Concierge Medicine

solumanculver · Jan 18, 2007

Hi,

How easy is it to start one of those boutique/concierge practices? It seems like the ideal practice set-up for family medicine. You have fewer patients, more time with each of them... and it seems like you also have a higher earning potential.

Red Beard · Jan 18, 2007

There was a decent discussion of this not long ago...you may find it with a search.

My understanding is that physicians who are moving toward this practice model are generally well established in a standard private practice or group, with a good sized patient population. They then propose the new arrangement to a select group of their patients, and once they have enough people signed on they can make the transition.

I imagine it might be very challenging to start a practice like this from scratch, with no prior relationships with any patients. Adding new charts would be a slow process, as you'd be cutting yourself out of one of the major ways that docs get new patients--referrals from insurers.

deleted87716 · Jan 18, 2007

Here ya' go:
http://www.medicaleconomics.com/memag/article/articleDetail.jsp?id=112475
http://www.aafp.org/online/en/home/policy/privatesector/healthplan/payment/designs/retainer.html

sdn1977 · Jan 19, 2007

solumanculver said:
Hi,

How easy is it to start one of those boutique/concierge practices? It seems like the ideal practice set-up for family medicine. You have fewer patients, more time with each of them... and it seems like you also have a higher earning potential.

I have 2 practices in my area which have gone this route and I'm curious to see how this will play out.

Currently, we are only 3 weeks into the year, but I've not gotten one request for a refill of a medication to these physicians. I've had many, many requests from pts that I obtain a refill of their medication, but to direct that refill request to a different physician.

Uniformly, their comment is the patient cannot afford this kind of medical care, so they can't continue with the physician who has changed to the boutique style.

But, its still early in the year....we'll just have to see how the next few months play out.

Faebinder · Jan 19, 2007

sdn1977 said:
I have 2 practices in my area which have gone this route and I'm curious to see how this will play out.

Currently, we are only 3 weeks into the year, but I've not gotten one request for a refill of a medication to these physicians. I've had many, many requests from pts that I obtain a refill of their medication, but to direct that refill request to a different physician.

Uniformly, their comment is the patient cannot afford this kind of medical care, so they can't continue with the physician who has changed to the boutique style.

But, its still early in the year....we'll just have to see how the next few months play out.

Keep us updated.

conciergedoc · Jan 23, 2007

🙂 Since a lot of people are curious about this, I want to let you know about my blog: www.myconciergedoc.com It's about what I'm going through in building my own concierge practice, straight out of residency, mixed up with some medically relavant issues. Hopefully I can discuss some ideas with you on the blog. I'm open to ideas on how to build the ideal conciereg practice and I'm sharing everything I come across in my steps, and missteps.

bkpa2med · Jan 23, 2007

What if you held the same patient base and kept good insurance and charged a flat fee for an office visit for those without insurance of your choice? Wouldn't that work?

deleted87716 · Jan 24, 2007

bkpa2med said:
What if you held the same patient base and kept good insurance and charged a flat fee for an office visit for those without insurance of your choice? Wouldn't that work?

Yes, but there are some legal issues to be aware of. This white paper (in MS Word format) gives a nice overview of some of the different retainer practice options.

http://www.aafp.org/online/etc/medi...tmp/Retainer%20Practices discussion paper.doc

Faebinder · Jan 24, 2007

I hope to see more and more FM go into this style of medicine.... truly bypassing all the stupid insurance company power.... it's in favor of the consumer and in favor of the physician.

drwatson · Jan 24, 2007

Many thanks to conciergedoc and his blog which linked to this article.

http://www.memag.com/memag/article/articleDetail.jsp?id=390167&searchString=concierge medicine

Doctor on retainer for $83/month, sounds great for the patient. But not if the insurance companies have anything to say about it.

