Economics of Concierge Medicine as a patient: What's in it for Me?

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DW and I have seen primary care physicians in the same practice for 20+ years.  Last week we got a letter saying they are going to a concierge medicine model.  Each patient pays $1650/year (or $3000/family) for complete services of the doctor.  No copays, no insurance, no bills, (theoretically) easier access to the doctor.

I totally get what's in the for the doctors.  Right now, they each probably pay the equivalent of one person full time to do nothing but  deal with insurance companies: submitting claims, following up on claims, processing insurance payments, researching policies to determine what they should pay, filing appeals with insurance companies to contest insufficient payment, etc.  Then probably another whole person to bill patients, follow up on unpaid bills, handle people's sob stories about why they can't pay, arrange hardship programs for those who are truly needy, contract with collection agencies for the rest, etc.  And the doctor often has his hands tied by an insurance company who tells him how to practice medicine, what he can and can't do, etc.  With an upfront payment and no insurance company involved, he can avoid all of that.

But as a patient, I'm not sure what I'm getting.  I mean, I see my primary care physician maybe once a year.  Is that really worth $1,650 (or even $1,500) to me?  I guess in theory I could get a cheaper insurance plan.  But I would think I'd still want insurance for:
1. Catastrophic coverage (do they even still sell catastrophic insurance?) to cover major disease/accident/condition
2. Hospitalization
3. Prescription coverage
4. Specialists (oncologists, urologists, endocrinologists, rheumatologists, etc.), should the need arise

I'm not sure I could find a policy for $125/month cheaper that would still protect me from major costs.  Especially as our current coverage (DW and I) is subsidized through my work.

Thoughts, anyone?  Anyone using or considering concierge medicine?

Chris.

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My PCP is also a hospital cardiologist. He's spread pretty thin.

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There's really nothing in it for you. It's all about cash for the doctor. Any tests or whatever you will probably still be billed for. So if you typically see him once a year, now you'll be paying $1,650 for that visit, vs many insurances having a zero copay on an annual checkup. I would find another doctor.

You can still buy the kind of insurance you're thinking about, but you'll have to pay the ACA penalty for it not providing "minimum essential coverage", which will undo any cost savings. Agreed that you should probably just evaluate another doctor.

The only way this could maybe be worth it is for someone with complicated health situations who has to see the doctor constantly and who has not-great insurance. They could actually save money and get better service, assuming he doesn't still nickle and dime you to death on side things and tests.

Rajjeq said:   The only way this could maybe be worth it is for someone with complicated health situations who has to see the doctor constantly and who has not-great insurance. They could actually save money and get better service, assuming he doesn't still nickle and dime you to death on side things and tests.
  Another upside is the ease of getting appointments. Depending on the ailment, it sometimes takes a week to get an appointment. For routine annual physical, the wait can be longer (like a month or more). Being able to get in touch with the doctor (or his/her nurse/assistant) is also not easy.

With a concierge service, I have heard/read that the above wait/delay will be non-existent (no first-hand experience). This there maybe value for more busy individuals.

Not much for you unless you want the luxury of easy access to a physician 24/7. It's typically a luxury move for both parties. You're right that it's gonna cost you more in the long term- unless you've been seeing the md monthly for problems.

Time to find a new doctor.

If you already have a great doctor, who is easy to get into see, and plays nice with your insurance – you have no need for a concierge doctor. In many major cities, a Dr. like that is a unicorn, hence the concierge practices.

This is in no way a replacement for medical insurance. 

gergles said:   You can still buy the kind of insurance you're thinking about, but you'll have to pay the ACA penalty for it not providing "minimum essential coverage", which will undo any cost savings. Agreed that you should probably just evaluate another doctor.
  
Important Update - Individual Shared Responsibility Payment

It reminds me of a TV shows in USA Network. I guess this is for upper middle class who has long term complicated health problems and don't want to wait for appointments. Their family or they want a peace of mind.

