Concierge Medicine

[Son of a Sailor]

What would those of you with practicing experience think of the viability for a family practice concierge/retainer practice? A size of, say 500 total patients.

This seems to be a great way to give people better care, while allowing a primary care doc to do very well for herself.

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[SDN]

I suppose it depends on the annual fee!

If you're a top physician with a practice in a wealthy area, you may be successful with this model.

However, in general I think this model will not work for most physicians or patients.

 

[MacGyver]

Concierge/boutique medicine market, if not saturated already, will be shortly.

Very very few people are willing to pay for their own healthcare.

I think in 10 years we wont be hearing any more about new boutique practices because docs have already flooded the market in all the available market areas (Beverly hills, manhattan, south beach, etc)

 

[Son of a Sailor]

I think you both misunderstand my question. I am not talking about charging a ridiculous fee. Keep in mind, people pay $1,000 per year for insurance on their Ford Taurus. They don't drive Ford Tauruseses (?) in Beverly Hills.

Also, I think people will eventually be forced to pay for their own healthcare. If you don't recognize this trend, you must be blind. Look at failing corporations that promise free healthcare for all retirees.

As far as saturation goes, I haven't seen any types of this service where I am from. This is after a considerable amount of research.

 

[SDN]

I think you could consider charging a reasonable sliding-scale fee based on age. Higher annual fee for older patients and lower fees for younger patients. After all, 20 year-olds don't go to the doctor very often.

On your second point, just like retirement benefits, health care benefits are being shifted from employer to employee. That's old news. However, concierge medicine doesn't address this issue. Usually, concierge docs charge an annual 'retainer' fee and also charge the patient's insurance for each visit.

Are you suggesting that you will only charge an annual fee and not bill insurance?

 

[Son of a Sailor]

I was addressing the assumption that individuals refuse to pay for their own healthcare, as one post claimed.

I just feel that this assumption was once true, but is quickly becoming incorrect.

 

[logos]

Are you suggesting that you will only charge an annual fee and not bill insurance?

Think it could be done that way? Charge a few thousand each to a couple hundred patients. No other charges. They have access to you 24/7/365 and you agree to spend as much time addressing their complaints as necessary.

 

[sophiejane]

Think it could be done that way? Charge a few thousand each to a couple hundred patients. No other charges. They have access to you 24/7/365 and you agree to spend as much time addressing their complaints as necessary.

It's happening, it's no longer a "could be."

 

[SDN]

Think it could be done that way? Charge a few thousand each to a couple hundred patients. No other charges. They have access to you 24/7/365 and you agree to spend as much time addressing their complaints as necessary.

No way would I assume that financial risk -- injectable costs alone could destroy that plan. You'd need to charge an annual fee, plus a fee for materials.

 

[mamadoc]

Think it could be done that way? Charge a few thousand each to a couple hundred patients. No other charges. They have access to you 24/7/365 and you agree to spend as much time addressing their complaints as necessary.

... and the people who can pay for this sort of care are EXACTLY the ones I would never want to have access to me 24/7/365 <shudder>. No thanks. People act entitled enough for their $20 co-pay; some of them would be absolutely insufferable under this model. Ugh.

 

[logos]

... and the people who can pay for this sort of care are EXACTLY the ones I would never want to have access to me 24/7/365 <shudder>. No thanks. People act entitled enough for their $20 co-pay; some of them would be absolutely insufferable under this model. Ugh.

Haha..probably true...but I suppose that if the number of people in your practice was small enough it could be tolerable?

 

[logos]

No way would I assume that financial risk -- injectable costs alone could destroy that plan. You'd need to charge an annual fee, plus a fee for materials.

Oops...I dont think I understood what I said when I said it. I guess what I meant was no other charges for services/time...have that all covered by the yearly fee. You would have to charge somehow for materials...otherwise you would essentially be acting as a form of health insurance...but without the huge customer base to allow for cost averaging. Same for any bills from hospitals/specialists.

Sounds kinda like being a Doc back in the day. Heck..you could probably even make house calls part of the deal

 

[sophiejane]

My understanding is that the fee (usually around $2000/patient/year or $5000/family/year) includes only the physician's outpatient services. Supplies, diagnostic tests, even hospital visits from the doctor, etc are all extra.

There is a contract between doctor and patient which is renewed annually, at which time EITHER party can opt out. So if the patient a hypochondriacal P.I.T.A., they will probably get the boot at the end of the year. The physician can also limit some visits, work in vacation time, etc.

There are several family docs in my area doing ***extremely*** well with this model. Not that it works for everyone, but in the right niche (and we're not even talking about Malibu or South Beach or Park Avenue here--this is middle America, and it's working here), it can be done.

 

[wakeboarder]

One of our IM staff is involved in this type of practice (I'm PGY3). He keeps very finacially satisfied in our midwest city (not Chicago).

