never say never but we don't plan on leaving Kaiser any time soon.
Nice to see others with similar views and experiences.

We have been with Kaiser back and forth over 35-40 years - and would never have left except for job insurance. Back now (on Medicare) for seven years. Better than ever. We each pay only $30/month plus Medicare part B. In this area (Washington - Baltimore) Kaiser seems to be growing as well.

For whatever reason(s), Kaiser does not work everywhere. In fact, I think I was that in several areas of the US, Kaiser "sold" to another plan and withdrew from those areas. Decades ago, in this area, there were several other HMO plans like Kaiser - but now Kaiser is the only one left with the "dedicated" Physicians and facilities.

Two recent experiences:

1. On a Thursday afternoon, after having some moderate, unexplained abdominal pain, I made an appointment for the next day with my PCP for late afternoon. She saw the appointment come up and phoned me (left message) that evening to tell me that I should see her earlier in the afternoon so she could order immediate blood tests. I saw her at 2 on Friday - got the tests - and turned out to be nothing of consequence. She even followed up with the test results after she returned home on a Friday evening...

2. My wife had an annual physical with her PCP at 10 am. Her doctor noticed something and immediately sent her to another, nearby center to see a surgeon at noon (under 2 hours) and the surgeon examined her and scheduled surgery at this appointment.

I doubt "concierge medicine" can top these, typical experiences.

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Re: Concierge medicine Worth It????

Post by 2pedals » Sat Jun 16, 2018 3:05 pm

reason-logic wrote:
Tue Mar 15, 2016 12:07 am
My wife and I have been seen by a concierge physician for nearly 10 years. Some of the advantages from my perspective:

1. 24/7 availability to speak to doctor by phone.
2. Email questions to doctor.
3. They know the best specialists and seem to get you in on a priority basis.
4. They will go with you to specialist appointments to ensure specialist knows your history and offer second opinion.
5. Our physician provides a med kit of various prescriptions that we take when we travel, so if we get ill physician can instruct us by phone to take a medicine we already have rather than trying to find a pharmacy in a strange or foreign city.
6. Provides a complete annual physical and extended appointments, I never feel they rush me out to see next patient.
7. The physician coordinates and makes appointments with other professionals, saving me time and ensuring coordination of information.
8. Can always be seen even without appointment.

I know there is a cost, but I am convinced this is a tremendous value when you consider what is at stake.
+1
After 5 years of using concierge medicine I find this post sums up my own experience to a tee. To me, it has been worth the extra cost I pay ($100 / mo). I can call my doctor anytime and get an phone interview within a few hours. The doctor will try to and almost always can answer my questions and concerns over phone without an office visit within a few hours. If a rarely needed office visit is required, I never had to wait (they schedule ample time between visits), they are never rushed and never a billing problem with insurance.

In a traditional setting an office would require time away from work, scheduling appoints can take weeks to get some very basic questions/concerns answered.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 3:11 pm

2pedals wrote:
Sat Jun 16, 2018 3:05 pm
reason-logic wrote:
Tue Mar 15, 2016 12:07 am
My wife and I have been seen by a concierge physician for nearly 10 years. Some of the advantages from my perspective:
1. 24/7 availability to speak to doctor by phone.
2. Email questions to doctor.
3. They know the best specialists and seem to get you in on a priority basis.
4. They will go with you to specialist appointments to ensure specialist knows your history and offer second opinion.
5. Our physician provides a med kit of various prescriptions that we take when we travel, so if we get ill physician can instruct us by phone to take a medicine we already have rather than trying to find a pharmacy in a strange or foreign city.
6. Provides a complete annual physical and extended appointments, I never feel they rush me out to see next patient.
7. The physician coordinates and makes appointments with other professionals, saving me time and ensuring coordination of information.
8. Can always be seen even without appointment.
I know there is a cost, but I am convinced this is a tremendous value when you consider what is at stake.
+1
After 5 years of using concierge medicine I find this post sums up my own experience to a tee. To me, it has been worth the extra cost I pay ($100 / mo). I can call my doctor anytime and get an phone interview within a few hours. The doctor will try to and almost always can answer my questions and concerns over phone without an office visit within a few hours. If a rarely needed office visit is required, I never had to wait (they schedule ample time between visits), they are never rushed and never a billing problem with insurance.
In a traditional setting an office would require time away from work, scheduling appoints can take weeks to get some very basic questions/concerns answered.
Glad this works out for you both. As I posted above, I get most of these benefits (or very similar) in my Kaiser plan - at no extra charge. Alost all prescription drugs can be refilled (90 day supply) by requesting online and sent by US Mail. I never feel unfairly "rushed" when I see my doctor in person. In addition to email or telephone appointments, I can (never used yet) schedule a "virtual housecall" with smartphone.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 3:15 pm

