Concierge FP

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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?
 
It's still going to be a niche practice option. Most people prefer to go to a doc who will bill their insurance. WIth more people covered under the ACA, the concierge market may actually shrink.

It's not the number of docs who want to be in a concierge practice that will drive that market. It's the number of patients who are willing to pay for that type of care.
 
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There is potential, I think, for concierge style practice post ACA as an option for people who wish to keep their medical information away from government snoops. As in doctors who pledge not to ask about gun ownership. As in doctors who keep paper records and pledge nto to turn any over to anybody without a warrant.
 
I think this route of practicing medicine will become more popular in coming years
 
Blue Dog said:
A timely article: http://www.amednews.com/article/201..._source=rss&utm_medium=&utm_campaign=20130415
Click to expand...

wait...so you can run a concierge practice *and* bill insurance for office visits like any other physician would?

Heck, if that's the case why wouldnt everyone do that?

This dude in the article is making a cool 720k JUST from the concierge fees. I assumed that the massive 1800 dollars/year fee would also cover all the office visits and he thus wouldn't be able to bill insurance for these, but if he can still do that....holy christ......

Even if he is only managing to cover his expenses on billing insurance for the 400 patients(who are probably going to come a lot....I mean hell they paid 1800 dollars),he is still a family med physician who made three quarters of a MILLION dollars in a year....and not seeing many patients at all.

If you're allowed to do this and bill insurance, how is this different from just adding your own copay on? For example, Im a psychiatrist....if I charged every patient that came to me a one time fee of 75 dollars for example and called it a concierge practice, I don't think this would affect my volume that much and if I saw just 12 new patients a week(not a lot), this would be an extra 40-50k a year in pure profit....for doing ABSOLUETLY NOTHING and with NO DOWNSIDE

sounds too good to be true....
 
Blue Dog said:
A timely article: http://www.amednews.com/article/201..._source=rss&utm_medium=&utm_campaign=20130415
Click to expand...

""What eventually may happen is the federal government starts requiring physicians to see a certain number of covered patients, either those on Medicaid or those insured on private plans through the ACA's health insurance exchanges, to maintain their medical licenses, Dr. Falk said. “I see that coming down the road, because otherwise there's going to be lot of people walking around with an insurance card who can't a find a doctor who will take care of them.” ""

😱

Now that would be a game changer.
 
vistaril said:
wait...so you can run a concierge practice *and* bill insurance for office visits like any other physician would?

Heck, if that's the case why wouldnt everyone do that?

This dude in the article is making a cool 720k JUST from the concierge fees. I assumed that the massive 1800 dollars/year fee would also cover all the office visits and he thus wouldn't be able to bill insurance for these, but if he can still do that....holy christ......

Even if he is only managing to cover his expenses on billing insurance for the 400 patients(who are probably going to come a lot....I mean hell they paid 1800 dollars),he is still a family med physician who made three quarters of a MILLION dollars in a year....and not seeing many patients at all.

If you're allowed to do this and bill insurance, how is this different from just adding your own copay on? For example, Im a psychiatrist....if I charged every patient that came to me a one time fee of 75 dollars for example and called it a concierge practice, I don't think this would affect my volume that much and if I saw just 12 new patients a week(not a lot), this would be an extra 40-50k a year in pure profit....for doing ABSOLUETLY NOTHING and with NO DOWNSIDE

sounds too good to be true....
Click to expand...

Vist... look at what he's offering:

http://www.modernmed.com/niedfeldt/pages/Services.aspx
"Same day or next day appointments
No waiting in the waiting room
Occasional home or office visits
Direct access to your physician's cell phone and email with quick response times
Access to your personal health records online, if available"

If you offered this level of access in Psychiatry you'd be toast. Especially the house calls. The authorities will be scraping your remains from someone's basement. 😉 Not trying to kill your buzz btw.
 
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F0nzie said:
Vist... look at what he's offering:

http://www.modernmed.com/niedfeldt/pages/Services.aspx
"Same day or next day appointments
No waiting in the waiting room
Occasional home or office visits
Direct access to your physician's cell phone and email with quick response times
Access to your personal health records online, if available"

If you offered this level of access in Psychiatry you'd be toast. Especially the house calls. The authorities will be scraping your remains from someone's basement. 😉 Not trying to kill your buzz btw.
Click to expand...