MiesVanDerMom · Jan 24, 2007

drwatson said:
Many thanks to conciergedoc and his blog which linked to this article.

http://www.memag.com/memag/article/articleDetail.jsp?id=390167&searchString=concierge medicine

Doctor on retainer for $83/month, sounds great for the patient. But not if the insurance companies have anything to say about it.

yeah but what if you get a brain tumor or get hit by a car? would the patient need to keep catastrophic insurance as well? my husband and I currently have catastrophic and pay for office visits out of pocket. i can't say as we'd be willing to pay a retainer. Also, my son has two genetic disorders, so this wouldn't work for him since he sees so many specialists. he'll always need to keep health insurance for all his various specialists.

i just don't like the idea of doctors abandoning medicare/medicaud patients like this. it seems to me you should at least keep a certain number of medicare/medicaid patients if you do this. doesn't seem ethical not to. not at all.

Faebinder · Jan 24, 2007

MiesVanDerMom said:
yeah but what if you get a brain tumor or get hit by a car? would the patient need to keep catastrophic insurance as well? my husband and I currently have catastrophic and pay for office visits out of pocket. i can't say as we'd be willing to pay a retainer. Also, my son has two genetic disorders, so this wouldn't work for him since he sees so many specialists. he'll always need to keep health insurance for all his various specialists.

i just don't like the idea of doctors abandoning medicare/medicaud patients like this. it seems to me you should at least keep a certain number of medicare/medicaid patients if you do this. doesn't seem ethical not to. not at all.

Yup, catastrophic insurance is easily maintained especially with a medical saving account but you and your husband should not need a retainer cause you arent chronically ill.. the concept is obviously best for chronically ill patients who need to see their primary care a lot.

Incase of your son, he might benefit from this if the practice was run by a pediatrician.... but i dont believe an FM concierge would work out for him.

Miami_med · Jan 24, 2007

MiesVanDerMom said:
i just don't like the idea of doctors abandoning medicare/medicaud patients like this. it seems to me you should at least keep a certain number of medicare/medicaid patients if you do this. doesn't seem ethical not to. not at all.

Why is this unethical?

drwatson · Jan 24, 2007

MiesVanDerMom said:
it seems to me you should at least keep a certain number of medicare/medicaid patients if you do this. doesn't seem ethical not to. not at all.

It seems like getting reimbursed 30% of what you bill is unethical. I doubt *any* other profession would accept that. Ask your car mechanic if he can fix your car today and then you will pay him 30% of his bill 6 months later.

Jiminy Cricket · Jan 24, 2007

How much demand actually exists for this type of healthcare. I'd imagine that soon, it will be a very tight and competetive market because you are catering to a select group of elite patients.

Therefor, the majority of fp's will still have to care for medicare/medicaid patients.

As for ethics, in a capitalistic system its survival of the fittest....anything goes.

deleted87716 · Jan 24, 2007

Concierge medicine and indigent care/Medicaid are on opposite ends of a spectrum. There's plenty in between.

Jiminy Cricket · Jan 24, 2007

KentW said:
Concierge medicine and indigent care/Medicaid are on opposite ends of a spectrum. There's plenty in between.

Do you think the inbetween will be able to pay a doc 5k to be there for him/her at anytime? this would be in addition to what they pay for h. insurance, bc correct me if i'm wrong, but this system of care still relies on their insurance to cover procedures and specialist care. From what i understand, people are just paying for a doc's availability?

deleted87716 · Jan 24, 2007

Jiminy Cricket said:
Do you think the inbetween will be able to pay a doc 5k to be there for him/her at anytime? this would be in addition to what they pay for h. insurance, bc correct me if i'm wrong, but this system of care still relies on their insurance to cover procedures and specialist care. From what i understand, people are just paying for a doc's availability?

This article discusses the different retainer practice models, and some issues related to each: http://www.wnj.com/concierge_jrm_3_2005/

Faebinder · Jan 25, 2007

But there is a third way that a physician can relate to Medicare, and that is by "opting out" of it entirely. If a physician "opts out" of Medicare, then she can charge Medicare patients whatever the traffic will bear and is not limited to the 115%. All the physician must do is have the patient sign a written agreement in which he or she acknowledges that the physician has opted out of Medicare and agrees to pay the physician whatever the physician wants to charge, presumably a market rate for the services. The pain for the physician in opting out of Medicare is that once she does so she cannot participate in Medicare again for two years. The physician in either Model II or Model III practices can therefore avoid the Medicare problem altogether simply by "opting out" of Medicare. Perhaps a rather drastic step, but an effective one.