Seems to me that the added $100/month or so is not really that much more. Also seems puzzling how these physicians can net as much when cutting so much back on patients. In addition, these physicians have added after hours "on call" work as well.
Last edited by dm200 on Sat Jun 16, 2018 3:34 pm, edited 1 time in total.

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Re: Concierge medicine Worth It????

Post by 2pedals » Sat Jun 16, 2018 3:33 pm

dm200 wrote:
Sat Jun 16, 2018 3:15 pm
Seems to me that the added $100/month or so is not really that much more. Also seems puzzling how these physicians can net as much when cutting back on patients.
No Kaiser plan is not offered in my area and by my employer. My employer offers Blue Cross Blue Shield PPO plans and Group Health at a much higher premium. If I retire and move into an area with a strong Kaiser presents I will keep your experience in mind.

I don't know how concierge medicine provider manages to provide this service for the amount I pay per month.

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 3:36 pm

2pedals wrote:
Sat Jun 16, 2018 3:33 pm
dm200 wrote:
Sat Jun 16, 2018 3:15 pm
Seems to me that the added $100/month or so is not really that much more. Also seems puzzling how these physicians can net as much when cutting back on patients.
No Kaiser plan is not offered in my area and by my employer. My employer offers Blue Cross Blue Shield PPO plans and Group Health at a much higher premium. If I retire and move into an area with a strong Kaiser presents I will keep your experience in mind.
I don't know how concierge medicine provider manages to provide this service for the amount I pay per month.
What is the "Group Health" specific plan? Is it an HMO like Kaiser?

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Re: Concierge medicine Worth It????

Post by ram » Sat Jun 16, 2018 3:53 pm

drawpoker wrote:
Fri Jun 15, 2018 8:25 pm
*** B U M P ***

Bringing this thread back up because yesterday received doc's letter informing me she has joined MDVip. Cost will be $1,650 a year, have until Sept 27 to make up my mind. Also contained the dire-sounding warning that this is being done first-come, first served, once she reaches "capacity" the unlucky ones go on "waiting list".
After getting over the initial shock (this is a very, very small town, pop less than 6,000, so this quite radical for our area) am very puzzled over some aspects of this.
Big Part of the MDVip requirements is that the practice agrees to a limit of 600 patients. Frankly, I cannot imagine that she has more than 600 patients right now. Or close to it. Altho a small town, we are the county seat, there is a small local hospital still operating (albeit with limited inpatient services, no maternity, no pediatrics, some other stuff not offered) so by my count, there are about 10 to 12 other docs, either internists or family practice, with offices right here all within one square mile, competing with her for patients.
If you take the whole county, not just the town, as the potential customer base for these doctors, that is just 20,000 people, according to the last census. Also, our county has been flat-lining for years, there has been no population growth. Nor is any expected, that would create a draw for doctors and other professionals. It's not likely neighboring counties will be a big source of patients. In fact, if you start going out-of-county to the west, you aren't far from Annapolis with its renowned Anne Arundel Medical Center complex. Which everyone would love to have for their own doctors, both PCP and specialists.
Is it realistic, given our demographics and the amount of competition already, for an PCP/internist to expect to be able to snare 600 people willing to pony up the concierge fee, every year, under these circumstances? Hope some of the docs who have been in this thread might return and share more of their thoughts on this.
Or, is this a trial balloon she is sending up, if she doesn't get the 600, she will just go ahead and retire early? She is 62 and has been practicing for 28 years. Burnout, maybe? A factor in this?
(She is not in solo, has another doc in partnership, but I looked it up, and this guy is also joining up with MDVip :oops: )
Even if she gets a 300 patient panel it should work. $1650 per patient X 300 = 495 K. At 45% overhead her take home will be 272 K ( 55%) even if she handles everything on the phone and never bills the insurance company for anything for routine physicals etc. Not billing insurance means a lot less paperwork for the physician and need for much less staff which results in lower overhead.
Employed primary care physicians typically make less than 272 K and have patient panels typically >1500. With a panel of 300 patients and > 1900 hours in a work year each patient will get 6+ hours of physician time per year.
Ram

