Concierge FP

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I was speaking hypothetically if you were to dissect out the value of the routine visits from the emergency ones. Obviously the insurance companies bundle them together because they want to get their hands on every piece of the pie and have greater control of the market. But the cost for these extensive services goes to the employer which then comes out of the employees paycheck. Having money deducted from your paycheck isnt as obvious as money you shell out. But that doesn't mean you're getting it for free. I would rather keep some of that money and pick my own doctor. If there is a doctor out there that goes out his way to get me cheap meds, sees me the same day I need to be seen, sends me an email, offers to see me in my house just because he cares...I'd pick him.

Clearly not everybody feels the same about this issue. In my field, however, patients aren't particularly satisfied with the 15 min med check. The 1200 or so patients in AtlasMD's practice probably feel the same way about former pcps.
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Blue Dog said:
Don't forget that most patients are (or should be) paying for high-deductible catastrophic insurance coverage on top of whatever they're paying you out-of-pocket for primary care.
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This combination is almost always going to end up being substantially cheaper for most patients than a run of the mill HMO/PPO plan. That is the real strength of this, it fixes the problem that HSAs/catastrophic hit you hard out of pocket for routine care. It also offers some protection against obscenely high ED visit costs (for things that you don't arrive in an ambulance).

Didn't you pysch guys get a change so you can bill E&M codes for 30 minute visits now profitably instead of having to do med checks?
 
There was a 10% bump in med management reimbursement counterbalanced by a drop in psychotherapy add-on reimbursement (below the rate of a non-md therapist). This works out well for psychiatrists seeing 3 or 4 patients an hour.
 
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Sorry, I don't have time to respond to all the above comments, our article was picked up by the Drudge Report. I'm busy responding to a flood of interest.
 
if you are already 'credentialed' as a provider with insurance companies and are already working as a employed urgent-care/hospitalist physician...........is it possible to open a direct primary care practice on the side without red tape from insurance companies?
 
AtlasMD said:
Sorry, I don't have time to respond to all the above comments, our article was picked up by the Drudge Report. I'm busy responding to a flood of interest.
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You guys need to get on one of those "doctor" TV shows. Keep the movement going. You're already the authority with this if more and more news agencies are picking it up. Awesome to see the public (comments sections) enthusiastic about it as well.
 
Blue Dog said:
"The Doctors" is pure crap.
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I've never actually seen it, so I wouldn't really know if its crap or not.

Just meant a legitimate segment on air to explain it. Not necessarily that show in particular. I'd think thats not the only option, could be wrong.
 
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Also atlasmd, you had me at ayn rand....totally hoping to do something like this once i get myself through med school
 
Alright blue dog, I suppose the best option is to just continue down the current path of corporate medicine. After all, the rising tide of corprations in medicine (insurance conglomerates, biotech companies, big pharma, hospital systems) has been such a wonderful development for physicians and patients!!

I mean, c'mon, corporations aren't driven by profit at all. They ONLY care about the patient's welfare and the professional satisfaction of physicians. Corporate bodies view the doctor-patient relationship as sacred! These insurance companies...they NEVER deny coverage for services or raise premiums to unaffordable levels. That would be unethical! Biotech firms, pharmaceutical companies, and hospitals--man, they are so altruistic! Those companies always price their goods and services fairly. They would never hike the price of one of their products 500% just to boost an already (very) healthy profit margin.

Yep, corporations are models of ethical conduct. If it weren't for corporations in medicine, we would see a massive uprising of physicians like AtlasMD... Physicians that make house calls and spend more than 10 minutes per patient in clinic. Physicians that spend more time actually talking to their patients than filling out paperwork and arguing with insurance companies. My god, what a horrendous vision!

If corporations weren't in charge, mid levels wouldn't be viewed as the cheaper "equivalent" of an MD. I mean, the government would actually have to train more doctors to take care of the population! What a shocking solution to the doctor shortage!

Thank god there are people like yourself to protect the corporate way.
 