I can definitely see a market for this type of concierge service for like pediatrics
lol at "authorities will be scraping your remains"
 
sazerac said:
""What eventually may happen is the federal government starts requiring physicians to see a certain number of covered patients, either those on Medicaid or those insured on private plans through the ACA's health insurance exchanges, to maintain their medical licenses, Dr. Falk said. “I see that coming down the road, because otherwise there's going to be lot of people walking around with an insurance card who can't a find a doctor who will take care of them.” ""

😱

Now that would be a game changer.
Click to expand...



Forcing you to ACCEPT and forcing you to SEE are 2 different things. The second is slavery. As long as there are doctors with a backbone left in this country it won't be happening.
 
F0nzie said:
Vist... look at what he's offering:

http://www.modernmed.com/niedfeldt/pages/Services.aspx
"Same day or next day appointments
No waiting in the waiting room
Occasional home or office visits
Direct access to your physician's cell phone and email with quick response times
Access to your personal health records online, if available"

If you offered this level of access in Psychiatry you'd be toast. Especially the house calls. The authorities will be scraping your remains from someone's basement. 😉 Not trying to kill your buzz btw.
Click to expand...

well yeah for 75 bucks I wouldnt offer that....I would use the 75 bucks as a way to just screen patients who really want to be seen rather than wait a long time or not be seen and call it a 'practice fee' or concierge practice or whatever...Im not sure how this is different from just jacking up their copay which is definately not allowed under the terms of the insurance.
 
vistaril said:
wait...so you can run a concierge practice *and* bill insurance for office visits like any other physician would?

Heck, if that's the case why wouldnt everyone do that?
Click to expand...

Because it can potentially land you in very hot water with commercial insurance and/or CMS. If you're "double-dipping," (i.e., charging an extra fee for services that are already covered by insurance) you can be dropped from commercial insurance panels and/or fined or jailed by CMS (fraud). You have to be very specific about what is covered by a concierge fee.

sazerac said:
"What eventually may happen is the federal government starts requiring physicians to see a certain number of covered patients, either those on Medicaid or those insured on private plans through the ACA's health insurance exchanges, to maintain their medical licenses"
Click to expand...

That would be difficult to enact, since medical licensing is overseen by the states, not the Federal government. It would also be unconstitutional (13th Amendment), as Tony Montana noted.

Besides, forcing doctors into bankruptcy certainly wouldn't solve the access problem.
 
I had a patient go through her insurance company to find a rheumatologist that was trying to sell her his concierge services on her first visit. $1500 per year, 50 minute appointments, same day appointments, unlimited # of visits. The alternative: limited # of appointments, waiting times, shorter visits. Wtf...

I just want to point out how cheap it is to use insurance companies as a self-promoting marketing tool. If you want to go concierge or cash, bite the bullet and market the practice yourself. If you don't like the way insurance pays you or tells you how to practice then cut the umbilical cord and do it the right way.
 
F0nzie said:
Vist... look at what he's offering:

http://www.modernmed.com/niedfeldt/pages/Services.aspx
Click to expand...

Honestly, his web site makes him sound like a pompous ass.

http://www.modernmed.com/niedfeldt/pages/Why-this-Practice.aspx

Dr. Niedfeldt is the best in the business. 🙄 Voted one of the Best Doctors in America (2007-2008) by over 30,000 of his peers, Dr. Niedfeldt is well-known in the field of sports medicine. But his big-league relationships with organizations like the Milwaukee Brewers, the US Snowboarding Team, and the Milwaukee Ballet don't preclude him from forming healthcare partnerships with everyday people like you. 😕 Born, raised, and trained right here in Wisconsin, he combines his extensive medical knowledge with small-town values to create a warm and friendly atmosphere in which to nurture your health and well-being. Central to that task is Dr. Niedfeldt's firm belief that staying active, as he himself does, is the best way to ensure a long and healthy life. He has the experience to help you set your healthcare goals and to achieve your optimum level of wellness. You want this guy on your team! 🙄
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23100879.jpg
 
Blue Dog said:
Honestly, his web site makes him sound like a pompous ass.
Click to expand...

Haha. Love the American Psycho reference.

Agree with the pompous. Especially when they vote themselves the "Best Doctor of 2012" with the local magazine and upload the emblem on their website. Like they just gave themselves a sticker for thinking so highly of themselves. Yay!
 
vistaril said:
This dude in the article is making a cool 720k JUST from the concierge fees. I assumed that the massive 1800 dollars/year fee would also cover all the office visits and he thus wouldn't be able to bill insurance for these, but if he can still do that....holy christ......
Click to expand...