This doctor does not expect most patients will take him/her up on this offer typically if it is a solo practice they expect about 500-600 people to agree to pay which is about $900,000. Figure about 5 visits per person per year allowing for time off its about 12 appointments a day and they are 40 minutes each so you get a lot of attention. In addition you usually get immediate cell phone access to the doctor and co-ordination of care with specialists.

Typically you still need insurance for hospital, tests , other doctors, ER etc. Often they are in a Concierge network so if out of town you can get service in other cities as well. If they are not going 100% concierge and will still see other patients then I would not recommend.

This is low end concierge care. For the very wealthy it is about $12,000 a year and the doctor will go with you to all specialty appts, come to your home or work to give a vaccine or treat a minor illness or draw blood, do simple diagnostics.

This was tried in Palm Harbor, Florida about 5 years ago.. It failed.

Rajjeq said:   The only way this could maybe be worth it is for someone with complicated health situations who has to see the doctor constantly and who has not-great insurance. They could actually save money and get better service, assuming he doesn't still nickle and dime you to death on side things and tests.
  
The thing is complicated health situations usually mean specialists, not primary care.  The only real advantage is the ease of being seen.  I can't see anyone but the rich going for it.

It's basically a higher level of service. If you don't need it, find another doctor. You still need regular insurance. I wonder if the fee would be covered under an HSA plan. You get a higher deductible insurance plan to qualify for the HSA and then use $1650 in the HSA to pay the fee. You just save a little on taxes. Basically it's all about access, you get quicker access. It can take weeks or more to get an appointment these days. If you're healthy and don't see the doctor that much in a year, then you mind as well skip it.

Primary medical care will soon get split among

  • Conceirge care if you can afford.
  • Urgent care centers.
  • Primary care practice attached to hospitals.
  • Health care centers typically handling Medicaid.

For condition management, I noticed my PCP changed my checkup schedule from 3 months to 4 months couple of years ago. Now it is 6 months between visits. He sold his practice to a large hospital chain in town couple of years ago and is now employed by the hospital.

My wife and I have had a concierge primary care physician for three years and couldn't be happier. The physician is reachable any time of the day or night. A typical office visit involves no waiting, and usually the physician spends a minimum of 30-45 minutes when we have an appointment. The annual physical is equivalent to an "executive physical" lasting 2.5 to 3 hours with enough blood tests to require the print out being in the form of a small booklet.
The most valuable aspect of a concierge physician is rarely mentioned. If we are admitted to the hospital, the concierge physician sees us as often as necessary, at least daily, and orders all medications and tests. Before we had a concierge physician my wife had the misfortune of dealing with a "hospitalist" when she was hospitalized. We would pay far more than our concierge physician's annual fee to avoid ever having to deal with a "hospitalist" again.
Concierge medicine isn't for everyone, but the peace of mind we receive is priceless, not to mention tax deductible. Speaking of taxes, a little known fact is that under the ACA the IRS can levy a fine for having no or inadequate insurance, but can only collect if the taxpayer is owed a refund. Congress failed to give the IRS authority to levy a fine directly on a taxpayer. If no refund is owed, there is no way for the IRS to collect. 

mississippi said:   My wife and I have had a concierge primary care physician for three years and couldn't be happier. The physician is reachable any time of the day or night. A typical office visit involves no waiting, and usually the physician spends a minimum of 30-45 minutes when we have an appointment. The annual physical is equivalent to an "executive physical" lasting 2.5 to 3 hours with enough blood tests to require the print out being in the form of a small booklet.
The most valuable aspect of a concierge physician is rarely mentioned. If we are admitted to the hospital, the concierge physician sees us as often as necessary, at least daily, and orders all medications and tests. Before we had a concierge physician my wife had the misfortune of dealing with a "hospitalist" when she was hospitalized. We would pay far more than our concierge physician's annual fee to avoid ever having to deal with a "hospitalist" again.
Concierge medicine isn't for everyone, but the peace of mind we receive is priceless, not to mention tax deductible. Speaking of taxes, a little known fact is that under the ACA the IRS can levy a fine for having no or inadequate insurance, but can only collect if the taxpayer is owed a refund. Congress failed to give the IRS authority to levy a fine directly on a taxpayer. If no refund is owed, there is no way for the IRS to collect. 