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http://www.breitbart.com/system/wire/upiUPI-20130614-232724-6523

OK, so I went and read this article as mentioned above. I don't see how this type of practice is better than the FFS that we already have from the patient's perspective. From my perspective it sounds great as I get money up front without fussing with a billing service. But if the patient has Medicare, you pay $100 to this PCP every month in compensation for seeing the doctor. But the same patient sees me for free. In theory, you get more time with the doctor? I don't see it. I see patients with same day scheduling and don't rush anyone out the door. What am I missing?
 
sb247 said:
I'm 7 yrs from finishing residency at least.....it could be required to take medicare to keep your license by then
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Unlikely, as medical licensing is done at the state level.

It would also be politically imprudent, as it's unconstitutional (13th Amendment), and would accomplish nothing in terms of improving access by legislating doctors into bankruptcy.
 
EtherBunny said:
Alright blue dog, I suppose the best option is to just continue down the current path of corporate medicine. After all, the rising tide of corprations in medicine (insurance conglomerates, biotech companies, big pharma, hospital systems) has been such a wonderful development for physicians and patients!!

I mean, c'mon, corporations aren't driven by profit at all. They ONLY care about the patient's welfare and the professional satisfaction of physicians. Corporate bodies view the doctor-patient relationship as sacred! These insurance companies...they NEVER deny coverage for services or raise premiums to unaffordable levels. That would be unethical! Biotech firms, pharmaceutical companies, and hospitals--man, they are so altruistic! Those companies always price their goods and services fairly. They would never hike the price of one of their products 500% just to boost an already (very) healthy profit margin.

Yep, corporations are models of ethical conduct. If it weren't for corporations in medicine, we would see a massive uprising of physicians like AtlasMD... Physicians that make house calls and spend more than 10 minutes per patient in clinic. Physicians that spend more time actually talking to their patients than filling out paperwork and arguing with insurance companies. My god, what a horrendous vision!

If corporations weren't in charge, mid levels wouldn't be viewed as the cheaper "equivalent" of an MD. I mean, the government would actually have to train more doctors to take care of the population! What a shocking solution to the doctor shortage!

Thank god there are people like yourself to protect the corporate way.
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http://www.hayabusa.org/forum/attachments/new-owners-forum/252785d1345748295-i-tired-twice-post-am-******-funny-animal-captions-animal-capshunz-amphibian-facepalm.jpg
 
Blue Dog said:
Unlikely, as medical licensing is done at the state level.

It would also be politically imprudent, as it's unconstitutional (13th Amendment), and would accomplish nothing in terms of improving access by legislating doctors into bankruptcy.
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Mandated purchase of health insurance is also unconstitutional in my mind and yet, here we are......a lot can happen in 7 yrs so I don't make too many assumptions on what the system will be by then
 
Blue Dog said:
Unlikely, as medical licensing is done at the state level.

It would also be politically imprudent, as it's unconstitutional (13th Amendment), and would accomplish nothing in terms of improving access by legislating doctors into bankruptcy.
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:thumbup:
 
sb247 said:
Mandated purchase of health insurance is also unconstitutional in my mind and yet, here we are......a lot can happen in 7 yrs so I don't make too many assumptions on what the system will be by then
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Judge Andrew Napolitano on an interview he conducted with Senator James Clyburn in Sept 2009:

Last week, I asked South Carolina Congressman James Clyburn, the third-ranking Democrat in the House of Representatives, where in the Constitution it authorizes the federal government to regulate the delivery of health care. He replied: “There’s nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do.” Then he shot back: “How about [you] show me where in the Constitution it prohibits the federal government from doing this?”

The vast majority of the statists that have managed to get elected don't give a rat's rear end about the Constitution. They only care about exerting more control and using legislation to ensure they get the votes to stay in power. I think it's an excellent probability that there will be legislation passed to make accepting medicare/medicaid a condition of licensure. The question is how long it will take to get to this point.
 
notinkansas said:
Judge Andrew Napolitano on an interview he conducted with Senator James Clyburn in Sept 2009:

Last week, I asked South Carolina Congressman James Clyburn, the third-ranking Democrat in the House of Representatives, where in the Constitution it authorizes the federal government to regulate the delivery of health care. He replied: “There’s nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do.” Then he shot back: “How about [you] show me where in the Constitution it prohibits the federal government from doing this?”