Not so fast Speedy Gonzales. If you check out his website you can see that he is hired by this company: http://www.modernmed.com/pages/index.aspx. They are likely mass marketing his services (something most physicians have absolutely no clue about) and taking a decent cut from his paycheck to run most of the operation so that he can focus on clinical work. (who wouldn't want to make money off of an eager doctor willing to provide 24 access and home visits to patients).

Although he practices concierge work, he did not build his practice from the ground up (which is the greatest challenge). Someone else is making good money off of him. The CEO of the corporation banks and time repeats itself...
 
I suppose concierge offers a different style of practice that appeals to many physicians. The business model seems relatively simplified (as compared to a traditional practice with coding, billing, etc) though, so I'd favor doing it myself and ultimately franchising other physicians rather than being the buyer of those services.
 
Blue Dog said:
Because it can potentially land you in very hot water with commercial insurance and/or CMS. If you're "double-dipping," (i.e., charging an extra fee for services that are already covered by insurance) you can be dropped from commercial insurance panels and/or fined or jailed by CMS (fraud). You have to be very specific about what is covered by a concierge fee.



That would be difficult to enact, since medical licensing is overseen by the states, not the Federal government. It would also be unconstitutional (13th Amendment), as Tony Montana noted.

Besides, forcing doctors into bankruptcy certainly wouldn't solve the access problem.
Click to expand...


In a private practice setting, can you develop your own style of concierge medicine? For instance say you have 300 patients, but having a longstanding relationship with many of them, you are certain that 25 will be willing to pay an additional fee for extra services. Can you set up a contract that essentially states you will charge a fee of "1000$" per year, SOLEY for providing your personal cell phone number, and promising them an in home or in office visit within 24 hrs of their initial call to you.? So you could still bill them normally for are, your only charging them additional fees for cutting in line anytime they want essentially.
Is this possible?
Thank you
 
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I would strongly advise against having a "split practice," where a subset of your patients pay a fee for "extra" care. There are some real liability issues there.
 
Blue Dog said:
I would strongly advise against having a "split practice," where a subset of your patients pay a fee for "extra" care. There are some real liability issues there.
Click to expand...

What are the major concerns in that instance? Since only those selected patients will know? I'm asking out of curiosity trying to learn and understand how family medicine works. Is that illegal?
 
1cor1311 said:
What are the major concerns in that instance? Since only those selected patients will know? I'm asking out of curiosity trying to learn and understand how family medicine works. Is that illegal?
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The perception, like it or not, will be that you provide "better" care to those able to pay for it. Should you ever have an adverse outcome and a lawsuit involving a non-concierge patient, expect to be accused of withholding services because of the patient's inability to pay. At best, you'll come off as a greedy bastard. At worst, a negligent greedy bastard.
 
vistaril said:
wait...so you can run a concierge practice *and* bill insurance for office visits like any other physician would?

Heck, if that's the case why wouldnt everyone do that?

This dude in the article is making a cool 720k JUST from the concierge fees. I assumed that the massive 1800 dollars/year fee would also cover all the office visits and he thus wouldn't be able to bill insurance for these, but if he can still do that....holy christ......

Even if he is only managing to cover his expenses on billing insurance for the 400 patients(who are probably going to come a lot....I mean hell they paid 1800 dollars),he is still a family med physician who made three quarters of a MILLION dollars in a year....and not seeing many patients at all.

If you're allowed to do this and bill insurance, how is this different from just adding your own copay on? For example, Im a psychiatrist....if I charged every patient that came to me a one time fee of 75 dollars for example and called it a concierge practice, I don't think this would affect my volume that much and if I saw just 12 new patients a week(not a lot), this would be an extra 40-50k a year in pure profit....for doing ABSOLUETLY NOTHING and with NO DOWNSIDE

sounds too good to be true....
Click to expand...

"In Dr. Niedfeldt's practice, individuals pay an annual retainer fee of about $1,800. But because he doesn't offer more complex medical services, such as surgeries or cancer treatments, his clients may decide to carry high-deductible secondary coverage to pay for that care."

It doesn't sound like he's doing this?
 
Blue Dog said:
The perception, like it or not, will be that you provide "better" care to those able to pay for it. Should you ever have an adverse outcome and a lawsuit involving a non-concierge patient, expect to be accused of withholding services because of the patient's inability to pay. At best, you'll come off as a greedy bastard. At worst, a negligent greedy bastard.
Click to expand...