   That last tidbit is interesting, but just how safe is that? I'm having trouble finding reputable sites backing this up. I'm seeing some articles (not exactly authoritive sources either) stating that paying ACA penalties is voluntary, but that sounds dangerously like the arguments some have made that paying taxes is voluntary? (The people who've gone to court w/ that latter argument haven't done very well...)

 

LorenPechtel said:   
 
  
......  I can't see anyone but the rich going for it.
 

  And the truly neurotic too!

mississippi said:   My wife and I have had a concierge primary care physician for three years and couldn't be happier. The physician is reachable any time of the day or night. A typical office visit involves no waiting, and usually the physician spends a minimum of 30-45 minutes when we have an appointment. The annual physical is equivalent to an "executive physical" lasting 2.5 to 3 hours with enough blood tests to require the print out being in the form of a small booklet.
 

  FYI, since the Affordable Care Act, all insurance plans must now offer such an annual physical FREE to the patient - plus perhaps some additional fee for tests.  Last year, I did have to pay $5.93 co-pay for the blood tests my doctor ordered.  My insurance otherwise is OK not great, high deductible and fees for almost everything.

You may get able together insurance reimbursement for your visits for out of network care.

ahallfatwallett said:   
mississippi said:   My wife and I have had a concierge primary care physician for three years and couldn't be happier. The physician is reachable any time of the day or night. A typical office visit involves no waiting, and usually the physician spends a minimum of 30-45 minutes when we have an appointment. The annual physical is equivalent to an "executive physical" lasting 2.5 to 3 hours with enough blood tests to require the print out being in the form of a small booklet.
  FYI, since the Affordable Care Act, all insurance plans must now offer such an annual physical FREE to the patient - plus perhaps some additional fee for tests.  Last year, I did have to pay $5.93 co-pay for the blood tests my doctor ordered.  My insurance otherwise is OK not great, high deductible and fees for almost everything.

  That is true plus preventive care such as prenatal care and vaccinations etc BUT likely to be changed with any new health care plans so keep informed

Not useful.  I knew a doctor (former hospitalist) who did the concierge medicine practice for a year and then left to go to a regular private family practice.  It theoretically sounds good to the doctor to reduce case loads (number of patients) but there really isn't enough patients to voluntarily part with additional sums of money to make this kind of practice sustainable.   The ultra-high end concierge for CEOs, celebrities, etc. is overkill IMO. But if they are scared of dying and can pay lots of money for a doctor to babysit them, that is their right.

I see my specialist/PCP of 30+ years under my bronze ACA plan, $75 co-pay. See him about four to six times a year with standard issue type blood tests.  Appts. are about 30 mins long (which is more than enough) if you go in prepared.  I don't need 24/7 email access to my doctor and his office already can refer me to any additional specialist I need.  If I am hospitalized, my care should be delegated to the hospitalist team anyway.  I schedule my next appointment at the doctor's office when I am done with the current appointment and rarely do I have to cancel or reschedule.  There is always tele-medicine where you can "see" any doctor for minor issues over any Wifi device anywhere in the world. 

The Heal app is a concierge service. A licensed medical doctor comes to your home for $99/visit. They accept insurance but I would advise against it since they charged me both ways.

Is this legal?

A couple of decades ago, a doctor in West Virginia took a monthly fee from his patients and charged nothing for office visits.

He was prosecuted for running an insurance scheme without a state licence to do so.

(I remember reading about this outrage in the newspapers in the Washington, DC area.)

This is becoming more common. Many providers charge $50-80 / month though. Your rate seems high.

Can you couple this with a high deductible health plan?  Would that make sense for your family?

Years ago when we become ill, our primary care physician will accept calls at night/ weekends. They would also see us in the hospital.