The vast majority of the statists that have managed to get elected don't give a rat's rear end about the Constitution. They only care about exerting more control and using legislation to ensure they get the votes to stay in power. I think it's an excellent probability that there will be legislation passed to make accepting medicare/medicaid a condition of licensure. The question is how long it will take to get to this point.
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How would they even regulate it with a concierge practice?

In other words, a practice may technically "accept it", but its not like the government schedules your individual appointments.

Are they going to say 10% of your annual billing must be via Medicare/Medicaid? Or do 10% of your patients need to be from one of those programs? Regulation of this would be absolute hell for state boards.

These patients would get the shaft during scheduling in order to accommodate ones own concierge clients.
 
DIce3 said:
http://www.breitbart.com/system/wire/upiUPI-20130614-232724-6523

OK, so I went and read this article as mentioned above. I don't see how this type of practice is better than the FFS that we already have from the patient's perspective. From my perspective it sounds great as I get money up front without fussing with a billing service. But if the patient has Medicare, you pay $100 to this PCP every month in compensation for seeing the doctor. But the same patient sees me for free. In theory, you get more time with the doctor? I don't see it. I see patients with same day scheduling and don't rush anyone out the door. What am I missing?
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That patient seeing you for free must have a great (expensive) medicare advantage plan, otherwise they are paying every visit. My relatively average PPO plan is 35$ copay for a primary care visit, and 12$ for generics. It doesn't take long before AtlasMD starts to save you money if you have a couple of active problems. Add in some urgent care type visits or a single minor emergency overnight and you have saved some serious money. It isn't hard to see the value if you take an unbiased look.
 
DIce3 said:
http://www.breitbart.com/system/wire/upiUPI-20130614-232724-6523

OK, so I went and read this article as mentioned above. I don't see how this type of practice is better than the FFS that we already have from the patient's perspective. From my perspective it sounds great as I get money up front without fussing with a billing service. But if the patient has Medicare, you pay $100 to this PCP every month in compensation for seeing the doctor. But the same patient sees me for free. In theory, you get more time with the doctor? I don't see it. I see patients with same day scheduling and don't rush anyone out the door. What am I missing?
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Hi. This article is about my practice. They don't have a copay, they get more time and more access and we save them on their medicines and labs.
 
notinkansas said:
You sounded good on Hannity the other day :D
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I just listened to it. The points Atlas made were really good and I loved what you had to say, it was just a shame it turned into a liberal vs conservative argument that is common to shows like this. This bickering is why we dont make progress, and its a shame.

I love that you are getting this out though, this has made me the most excited I have ever been about going into medicine.

One side question that I have had, can patients use their HSA or flex to pay their membership dues?
 
AlmostJesus said:
One side question that I have had, can patients use their HSA or flex to pay their membership dues?
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I'm glad to hear that you liked it. It's great to know that people are getting excited about medicine again.

The use of health savings accounts right now is a gray area but there is a bill before the House and Senate that would clarify this and make it legal.
 
Just listened to it. "Do we have car insurance that buys gasoline, tires, oil changes" - great example that I would keep using since the public can relate. Thought you articulated your points and argued well. Keep pushin'.
 
ActionFigure said:
I know this topic has been discussed before, but in light of the ACA, how common do you think concierge FM will become today? I think it is something I may consider once I finish residency. royal pains anyone?
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I know someone who worked in a concierge practice that's now a prominent chain in the metro cities. He quit in a year because the culture was too different- entitled patients, calls 24/7, having to get vitals himself & not having a med assistant.
At the end even the fancy sofa at the reception & prime location in the city was too suffocating for him.
 
medicienne said:
I know someone who worked in a concierge practice that's now a prominent chain in the metro cities. He quit in a year because the culture was too different- entitled patients, calls 24/7, having to get vitals himself & not having a med assistant.
At the end even the fancy sofa at the reception & prime location in the city was too suffocating for him.
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There is no reason you can't have a med assistant to take vitals and no reason you have to have a fancy sofa or prime location.
 
medicienne said:
I know someone who worked in a concierge practice that's now a prominent chain in the metro cities. He quit in a year because the culture was too different- entitled patients, calls 24/7, having to get vitals himself & not having a med assistant.
At the end even the fancy sofa at the reception & prime location in the city was too suffocating for him.
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Sorry to hear. Still not so much the fault of the model.