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Re: Concierge medicine Worth It????

Post by ResearchMed » Sat Jun 16, 2018 4:06 pm

2pedals wrote:
Sat Jun 16, 2018 3:05 pm
reason-logic wrote:
Tue Mar 15, 2016 12:07 am
My wife and I have been seen by a concierge physician for nearly 10 years. Some of the advantages from my perspective:

1. 24/7 availability to speak to doctor by phone.
2. Email questions to doctor.
3. They know the best specialists and seem to get you in on a priority basis.
4. They will go with you to specialist appointments to ensure specialist knows your history and offer second opinion.
5. Our physician provides a med kit of various prescriptions that we take when we travel, so if we get ill physician can instruct us by phone to take a medicine we already have rather than trying to find a pharmacy in a strange or foreign city.
6. Provides a complete annual physical and extended appointments, I never feel they rush me out to see next patient.
7. The physician coordinates and makes appointments with other professionals, saving me time and ensuring coordination of information.
8. Can always be seen even without appointment.

I know there is a cost, but I am convinced this is a tremendous value when you consider what is at stake.
+1
After 5 years of using concierge medicine I find this post sums up my own experience to a tee. To me, it has been worth the extra cost I pay ($100 / mo). I can call my doctor anytime and get an phone interview within a few hours. The doctor will try to and almost always can answer my questions and concerns over phone without an office visit within a few hours. If a rarely needed office visit is required, I never had to wait (they schedule ample time between visits), they are never rushed and never a billing problem with insurance.

In a traditional setting an office would require time away from work, scheduling appoints can take weeks to get some very basic questions/concerns answered.
About the "never a billing problem with insurance"... how does it work with insurance? Or are you paying the concierge fee plus all medical costs without insurance (!?).

RM
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Re: Concierge medicine Worth It????

Post by ResearchMed » Sat Jun 16, 2018 4:12 pm

dm200 wrote:
Sat Jun 16, 2018 3:36 pm
2pedals wrote:
Sat Jun 16, 2018 3:33 pm
dm200 wrote:
Sat Jun 16, 2018 3:15 pm
Seems to me that the added $100/month or so is not really that much more. Also seems puzzling how these physicians can net as much when cutting back on patients.
No Kaiser plan is not offered in my area and by my employer. My employer offers Blue Cross Blue Shield PPO plans and Group Health at a much higher premium. If I retire and move into an area with a strong Kaiser presents I will keep your experience in mind.
I don't know how concierge medicine provider manages to provide this service for the amount I pay per month.
What is the "Group Health" specific plan? Is it an HMO like Kaiser?
Years ago, when I was living in Seattle, we had Group Health (a coop), which I think may have been taken over by Kaiser?

It was phenomenal.i
I had expected them to turn away anything other than really serious problems, to save money.
But as it turned out, and especially with little children, they covered even OTC meds, by handing them right to you (patient or parent), with the logic that it was less expensive to prevent than to wait for, say, a cold, to become something more serious.

And when I had a life-threatening problem out of the blue, they didn't seem to hold back on any specialists, or keeping me in hospital, etc., until they had at least a handle on what was happening.
(To this day, major medical centers elsewhere have never dealt with the same problem any better than Group Health, where it was first diagnosed.)

Group Health sure seemed like what "concierge medicine" is now...

But when we moved, the local (elsewhere) medical "coop" (one presumably affiliated with Group Health??) would make one wait *weeks* for anything at all.
Totally different.
We were "outta there" fast!