Sophiejane's post above gives a good approximation of what I've heard about in these groups. As it was explained to me, there are of course variations on the theme. Some examples:

1. In my staff's practice, they actually admit. So they are on call and will meet the patient in the ED and follow them in the hospital. Some groups do not offer this.
2. Patients in his model pay $5000 for the year, but have to have supplemental catastrophic insurance. Otherwise one ICU stay would wipe out your practice. Peds pay less ($2000?) and are actually a loss due to the cost of visits and vaccines. Other payment schemes exist.
3. Routine labs are deducted from the annual fee, as are aforementioned shots. Many value-added services are included as well, such as routine baseline CXR's and treadmills. MRI's and CT scans are extra.

As far as patient population, I'm sure it varies, but this group sees middle-aged middle-class men primarily. Many are self-employed and found this to be cost-effective compared to full insurance. Many simply want to get what they pay for. I think very few patients would be the type to page you from the grocery store and ask which kind of butter they should buy.

As far as compensation, they do very well - even part-time it would exceed most full-time PCP's. Besides their payment schedule, this is also due to having virtually no support staff. They have no nurses. They have no billing department. The patient meets the physician, vitals are taken by the physician, exam is done by physician, and billing has been sorted out beforehand. They keep a higher percentage of the revenue generated than do other PCPs. (And at 200-400 patient load, you do the math....)

As far as benefits, there are many. My favorite is that you can appropriate more resources than you may traditionally, since labs and tests do not need to be justifiable to insurance companies. Of course I am not encouraging wasteful medical practice. But we understand that preventative guidelines are influenced by the cost, as well as disease prevalence and other factors. By taking cost out of the equation, we can reevaluate our goals. In Japan, EGD's are done to screen for gastric ca. Gastric ca is just as fatal here; we just do not screen because the lower incidence here makes the cost outweigh the benifit. This is an example of how one could be free to practice outside normal parameters (assuming you do EGD's )

 

[Leukocyte]

So I will be paying $2000 to $5000 for my Primary Care physcian services ONLY, and that does not include labs, rads, procedures, hospitial stays, ER visits, OR services, medications?!!!

Why the hell would I do that If I live in Kansas trying to make ends meet?! What you are suggesting is that I have a "family physician" like rich folks do (or used to do in the 60's).

Having a personal "family physician" is a luxary that only some rich folks can afford. It is like having your personal Chef, your personal Driver, your personal butler...... This sort of thing only belongs in Beverly Hills. Forget Manhattan, rich folks are moving away from this ****hole of a "city" as more and more immigrants are moving in each year. Rich folks are moving to the suburbs in Long Island like the Hamptons. Manhattan is for the young poor stuggling "YUPIES" and immigrants you can barely pay their rent.

 

[MacGyver]

The reality is that the market for "boutique medicine" is so small that it will quickly become saturated.

Evne a city like NYC or Chicago could probably only support 200 concierge docs or so, the vast majority of people would never pay that kind of money

 

[secretwave101]

They have access to you 24/7/365 and you agree to spend as much time addressing their complaints as necessary.

You just defined the opposite of a "lifestyle" specialty. I'd guess the burnout rate on this type of call schedule will be huge. Good money, bad life.

 

[sophiejane]

Seems like there would be no reason why you couldn't provide concierge services to a small number of patients in addition to your traditional practice. Have routinely scheduled concierge clinic one day or half day a week and see more urgent cases as they come up. Give staff that day off.

You could also offer cash services to all patients in addition to taking insurance. If enough people want it, you can gradually decrease your billing/insurance staff as you build your practice.

I'm not in practice yet, so this is just assumption...does it sound feasable to others who are out there? Kent?

 

[deleted87716]

I'm not in practice yet, so this is just assumption...does it sound feasable to others who are out there? Kent?

There are a few docs in my area who have opened retainer practices (I prefer to avoid the terms "concierge" and "boutique" because of their luxury/exclusive connotations). In a retainer practice, what you're really selling is your time. The people who pay you are going to do so because they want to spend more time with their doctor than is typically possible under third-party payor medicine. To be successful, you'll need to be able to provide them with what they value. Most retainer practices have panels of around 500-600 patients per physician.

The majority of patients who will gravitate towards this model will be well-off older people with multiple chronic medical problems, and the younger well-heeled "worried well". If you dislike dealing with either group of patients, a retainer model practice is not for you.

I don't think "hybrid" or "transitional" practices will likely be very successful. If you're going to go retainer, you need to go all the way. You won't be able to deliver the kind of service that a retainer patient expects if you're still busy seeing a larger panel of patients in a third-party payor environment.

You will need to very carefully investigate insurance laws in your state if you plan to charge a retainer. In some states, accepting payment in advance for medical care constitutes selling insurance (and you aren't licensed to do that.) If you're going to bill the patients' insurance companies in addition to charging a retainer, you need to make sure that your retainer doesn't cover services that are included in your contract, or else you'll be accused of "double-dipping." Where Medicare fraud is concerned, the penalities are pretty stiff...tread carefully.

If you're clueless, you can always sign on with one of the national retainer-model firms like MD2 or MDVIP, and they'll take care of all the red tape for you (in exchange for a piece of the action, of course.)