There are a couple of concierge practices popping up in my area, and one that I know of offers "tiers" of service, but even the lower tier involves same- or next-day appointments. The main difference is that the higher tier gets you the right to have the MD make house calls, and the lower one requires the patient to be seen at the MD's office.

Have yet to see any malpractice suits involving such practices (I defend physicians in malpractice cases) but it's an interesting argument. On the one hand, I think you may have a point. On the other, I think I could argue quite convincingly that the standard of care is not the concierge level of service, but rather the nonconcierge level. Unless the plaintiff can find a FM physician who will testify that every FM doc MUST provide concierge-level attention for the cut-rate HMO prices, that would be a tough story to sell. Because I think most jurors would realize that they haven't seen their doctors providing home care, same-day appointments, and their home phone numbers.
 
notinkansas said:
There is potential, I think, for concierge style practice post ACA as an option for people who wish to keep their medical information away from government snoops. As in doctors who pledge not to ask about gun ownership. As in doctors who keep paper records and pledge nto to turn any over to anybody without a warrant.
Click to expand...

I love talking about guns with my patients! I own many and allmy patients do too!
The older ones can be a huge source of knowledge at that!
🙂
Do I document that in my pn? Nooooo. And I won't unless I must.
 
SpaceLeftBlank said:
There are a couple of concierge practices popping up in my area, and one that I know of offers "tiers" of service, but even the lower tier involves same- or next-day appointments. The main difference is that the higher tier gets you the right to have the MD make house calls, and the lower one requires the patient to be seen at the MD's office.

Have yet to see any malpractice suits involving such practices (I defend physicians in malpractice cases) but it's an interesting argument. On the one hand, I think you may have a point. On the other, I think I could argue quite convincingly that the standard of care is not the concierge level of service, but rather the nonconcierge level. Unless the plaintiff can find a FM physician who will testify that every FM doc MUST provide concierge-level attention for the cut-rate HMO prices, that would be a tough story to sell. Because I think most jurors would realize that they haven't seen their doctors providing home care, same-day appointments, and their home phone numbers.
Click to expand...

Great point!
It seems plausible then, as long as you are giving same medical services to all, and charge for extra attention.
But some of your patients( ones that can't pay the fee) will feel alienated by this.
I loved once the idea of house calls and all. I don't see it happening in infectious diseases though! No thanks.
 
tartesos said:
Great point!
It seems plausible then, as long as you are giving same medical services to all, and charge for extra attention.
Click to expand...

We contract with insurance companies to promote our practices. In a way it's sort of like hiring a company to market the practice but instead of paying them directly, they take a decent chunk out of our paycheck and pay us the remainder. If we are enlisting the services of the insurance company and agreeing to see patients under their terms, we should honor that. No extras, no bells or whistles. It would be no different than signing a contract with an organization and stealing the patients for your private practice. Be ethical and do it the right way.
 
tartesos said:
Great point!
It seems plausible then, as long as you are giving same medical services to all, and charge for extra attention.
But some of your patients( ones that can't pay the fee) will feel alienated by this.
I loved once the idea of house calls and all. I don't see it happening in infectious diseases though! No thanks.
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Maybe not even the same medical services, just the ones that a reasonable FM doc would provide to a similar patient under similar circumstances.

Your second point (about alienation) might be true, but the reality is that there's all kinds of things or services people might want but can't afford. I wouldn't mind a private jet, but I don't get bent out of shape just because my budget only allows for economy-class tickets. It continues to startle me that everyone expects everything from physicians and wants to pay nothing (granted, being a lawyer retained by insurance companies to represent their insureds provides me with a similar experience).
 
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tartesos said:
I love talking about guns with my patients! I own many and allmy patients do too!
The older ones can be a huge source of knowledge at that!
🙂
Do I document that in my pn? Nooooo. And I won't unless I must.
Click to expand...

Hahaha.. then you know what I mean. Your attitude is what many are looking for....
 
tartesos said:
Some concierge practices don't charge the insurance copay to patients that pay the concierge fee, is that a good way of doing it and avoid trouble with insurance companies?
Click to expand...

No. It doesn't change anything from the contractual standpoint.
 
Does the annual fee for joining a concierge practice typically offer any help/coverage for things like labs, xrays, meds etc.that the patient may need?
 