RM
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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 4:14 pm

Even if she gets a 300 patient panel it should work. $1650 per patient X 300 = 495 K. At 45% overhead her take home will be 272 K ( 55%) even if she handles everything on the phone and never bills the insurance company for anything for routine physicals etc. Not billing insurance means a lot less paperwork for the physician and need for much less staff which results in lower overhead.
Employed primary care physicians typically make less than 272 K and have patient panels typically >1500. With a panel of 300 patients and > 1900 hours in a work year each patient will get 6+ hours of physician time per year.
Wow --

Adds up, doesn't it!

Of course, many such regular patients are only seen once or twice (or less) per year.

I also wonder about the patient "mix" for concierge. Easier or more difficult ones??

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Re: Concierge medicine Worth It????

Post by dm200 » Sat Jun 16, 2018 4:38 pm

From my current and (7 years) recent experience with Kaiser - it seems that, with so much electronic "stuff" - Physicians can personally manage patients much more productively and efficiently these days. Compared with a few years ago, Physicians "touch" the computer a LOT more than they "touch" me. At my last physical, my Physician only "touched" me to listen to my heart with her stethescope and look in my ears. Took 1-2 minutes. Going though my records, etc. - on the computer took her about 15 minutes.

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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Jun 16, 2018 4:45 pm

dm200 wrote:
Sat Jun 16, 2018 12:29 pm
I wonder if anyone who has signed up for "concierge medicine" has been able to offset any of the annual fee with other savings?
According to the MDVIP website, the yearly fee can be paid with an HSA.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Jun 16, 2018 4:49 pm

dm200 wrote:
Sat Jun 16, 2018 4:14 pm
Even if she gets a 300 patient panel it should work. $1650 per patient X 300 = 495 K. At 45% overhead her take home will be 272 K ( 55%) even if she handles everything on the phone and never bills the insurance company for anything for routine physicals etc. Not billing insurance means a lot less paperwork for the physician and need for much less staff which results in lower overhead.
Employed primary care physicians typically make less than 272 K and have patient panels typically >1500. With a panel of 300 patients and > 1900 hours in a work year each patient will get 6+ hours of physician time per year.
Wow --

Adds up, doesn't it!

Of course, many such regular patients are only seen once or twice (or less) per year.

I also wonder about the patient "mix" for concierge. Easier or more difficult ones??
Slow down guys. What makes you think the physician gets all of that $1650? MDVIP gets $1650. Then MDVIP pays the physician whatever they agreed to.

drawpoker
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Re: Concierge medicine Worth It????

Post by drawpoker » Sat Jun 16, 2018 5:10 pm

According to the Wiki entry on MDVip business model - on a $1,650 bite the physician has to give MDVip $500 of that, per year, per patient. I guess on the other tier, the $2,300 bite, the doc pays more to MDVip. Dunno.

For the poster who speculated she could get by and never bill an insurance company for anything but routine physicals - she has a ton of Medicare patients. In fact, seldom do I sit in the waiting room and see anything but grey-haired old folks.
(Am on Medicare too. But I bleach my hair blonde so I stay a perpetual 39 :P :P)
Her heavy Medicare load is probably because although she is practicing as an internist she has under her belt the extra credentials/training to call herself "specializing in geriatrics".

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Sat Jun 16, 2018 5:47 pm

dm200 wrote:
Sat Jun 16, 2018 4:38 pm
From my current and (7 years) recent experience with Kaiser - it seems that, with so much electronic "stuff" - Physicians can personally manage patients much more productively and efficiently these days. Compared with a few years ago, Physicians "touch" the computer a LOT more than they "touch" me. At my last physical, my Physician only "touched" me to listen to my heart with her stethescope and look in my ears. Took 1-2 minutes. Going though my records, etc. - on the computer took her about 15 minutes.
This is an entirely different problem that is growing worse.
Feeding the computer involves checking countless useless boxes created as requirements for Medicare reimbursement which have started to spilled over into private insurance also. This eats away at the time given to the patient and greatly increases the workload for physicians. Many docs see their patients during the day then complete their records for a few hours after work.

https://www.pbs.org/newshour/health/doc ... s-patients

http://www.wbur.org/commonhealth/2017/0 ... al-records

https://ehrintelligence.com/news/epic-i ... rated-docs

mac808
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Re: Concierge medicine Worth It????