We have everyone from homeless to billionaires. It's a nice balanced approach. We love it.
 
I recommend watching the entire video but if you're pressed for time then skip to 17:00 for the DPC part

[YOUTUBE]http://www.youtube.com/watch?v=QLqrjLBV95o[/YOUTUBE]
 
I like the concept a lot. I wonder how much tougher it would be in a real rural environment. Towns of a couple of hundred or 1-2k; being further a part and also having a lower population density. Granted, office overhead might be lower with a smaller place.
 
medicienne said:
I know someone who worked in a concierge practice that's now a prominent chain in the metro cities. He quit in a year because the culture was too different- entitled patients, calls 24/7, having to get vitals himself & not having a med assistant.
At the end even the fancy sofa at the reception & prime location in the city was too suffocating for him.
Click to expand...


Most definitely not the fault of the model. The entitlement mentality is also found large quantities in the current model of practice. There is a large segment of the population who don't think they should have to pay one red cent for their health care. When the physician suggests a screening test or a prescription, these patients ask incredulously, "Who is going to PAY for it" and will take no action to improve/promote their own health unless a third party covers the cost.
 
Cooperd0g said:
I like the concept a lot. I wonder how much tougher it would be in a real rural environment. Towns of a couple of hundred or 1-2k; being further a part and also having a lower population density. Granted, office overhead might be lower with a smaller place.
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Fair question but basic business sense can answer it. Small town likely = few/no doctors = high demand / low supply = opportunity. Maybe you charge less and take more patient. Or maybe you just make more bc the town knows that If they lose their doctors they'll risk losing their town.

Ie this would work beautifully.
 
AtlasMD said:
Fair question but basic business sense can answer it. Small town likely = few/no doctors = high demand / low supply = opportunity. Maybe you charge less and take more patient. Or maybe you just make more bc the town knows that If they lose their doctors they'll risk losing their town.

Ie this would work beautifully.
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Over the past year, Ive done study of farmers in South Dakota where I inquired about health insurance coverage and use of health services. While I did not find anything groundbreaking, one of the main findings I presented was the high prevalence of insurance among farmers, but those 50-65 have a hard time affording health insurance, despite having increasing health care needs as they age. In the comments section, I received comments about how people are spending up to 40% of their income in health insurance, because they dont have access through group sources unless someone works off the farm.
In my manuscript, I did include one sentence with my ideas, which included direct care practices as an idea for helping farmers get access to the health care system. It makes a lot of sense among this population.
Example:
Farming family of 4 in rural SD
~50 year old husband and spouse with two teenaged kids. Both spouses work on the farm.
Self purchased policy
2k ded, 50% copay to 2k, with accident insurance - $1210/month = $14,500/year before deductibles
10k ded, 50% copay to 5k, with accident insurance - $445/month + $170/month direct care fees (2 45+ adults, 2 children) = $7380 before deductibles
Pair this with a HSA and it becomes much more affordable to get coverage for your family with an increase in routine care availability.
Thus, with a well presented argument, I think this idea could take off in a rural area. The advantage with catering to a rural area is that farmers generally avoid seeking care, so it may be possible to keep a slightly higher volume. Also, rural areas tend to love the "small town doc" type of doctor that can provide services such as same day appointments, easy access, the feeling they are being listened to, etc.
I did find out that my manuscript was accepted to be published in the journal South Dakota Medicine, so I guess its another small plug for direct care.
edit: If anyone wants more information on this study, message me.
 
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AtlasMD said:
Fair question but basic business sense can answer it. Small town likely = few/no doctors = high demand / low supply = opportunity. Maybe you charge less and take more patient. Or maybe you just make more bc the town knows that If they lose their doctors they'll risk losing their town.

Ie this would work beautifully.
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Some of the very rural areas in Tennessee and Kentucky in the general area where I wen to medical school has some specialists who would spend one day a week at a couple of the more rural areas. (eg. Dr ENT came every other tuesday or something like that) The hospital provided an exam room.

Just thinking out loud here- maybe a model of 2 days in one place and 3 days in another, kind of surrounding a larger area?

At any rate, I'm sure there is a way to work out a DPC practice to accommodate rural areas. That's the beauty of DPC- you don't have to do it the same way everywhere- the perfect environment for innovation.
 
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