Now if you are ill or need an antibiotic after hours you are directed to the ER or urgent care. Not only is this expensive for patients, there is no continuity of care.

When you enter a hospital, you are assigned a hospitalist who is working on shifts. When test results are back another hospitalist will make the critical decisions based on some medical notes

When you leave the hospital, your primary care physician will have digest your hospital medical records in a few minutes or if they are diligent spend time to re-evaluate your problems.

A concierge physician will be valuable if you have chronic medical problems that may entail hospitalization, or require careful attention. Otherwise, it may not be cost effective.

There are many advantages to having a physician who is able to devote more time to your medical illness.

My sister pays about the same for a doc in TX. She swears by her doc.

Remember the joke: what do you call the guy who graduates last in the med. school class:



Doctor!

qcumber98 said:   The Heal app is a concierge service. A licensed medical doctor comes to your home for $99/visit. They accept insurance but I would advise against it since they charged me both ways.
  So they charged you more than $99 a visit?

TravelerMSY said:   If you already have a great doctor, who is easy to get into see, and plays nice with your insurance – you have no need for a concierge doctor. In many major cities, a Dr. like that is a unicorn, hence the concierge practices.

This is in no way a replacement for medical insurance. 

  
Ah, that's the rub.  I do already have a great doctor who is easy to get into see and plays nice with my insurance.  Until a month and a half from now when he will only see concierge patients.

As many on here have suggested, I'm probably going to have to find another doctor.

Chris.

rpi1967 said:   
qcumber98 said:   The Heal app is a concierge service. A licensed medical doctor comes to your home for $99/visit. They accept insurance but I would advise against it since they charged me both ways.
  So they charged you more than $99 a visit?

  They charged me $99 and they billed my insurance.  I didn't realize until months later that my insurance paid them $119.  The strange thing is, when I initially submitted the $99, my insurance denied my claim.  You see, I had my credit card number in the Heal app but when they called to confirm my appointment, they asked if I wanted to use my insurance and I said yes.  It took several weeks of emails, phone calls, and tweets to get them to issue a refund.  Unfortunately, it was for $99 instead of $119 but at this point, I was so done with them.

The doctors are probably violating the agreements they have with insurance companies because they typically require doctors to charge no more than their allowed amounts.  So if a doctor normally charges $1,500 to cash customers but the insurance allows only $800, then the most you can be charged is $800.  Insurers do this to prevent doctors from using insurance to pad their bills.  

It's unlikely that a concierge doctor will provide better care because they tend to be more market oriented and less medically oriented than normal.  

My FIL is a doctor and professor of medicine and hates concierge medical service.  On the other hand he's in the minority of specialists who takes Medicaid.

sfchris said:   Time to find a new doctor.
  Doctors no longer get into Medicine to help their fellow man, they now have their goals set on exploiting their patients pain and suffering for one thing only..... their own personal gain.

They deserve no respect. 

kingdoodler said:   sfchris said:   Time to find a new doctor.
  Doctors no longer get into Medicine to help their fellow man, they now have their goals set on exploiting their patients pain and suffering for one thing only..... their own personal gain.

They deserve no respect. 



All people who make such generalized condemnations are fools.






Wait....

larrymoencurly said:   The doctors are probably violating the agreements they have with insurance companies.. .


I thought that the general idea with concierge medicine was that it operates outside insurance. If so they are not bound by agreements with the insurance companies.

I think there are plenty of benefits that folks are overlooking. For starters, many of these concierge plans guarantee same visits and also to tele-doctor for common things. This alone can be a huge value in terms of time and not being hassled while you are already not in a good situation. In addition, many offer labs and other tests at an extremely low cost, like less than co-insurance costs than what is covered by insurance.