The future for this sort of thing is very limited. Some of the responses here are very naive. Once you get out in practice you'll notice that most patients don't want to spend one penny on their healthcare. Good luck finding enough rich folks to support your niche practice.
 
Paddington said:
The future for this sort of thing is very limited. Some of the responses here are very naive. Once you get out in practice you'll notice that most patients don't want to spend one penny on their healthcare. Good luck finding enough rich folks to support your niche practice.
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This attitude is precisely why physicians continue to get screwed over by bureaucrats in Washington and greedy businessmen in hospital admins and insurance companies. The truth of the matter is that nobody WANTS to pay for any service, including health care. The only way things are going to get better for physicians AND patients, is for physicians to change the system. The corrupt idiots in Washington can't do it and we sure as hell can't rely on the greedy MBAs out there to "fix" a broken system.

I don't understand why primary care docs are so reluctant to venture into the cash only model. You guys have all the power in the current system, but you project such weakness and vulnerability. You have all the patients and you control all referrals. That's tremendous power.

The easiest solution to the crisis in primary care is for physicians to opt out. The income disparity between pcps and specialists will evaporate. You'll get to spend more quality time with your patients. No more hassles with insurance companies. No more ridiculous administrative tasks and overhead. You went into medicine to take care of pts, not push paperwork and argue with third party payors.

If you genuinely want to maximize your time in patient care and you want to earn what you clearly deserve, then the course of action is obvious--opt out of insurance. Plain and simple.
 
Paddington said:
The future for this sort of thing is very limited. Some of the responses here are very naive. Once you get out in practice you'll notice that most patients don't want to spend one penny on their healthcare. Good luck finding enough rich folks to support your niche practice.
Click to expand...

I looked up some of the info on this - many middle class families can afford to do this.

You may need people who make 50-100k to be your clientele, but that's a lot of people. The current model delivers care that isn't as good, costs a lot more, and hurries patients out the door in 15 minutes. It seems you could deliver better care in this model and avoid insurance executives who make $100 million annually off you churning patients through this giant system.

edit: found this link:

http://conciergemedicinetoday.com/
Myth #1:
Concierge Medicine is just for the wealthy.
Reality: This is no longer true. Many forms of concierge medicine cost around $150 per month, which is the price of a package of cigarettes per day, or a daily cup of Starbuck's Frappuccino. Dr. Garrison Bliss in Seattle, Washington offers concierge care to patients for $39 to $79 per month, based upon the age of the patient. The cost of concierge medicine depends upon the services that are offered by the individual doctor. Costs range from $1,500 per year to $15,000 per year.

Myth #2:
Concierge Medicine is too expensive, because I still need health insurance.
Reality: Though catastrophic medical insurance, or Medicare benefits, are necessary for patients to avoid bankruptcy in the event of an unforeseen medical catastrophe, many people find that they can lower the cost of their total medical care by combining a high-deductible health insurance plan with a Health Savings Account. This can make concierge medicine quite affordable. Insurance laws and laws governing concierge care vary from state to state, so you need to consult with your account and local insurance agents before you opt for one of these plans. However, concierge care coupled with a high-deductible insurance plan is often equivalent to the cost of traditional health insurance.

Myth #3:
Concierge Medicine will only worsen the shortage of primary care doctors.
Reality: Though it is true that doctors decrease the size of their practices when they switch to a concierge model, there is presently a mass exodus of doctors from primary care medicine. Young doctors are refusing to go into primary care medicine. This is due to the fact that practicing primary care medicine in our current broken system, seeing 30 patients per day, making only one-third to one-forth of what a specialist makes, has created an understandable shortage of doctors willing to practice primary care medicine. Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective. It is our current broken system that has caused a shortage of primary care doctors; and if we stay on the old path, it will only get worse.

Myth #4:
Concierge Doctors are greedy and don't care for the underprivileged.
Reality: On average, a concierge physician earns the equivalent salary of a specialist, such as a gastroenterologist, a cardiologist or a radiologist. Most concierge doctors do a significant amount of charity work, often seeing about 10 percent of their patients free-of-charge. Concierge medicine simply puts the incomes of internists and family practitioners on par with their colleagues.

