Concierge Medicine

[drturkleton]

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I realize there have been threads on this topic before, but I am just curious what people's thoughts are on concierge medicine. I just came across a few New York Times articles about these practices, and I was shocked by how angry some commenters were.

The commenters' main arguments were that a) concierge medicine exacerbates the disparity in medical care between the haves and the have-nots (the moral argument), and b) taxes fund medical training, so doctors' responsibility is to the taxpayers (the public service argument).

Concerning the first point, from what I gather, prices start at about $1500-2000 per person per year, so individuals who can't afford an extra $125/month are priced out (I realize this price is higher for families). As long as those who are priced out or choose not to pay a retainer can retain access to primary care - although they may have to wait longer to see an MD, or see an NP or PA for more immediate care - it may be difficult to argue that primary care raises ethical issues. In fact, for almost any (non-medical) service, the buyer can only choose two of the three: cheap, fast, or high-quality.

As far as taxes subsidizing medical training, one could make the argument that the majority of tax revenue comes from the haves - the top decile of earners contributes almost 70% of the total income tax, the top quartile contributes over 85%, and the top half over 95% - so concierge care is, in the reasoning of this argument, providing a higher return on these taxpayers' investment in terms of quality.

For the record, I don't plan to go into a field where concierge medicine would even be feasible. However, I am curious what people think about it. I personally think it's good for primary care doctors and for the patients who can afford it, and I view it as falling under the same category as private school, private college, etc.

 

[Slack3r]

Pro tip: Don't read internet comments, especially not from the NYT.

 

[cbrons]

Pro tip: Don't read internet comments, especially not from the NYT.

Word. The socialists who typically write for and read the NYT believe that doctors should be slaves of the state, not individuals who act via free and voluntary association. Of course, many of these same people are slobs on welfare (of one form or another) who contribute nothing to the taxbase. Best to just ignore the wastrels and go about your business.

 

[cbrons]

By the way, this website has a lot of good info on concierge medicine: http://www.aapp.org/

 

[JaggerPlate]

All altruistic 'it creates a disparity in care,' 'it won't solve the primary care crisis,' 'doctors should treat everyone,' commentary aside ... I think it's a great thing. HOWEVER ...

I've reviewed and discussed the situation numerous times with practicing FM docs on this site and with business people in health administration classes and the fact of the matter is that a. it's a very, very niche market b. it takes a long time to transition from taking insurances to a concierge model (you're dreaming if you think you can hang a concierge shingle right out of residency) c. the number of people willing to pay for these services are very few and far between and d. it's going to limit you geographically to a few big cities that are probably already highly saturated with plenty of good docs and guys already doing this.

I'd love to see this model take off more, and while it's a possibility in the future, I simply think the potential is very limited in the present and not-so-distant future. The best example I've seen was an Internist in Beverly Hills who set up a model similar to the one you're describing - he does not take insurance and instead his members pay an annual fee. In exchange for this fee, all office visits are covered (members still need some sort of disaster insurance for hospital visits/emergencies - another downfall in my book) and members benefit from additional perks like guaranteed same day appointments, direct email access with the physician, and the ability to call the doc's cellphone.

Another interesting one I saw recently was a geriatric doc in AZ who set up a concierge model. What I thought was interesting here was the fact that this doc skirted the need for additional insurance for disaster scenarios because all his patients were eligible for Medicare (though I'm not 100% on the legality of that one).

Regardless, if this is something you're considering, I'd really, really do some honest research and come to terms with the reality of how difficult and long of a process it can be before you're charging a significant group of patients 2k a year for your services.

 

[JaggerPlate]

Word. The socialists who typically write for and read the NYT believe that doctors should be slaves of the state, not individuals who act via free and voluntary association. Of course, many of these same people are slobs on welfare (of one form or another) who contribute nothing to the taxbase. Best to just ignore the wastrels and go about your business.

By the way, this website has a lot of good info on concierge medicine: http://www.aapp.org/

👍 on both accounts.

 

[MedicineMike]

Word. The socialists who typically write for and read the NYT believe that doctors should be slaves of the state, not individuals who act via free and voluntary association. Of course, many of these same people are slobs on welfare (of one form or another) who contribute nothing to the taxbase. Best to just ignore the wastrels and go about your business.

love it!

 

[IvyHopeful20]

95% of the US population can't afford this or wouldn't want to even if they could, so it is and will always be a niche market. It will be interesting if the prices go down for premium service if more and more primary care docs start crowding the limited market.

Hey if you can get this type of gig, good for you. I've no problem with it. But for the vast majority of physicians, it's not really a realistic option.

 

[rbnsafsadgf]

The commenters' main arguments were that a) concierge medicine exacerbates the disparity in medical care between the haves and the have-nots (the moral argument), and b) taxes fund medical training, so doctors' responsibility is to the taxpayers (the public service argument)..

So, you mentioned A) furthering disparities and B) public service obligation, but I would also add C) fewer patients (who presumably are sick) get seen. However, if you still see as many pts as you otherwise would C is out. There is also the argument that rich people are less sick, so each "unit" of medical care creates a less "health" -- that is the marginal benefit of health care is smaller with the healthier one is to start off with. This could be considered A1.

Word. The socialists who typically write for and read the NYT believe that doctors should be slaves of the state, not individuals who act via free and voluntary association. Of course, many of these same people are slobs on welfare (of one form or another) who contribute nothing to the taxbase. Best to just ignore the wastrels and go about your business.