I swear sometimes I wonder how in the world did the leading docs of the AMA put up with that. Two years is an f-ed up long time. Go Concierge.

Jiminy Cricket · Jan 25, 2007

Basically, if enough fp's and im's switch to concierge, we will be going to war with health insurance companies and hmo's . they are going to try their best to make this illegal.

i think concierge is a great idea. the med system is ludicrous and has ignored fp's and im's for a long time. when the doc is the business man, the patient gets higher quality care at the same price because there are not so many middle men.

think about the numbers of middle men in hmo's and ppo's etc.

this is a move by general physicians to fight back and defend our turf. currently, gp's are getting smacked around ...this is a move in the direction of change.

toothless rufus · Feb 15, 2007

Jiminy Cricket said:
Basically, if enough fp's and im's switch to concierge, we will be going to war with health insurance companies and hmo's . they are going to try their best to make this illegal.

Make it illegal because they are being bypassed, and not getting their ill-gotten gain? The insurance industry is sick, and needs to be euthanized.

This sounds like an awesome idea, btw! Bub-bye third party payors, hello 100% compensation.

There isn't any real reson you couldn't do concierge, and take medicare, though; like a natural law of the universe. So, why do they limit this option?

deleted87716 · Feb 17, 2007

toothless rufus said:
There isn't any real reson you couldn't do concierge, and take medicare, though; like a natural law of the universe. So, why do they limit this option?

Well, they don't, really. You just have to be careful. Read paragraph IV of the article in the link that I posted previously.

zinjanthropus · Mar 16, 2007

sorry to drag up an old thread, but I had a couple of questions about concierge medicine.

1. Do you think that only primary care physicians will be legally/ethically able to practice concierge medicine? What if a EM physician, or a hospitalist, etc wanted to take a small load of concierge patients to supplement income or to do something a little different at some point in their career? Any barriers to this?

2. Are concierge physicians able to get admitting privileges to hospitals?

thanks for any info.

deleted87716 · Mar 16, 2007

zinjanthropus said:
Do you think that only primary care physicians will be legally/ethically able to practice concierge medicine? What if a EM physician, or a hospitalist, etc wanted to take a small load of concierge patients to supplement income or to do something a little different at some point in their career? Any barriers to this?

Nothing except practicality.

Are concierge physicians able to get admitting privileges to hospitals?

Sure, why wouldn't they?

zinjanthropus · Mar 17, 2007

KentW said:
Nothing except practicality.

Sure, why wouldn't they?

no idea - they don't teach us much about the logistics of practicing medicine in med school so i just thought i would ask....for example, i had no idea until recently, that if an EM physician ever tried to do primary care they would likely be unable to due to lack of reimbursement from insurance....probably obvious to most, but a new concept to me.

deleted87716 · Mar 17, 2007

zinjanthropus said:
i had no idea until recently, that if an EM physician ever tried to do primary care they would likely be unable to due to lack of reimbursement from insurance.

I'm not sure what you've heard, but it's actually fairly common for EM-trained folks to do urgent care (basically primary care without an appointment.) They'd have to be credentialed by third-party payers, same as anyone else, but that shouldn't be a problem.

zinjanthropus · Mar 17, 2007

KentW said:
I'm not sure what you've heard, but it's actually fairly common for EM-trained folks to do urgent care (basically primary care without an appointment.) They'd have to be credentialed by third-party payers, same as anyone else, but that shouldn't be a problem.

thanks for the responses KentW...
that was actually the focus of my conversation - I was talking with a FP about EM docs doing acute care at a primary care office. His claim was that the EM doc would be okay only to see the acute care visits but would not ever be able to see routine f/u visits due to billing. Is this accurate?

deleted87716 · Mar 17, 2007

zinjanthropus said:
I was talking with a FP about EM docs doing acute care at a primary care office. His claim was that the EM doc would be okay only to see the acute care visits but would not ever be able to see routine f/u visits due to billing. Is this accurate?

No, billing shouldn't be a problem.

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