Myth #5:
Concierge Medicine is unethical.
Reality: Most doctors who practice traditional medicine in our current third-party payer system have an obvious conflict of interest. They sign contracts with HMOs and insurance companies in exchange for patient referrals from these companies. In many of these contracts, doctors agree to limit or ration care to patients to maximize profits for these companies, their Wall Street shareholders and their CEOs. Some contracts even prevent the doctor from sharing this information with their patients. By any reasonable assessment, this third-party payer system is intrinsically unethical. Concierge medicine, by contrast, has no third-party conflicts. Patients pay their doctor directly for his services in the concierge model, just as they did in the days of Marcus Welby. In the concierge model, the doctor is the advocate for one party and one party only: the patient. He has no allegiance to or conflicts with third parties.

Source: http://www.conciergemedicinemd.com/the-clinic/what-is-concierge-medicine/myths–realities/
Click to expand...
 
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Blue Dog said:
Typically, no. On a related note, concierge fees can run afoul of your state's insurance laws if you're not careful.

Concierge Medicine: Legal Issues, Ethical Dilemmas, and Policy Challenges
http://www.healthlawyers.org/Public..., Ethical Dilemmas, and Policy Challenges.pdf
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I always find it interesting that the government is trying to find any and every way to control how doctors deliver care in America. All the free market philosophy stuff is BS. They only believe it so far as it makes them money. There's no reason in the world that a physician should be prevented from opening up a concierge practice, but the government decides that since it's healthcare, they have the right to intervene - the stock market? Nope.

It's hilarious that they talk about this as having "ethical issues". Is it ethical to see churn patients around in 15 minutes a visit? Is it ethical to pay insurance execs millions and thereby increase healthcare costs for all? Is it ethical to have a system so inefficient that you have hundreds of unnecessary employees there just to manage administrative tasks and compliance tasks? Is it ethical to pay some physicians 4 times more because a random board has decided that's the best way to do things? Medical ethics is a big joke. It should be called, "Profitable business methods" instead of "medical ethics". The whole idea on this being "unethical" is based upon creating a lack of access... but the better question is, should we have tons of access to crappy care for everyone? That creates a need of more access because everyone is getting sick. If you have 3000 patients and see them 5 minutes a visit, they could develop more disease due to terrible care - while someone with 300 patients that takes exquisite care could be lowering the burden on advanced and emergency care.

Anyway, the legality is iffy if anything. A doctor can charge more for the membership to the program, then they aren't exceeding any of the fee schedules. You can always creatively work your way around the law - you just need to know the law or hire a lawyer. With enough physicians doing this, there will be maps around the law. Anyway, this is only for people accepting medicare patients. If you don't accept those patients, you don't even need to worry about the law.

Anyway, in summary: the government is very incompetent.

secretary thompson responded in a letter dated May 1, 2002, finding that as long as the concierge fee was truly for noncovered services,
it would not violate Medicare law,
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F0nzie said:
Not so fast Speedy Gonzales. If you check out his website you can see that he is hired by this company: http://www.modernmed.com/pages/index.aspx. They are likely mass marketing his services (something most physicians have absolutely no clue about) and taking a decent cut from his paycheck to run most of the operation so that he can focus on clinical work. (who wouldn't want to make money off of an eager doctor willing to provide 24 access and home visits to patients).

Although he practices concierge work, he did not build his practice from the ground up (which is the greatest challenge). Someone else is making good money off of him. The CEO of the corporation banks and time repeats itself...
Click to expand...

Possibly, but I can guarantee that there are less hands in his pocket than in the average doctor's pocket (tons of insurance execs, employees, big pharma, government, etc).
 
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sazerac said:
""What eventually may happen is the federal government starts requiring physicians to see a certain number of covered patients, either those on Medicaid or those insured on private plans through the ACA's health insurance exchanges, to maintain their medical licenses, Dr. Falk said. “I see that coming down the road, because otherwise there's going to be lot of people walking around with an insurance card who can't a find a doctor who will take care of them.” ""

😱

Now that would be a game changer.
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I agree. In fact, unless an increasing number of patients DEMAND to be able to see cash based doctors, I can easily imagine a scenario in which doctors are REQUIRED to accept Medicare/Medicaid to maintain licenses. The government won't be able to stand losing control. The day this happens, I'm out for good.

On a side note, it's amazing how Medicare, not even 50 years old yet, has conditioned some people to believe that they should not have to pay one red cent for their own health care. It boggles my mind how many people, when asked as simple question like "Have you been to the eye doctor for a glaucoma screen in the past year" indignantly reply, "NO, who is going to pay for it." Sheesh. Medicare was implemented within these people's lifetimes and yet they have been thoroughly indoctrinated.
 