Having a general statement about "concierge" plans can not yield great responses that provide value because they are all so different. It really will be the "branding" of the doctor... what value they provide and the reputation that they carry, even moreso than it has ever been. Also, there are some insurance plans out there that have a cooperative nature with concierge plans. For instance, I know that some of the local faith-based insurance cooperatives (offered through churches and satisfy ACA requirements) actually cover the concierge subscription fees, which are generallly not covered via FSA/HSA. If they could be covered by FSA/HSA and also count towards deductible, that would change the dynamic drastically.

kingdoodler said:   
sfchris said:   Time to find a new doctor.
  Doctors no longer get into Medicine to help their fellow man, they now have their goals set on exploiting their patients pain and suffering for one thing only..... their own personal gain.

They deserve no respect. 


Holly generalization! I think its YOUR doctor who is the problem. Lucky for you, you have the opportunity to see another physician if you want.
Visit or talked to a doctor who specialized in the field of family medicine and works in inner city clinics. It may change your mind a bit. 
Also, doctors who work for hospitals only get a maximum amount of time per patients and are graded as so. That may seem like they don't care and have no emotion during the initial exam. 

mississippi said:    If we are admitted to the hospital, the concierge physician sees us as often as necessary, at least daily, and orders all medications and tests. Before we had a concierge physician my wife had the misfortune of dealing with a "hospitalist" when she was hospitalized. We would pay far more than our concierge physician's annual fee to avoid ever having to deal with a "hospitalist" again.
 

Having your personal doctor coordinate your care in the hospital and not a "hospitalist", would be worth more than $1650 to me.  Hospitalists are well trained physicians, but all they know about you is the couple of minutes they spend reading your chart.  Many times you will have a different one each day, and they can't wait to get out of your room and on to their next patient.

larrymoencurly said:   The doctors are probably violating the agreements they have with insurance companies because they typically require doctors to charge no more than their allowed amounts.  So if a doctor normally charges $1,500 to cash customers but the insurance allows only $800, then the most you can be charged is $800.  Insurers do this to prevent doctors from using insurance to pad their bills.  

It's unlikely that a concierge doctor will provide better care because they tend to be more market oriented and less medically oriented than normal.  

My FIL is a doctor and professor of medicine and hates concierge medical service.  On the other hand he's in the minority of specialists who takes Medicaid.


As others have pointed out the whole idea here is to not involve insurance, so I'm not sure how this could run afoul of any insurance agreement; there is no agreement between the doctor and any insurance company.

I don't think I'd assume that a doctor who has proven to me for 20+ years to be an excellent physician, patient-centric and exceedingly caring would suddenly become​ a greedy SOB and medically incompetent just because he changed his business model. I could be wrong.

FWIW, for most of the years my wife has been seeing this doctor, she's been on Medicare ( sometimes primary other times secondary to private insurance) and there's never been an issue. Still, I can understand why the doctor would want to be free from the shackles of usually idiotic and often counterproductive Medicare rules.

Chris.

robby69 said:   
mississippi said:    If we are admitted to the hospital, the concierge physician sees us as often as necessary, at least daily, and orders all medications and tests. Before we had a concierge physician my wife had the misfortune of dealing with a "hospitalist" when she was hospitalized. We would pay far more than our concierge physician's annual fee to avoid ever having to deal with a "hospitalist" again.
Having your personal doctor coordinate your care in the hospital and not a "hospitalist", would be worth more than $1650 to me.  Hospitalists are well trained physicians, but all they know about you is the couple of minutes they spend reading your chart.  Many times you will have a different one each day, and they can't wait to get out of your room and on to their next patient.

  
I appreciate what you're saying, but I think your math may be off.  How often are you hospitalized?  In my 54 years on earth, I've been hospitalized once (about 20 years ago), and that for less than 24 hours.  I am getting older, so let's say in the next 10 years I'm hospitalized one more time.  So for ten years I'm paying $1,650 (assuming it doesn't increase in price) to cover that one hospital stay.  So it's really costing me $16,500 to get my doctor to coordinate my one hospital visit.  Is it worth $16,500 for that?  Maybe.  But that's closer to the actual math.

Chris,
 

Skipping 47 Messages...
My PCP is also a hospital cardiologist. He's spread pretty thin.



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