Post by mac808 » Sat Jun 16, 2018 6:47 pm

mouses wrote:
Sat Jun 16, 2018 10:33 am
Single payer is really the only way to go. Sure, it has its problems, but they are dwarfed by the enormous waste of money that winds up in the pockets of the insurance and pharmaceutical companies with the current system. Concierge vs. non-concierge is just trying to put a bandaid on a fracture.
Single payer wouldn't fix most of the issues talked about on this thread.

There is a severe supply/demand imbalance and the bottom line is that there simply aren't enough primary care physicians in the US to provide high quality care to everybody who needs it. This problem will take decades to solve, because it takes a long time to train new primary care physicians, and the financial incentives (educational debt, opportunity cost, low income relative to time spent in school) aren't there. Mid-levels were rushed in but now the cradle-to-grave hospital systems (e.g. Kaiser) are realizing they just create more problems in the long-run.

I signed my entire family up for a concierge practice years ago and it's one of the best decisions I ever made. I strongly encourage everyone reading this to budget for this expense in the future. Even if you don't feel you need it now, the healthcare system is changing rapidly and the day may arrive in the future when you change your mind.

2pedals
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Re: Concierge medicine Worth It????

Post by 2pedals » Sat Jun 16, 2018 7:04 pm

ResearchMed wrote:
Sat Jun 16, 2018 4:06 pm
2pedals wrote:
Sat Jun 16, 2018 3:05 pm
reason-logic wrote:
Tue Mar 15, 2016 12:07 am
My wife and I have been seen by a concierge physician for nearly 10 years. Some of the advantages from my perspective:

1. 24/7 availability to speak to doctor by phone.
2. Email questions to doctor.
3. They know the best specialists and seem to get you in on a priority basis.
4. They will go with you to specialist appointments to ensure specialist knows your history and offer second opinion.
5. Our physician provides a med kit of various prescriptions that we take when we travel, so if we get ill physician can instruct us by phone to take a medicine we already have rather than trying to find a pharmacy in a strange or foreign city.
6. Provides a complete annual physical and extended appointments, I never feel they rush me out to see next patient.
7. The physician coordinates and makes appointments with other professionals, saving me time and ensuring coordination of information.
8. Can always be seen even without appointment.

I know there is a cost, but I am convinced this is a tremendous value when you consider what is at stake.
+1
After 5 years of using concierge medicine I find this post sums up my own experience to a tee. To me, it has been worth the extra cost I pay ($100 / mo). I can call my doctor anytime and get an phone interview within a few hours. The doctor will try to and almost always can answer my questions and concerns over phone without an office visit within a few hours. If a rarely needed office visit is required, I never had to wait (they schedule ample time between visits), they are never rushed and never a billing problem with insurance.

In a traditional setting an office would require time away from work, scheduling appoints can take weeks to get some very basic questions/concerns answered.
About the "never a billing problem with insurance"... how does it work with insurance? Or are you paying the concierge fee plus all medical costs without insurance (!?).

RM
I am contracting and paying extra for the concierge medicine that includes access to a primary care physician 24/7 and these services include:
Primary, urgent, and preventive care by board-certified doctors
Referral management and care coordination
Onsite labs and prescriptions
Health risk assessment
Active management of chronic diseases
Basic vision and hearing screening
Fitness and nutrition coaching
And some medical procedures, i.e. for example I have have moles and a pilar cyst removed.

So when I say I never have a billing problem with insurance, I meant that my concierge medicine primary care physician does not bill me for any of the services provided above. I never ever get a bill except the monthly retainer fee. Insurance issues are avoided completely when services are provided, no co-pay, no deductibles, no co-insurance, no maximum out of pockets, no insurance claim denials, no out of network issues, no haggling with the insurance company. When the primary care physician does something I do not get a bill. If the primary care physician does not do something the procedure is not covered and he/she will refer me to a specialist and then I go to a specialist. If the service is not provided I use my insurance.

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