Great thread and interesting conversation.

The best that I can tell, i'm the only "concierge physician" thats commented so far (skipped a few posts in the middle ;-)

my 2 cents - concierge family practice will grow to become the standard, drop the concierge, and will be the new "family medicine". Health reform will drive this b/c the current insurance based model (regardless of who resides in the oval office) is unsustainable and unaffordable.

my model of "concierge" is more aptly described as "direct primary care":

by going 100% ins free, and working directly with the patients, then the incentives are appropriately aligned so that my first and last responsibility is to them. now that doesn't mean i rx pain meds or abx when they don't need them...the customer is usually right...and the patient is usually wrong about abx.

The avg practice has 7-10 employees per doc to play the ins game. crazy! http://goo.gl/FvPBu

We have 1 staff/RN for 3 doctors. Overhead is less than 30% and income is up 40%.

Model: low monthly membership, $10-100/mo/pt based on age only (not on pre-existings) for unlimited home/work/office/tech visits, no coapys, all procedures free and up to 95% discount on medicines and labs = then they can find insurance up to 30-50% cheaper.
doesn't work? too good to be true? drunk? yes only to #3 🙂
simple math: $50/pt/mo x 600 pt x 12 mo = $360 - 30% overhead - 240k - employer taxes/benefits - $200ish take home per doc.

oh and does it help that i only saw 25 pts last week? WEEK

wholesale meds = HUGE value, more than pays for the membership for many patients. the poor need this the most. prilosec is $2.49 per month. HCTZ is $0.01/pill. Zofran $3.75/bottle. leflunomide $11 mo for us, $120 generic at pharm and $950 brand at pharm.....uhhhhh...easy call for every pt [with RA that is]
wholesale labs = cbc $2, cmp $4.5, lipids $3, tsh $3, T3/4 $4/ea, etc etc.

included procedures: laceration repair, bx, joint injections, ultrasound (non-dx ob), ekg, holter, spiro, audiometry, UA, rapid strep, dexa (yup, i bought a dexa in residency, long story), home sleep apnea screening, minor surgical procedures, medical laser treatments (aerolase.com).----think about it, all that stuff is cheap to do after you have the equipment. If it keeps the pts coming back, who cares how often they get a $0.40 ekg?!

THEY ABUSE IT -- i'll just address it now b/c it'll be asked. No. They. Don't. they have my cell phone, they text, they tweet, they facebook, [few] skype, they email. But they DON'T abuse it. For 1) its only 600 people, 2) they are very gracious in returning the trust you give them. 3) it drops in their chart (mind blown?)

INSURANCE WILL SQUASH THIS - nope, wrong again. we've shown insurance companies how to rethink their business model. they save so much $$$ when they work with us that its silly. They are working WITH us now b/c it lets them lower their premiums. Ok ok, by now if you're still reading, you think i'm drunk on my own koolaid (flavor: delusions of grandeur). True.

ONLY FOR THE RICH - really? come on, now you're not even trying. $10/mo/kid for unlimited care? for the rich?

ok, thats good for now
thoughts?
 
^ Thanks for posting, Josh.

Doubt you remember, but you and I met at a meeting a couple of years ago. I was impressed by your practice model then, and am glad to hear things are doing well.

I also appreciate you posting using your practice name, so folks here can Google it (hint) and learn more about what you do. Good stuff. 🙂
 
Sounds good to me! How does EMR work for you? And, how does the patient get specialist care, procedures/surgery, and hospitalized?
 
AtlasMD said:
Great thread and interesting conversation.

The best that I can tell, i'm the only "concierge physician" thats commented so far (skipped a few posts in the middle ;-)

my 2 cents - concierge family practice will grow to become the standard, drop the concierge, and will be the new "family medicine". Health reform will drive this b/c the current insurance based model (regardless of who resides in the oval office) is unsustainable and unaffordable.

my model of "concierge" is more aptly described as "direct primary care":

by going 100% ins free, and working directly with the patients, then the incentives are appropriately aligned so that my first and last responsibility is to them. now that doesn't mean i rx pain meds or abx when they don't need them...the customer is usually right...and the patient is usually wrong about abx.

The avg practice has 7-10 employees per doc to play the ins game. crazy! http://goo.gl/FvPBu

We have 1 staff/RN for 3 doctors. Overhead is less than 30% and income is up 40%.

Model: low monthly membership, $10-100/mo/pt based on age only (not on pre-existings) for unlimited home/work/office/tech visits, no coapys, all procedures free and up to 95% discount on medicines and labs = then they can find insurance up to 30-50% cheaper.
doesn't work? too good to be true? drunk? yes only to #3 🙂
simple math: $50/pt/mo x 600 pt x 12 mo = $360 - 30% overhead - 240k - employer taxes/benefits - $200ish take home per doc.

oh and does it help that i only saw 25 pts last week? WEEK

wholesale meds = HUGE value, more than pays for the membership for many patients. the poor need this the most. prilosec is $2.49 per month. HCTZ is $0.01/pill. Zofran $3.75/bottle. leflunomide $11 mo for us, $120 generic at pharm and $950 brand at pharm.....uhhhhh...easy call for every pt [with RA that is]
wholesale labs = cbc $2, cmp $4.5, lipids $3, tsh $3, T3/4 $4/ea, etc etc.

included procedures: laceration repair, bx, joint injections, ultrasound (non-dx ob), ekg, holter, spiro, audiometry, UA, rapid strep, dexa (yup, i bought a dexa in residency, long story), home sleep apnea screening, minor surgical procedures, medical laser treatments (aerolase.com).----think about it, all that stuff is cheap to do after you have the equipment. If it keeps the pts coming back, who cares how often they get a $0.40 ekg?!

THEY ABUSE IT -- i'll just address it now b/c it'll be asked. No. They. Don't. they have my cell phone, they text, they tweet, they facebook, [few] skype, they email. But they DON'T abuse it. For 1) its only 600 people, 2) they are very gracious in returning the trust you give them. 3) it drops in their chart (mind blown?)

INSURANCE WILL SQUASH THIS - nope, wrong again. we've shown insurance companies how to rethink their business model. they save so much $$$ when they work with us that its silly. They are working WITH us now b/c it lets them lower their premiums. Ok ok, by now if you're still reading, you think i'm drunk on my own koolaid (flavor: delusions of grandeur). True.

ONLY FOR THE RICH - really? come on, now you're not even trying. $10/mo/kid for unlimited care? for the rich?

ok, thats good for now
thoughts?
Click to expand...

Thank god people like yourself are out there, changing the paradigm of medical practice. Thank you for having the courage to laze your own path! I wish the pcps en masse would follow in your foot steps. You guys have the power to change the whole ball game for docs in the us!
 
thank you very much! too kind. We'd love to change the world but we need docs like yourself you can see the vision and are willing to buck the status quo! Thankfully with each new doc its getting easier.

We're passionate about helping doctors see that there is a better way to practice so if i can be of any help at all, please don't hesitate to email me direct at drjosh @ atlas.md

best,
josh
 
hmmm blue dog...i'd definitely remember meeting a blue dog that talks....or at least types...

Thanks for the support! Our patients need us, their doctors, to create a grass roots movement that turns into a ground swell!! 🙂

and for anyone interested in learning more, my clinic's site is www.atlas.md/wichita

as always, i'm more than happy to answer any question or consult with any doc to help them do the same.
 
lowbudget said:
Sounds good to me! How does EMR work for you? And, how does the patient get specialist care, procedures/surgery, and hospitalized?
Click to expand...

EMR - we built our own, you can imagine nothing out there works the way we need it to. everything else is built for billing insurance. Ours is built so a doctor can sign for an account in a few steps and literally RUN their office from their phone/tablet/computer.

Specialist care - well we decrease the NEED for specialist care when we have the time to spend with our patients and manage their medicines etc. But when they do need a referral, we either use their insurance or look for cash discounts.

Hospitalization - thats what major medical insurance is for. But b/c we're saving patients so much money, sometimes $1k/mo on their ins, its easier to afford the major medical stuff.

Imaging - we have negotiated rates for imaging like CTs and MRIs. MRI of the knee $400. Plain films, $20-40.
 
FWIW, if I ever do direct pay (never say never), that's the way I'd want to do it. 🙂
 
Concierge practices create a self selected population of patients that tend to be much more high maintenance. These tend to be the patients that are a pain in the behind to deal with. I have recommended concierge doctors to a good number of my patients over the years... "you DESERVE concierge level care that I don't think I am providing and as a result, I recommend you check out Dr. XYZ." I have never fired a patient in 12 years of private practice but I can tell you this is THE best way to get rid of patients without firing anyone.
 
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