Yeah, because being sick and health care are about a free choice. Those damn patients with infective endocariditis not shopping around for a better and cheaper hospital. "Hey Doc -- How much is that Vanc? let's go with the $4 90-day Walmart special and skip the echo."

it's a very, very niche market

and this.

To the OP, if you want to provide concierge-like, high quality medical care, check out medical homes. E.g., http://www.npr.org/templates/story/story.php?storyId=129432707 and the many peer reviewed articles about the same.

 

[Pseudopseudonym]

I suggest you check out: http://directpayhealth.com/

It's not quite as niche as "Concierge Medicine" in that it is much more affordable. I look at the direct pay model as a blend between what dominates now and concierge medicine. This guy has some really interesting points (like how his services actually cost less and his patients have had better outcomes).

I like the direct pay model more than concierge medicine because (as another poster noted above) it allows more variance in location and type of practice. The more I read about direct pay, the more intrigued I am.

Yeah, because being sick and health care are about a free choice. Those damn patients with infective endocariditis not shopping around for a better and cheaper hospital. "Hey Doc -- How much is that Vanc? let's go with the $4 90-day Walmart special and skip the echo."

Nice work on the fear mongering. I think everyone knows we aren't talking about patients who are deathly ill. No one wants to turn someone away with "infective endocariditis" but people need to take responsibility for their own health (please note that I am referring to "primary care" type health - exercising, eating right, and not smoking).

 

[cbrons]

I suggest you check out: http://directpayhealth.com/

It's not quite as niche as "Concierge Medicine" in that it is much more affordable. I look at the direct pay model as a blend between what dominates now and concierge medicine. This guy has some really interesting points (like how his services actually cost less and his patients have had better outcomes).

I like the direct pay model more than concierge medicine because (as another poster noted above) it allows more variance in location and type of practice. The more I read about direct pay, the more intrigued I am.



Nice work on the fear mongering. I think everyone knows we aren't talking about patients who are deathly ill. No one wants to turn someone away with "infective endocariditis" but people need to take responsibility for their own health (please note that I am referring to "primary care" type health - exercising, eating right, and not smoking).

Direct pay is good too, and there are several examples out there of primary care physicians providing services on a fee-for-procedure basis. Of course, such services are rendered after the physician prices each procedure and negotiates directly with the customer (patient). It is perfect for a lot of middle class people with no chronic health conditions (or serious ones anyway) who need a physical or a checkup for a routine illness. In such cases, people would purchase "catastrophic" health insurance only, and rely on direct-pay for the real routine stuff. It is a win-win for both, since the pt doesn't have to pay high insurance premiums and the physician doesn't the have to maintain the massive overhead necessary to properly document and bill insurance companies.

 

[Pseudopseudonym]

Direct pay is good too, and there are several examples out there of primary care physicians providing services on a fee-for-procedure basis. Of course, such services are rendered after the physician prices each procedure and negotiates directly with the customer (patient). It is perfect for a lot of middle class people with no chronic health conditions (or serious ones anyway) who need a physical or a checkup for a routine illness. In such cases, people would purchase "catastrophic" health insurance only, and rely on direct-pay for the real routine stuff. It is a win-win for both, since the pt doesn't have to pay high insurance premiums and the physician doesn't the have to maintain the massive overhead necessary to properly document and bill insurance companies.

Agreed. This guy claims that their internal audit showed it saved $250,000 PER PROVIDER in overhead.

 

[MossPoh]

As far as taxes subsidizing medical training, one could make the argument that the majority of tax revenue comes from the haves - the top decile of earners contributes almost 70% of the total income tax, the top quartile contributes over 85%, and the top half over 95% - so concierge care is, in the reasoning of this argument, providing a higher return on these taxpayers' investment in terms of quality.

Well yea, but there is also a scary difference between the amount those groups make. Also, the real bank comes from the mega-rich, who are notorious for escaping through various tax loopholes and then investing money wherever they will get the most returns, which often isn't the US.


There are also plenty of data out there showing how upfront payment for medical services actually reduces visits, with a fairly strong correlation that it has reduced health outcomes as well.

From a practical perspective, I think it wouldn't necessarily work out any better than anything we have now. To me, it essentially is an open promotion that we are just another good/service and they are customers who get what they want. It has the potential to create as much self-entitlement as anything else.

 

[cbrons]

Yeah, because being sick and health care are about a free choice. Those damn patients with infective endocariditis not shopping around for a better and cheaper hospital. "Hey Doc -- How much is that Vanc? let's go with the $4 90-day Walmart special and skip the echo."

No idea what the misfortune of becoming ill has to do with a physician being allowed the free will to make his/her own choices about when, where, if, and under what circumstances they provide their services. Perhaps you could elaborate?

 

[cbrons]

Well yea, but there is also a scary difference between the amount those groups make. Also, the real bank comes from the mega-rich, who are notorious for escaping through various tax loopholes and then investing money wherever they will get the most returns, which often isn't the US.

And yet, even with such loopholes, they still pay the vast majority of taxes.

There are also plenty of data out there showing how upfront payment for medical services actually reduces visits,

Not surprising... if you are paying for a good/service directly out of your own pocket, you are likely to be more judicious in shopping around for the best price and deciding how much of a good/service you actually need.

with a fairly strong correlation that it has reduced health outcomes as well.

Sources?

 

[Mattchiavelli]

as far as the philosophical point the OP brought up regarding tax $$ subsidizing medical education both to get an MD and to train a resident, I would argue that the population in general reaps benefits from this investment. Even if a person is born at home and never sees a physician til they die, they're still benefitting from things like herd immunity with vaccinations of others, knocking out communicable disease in others, lowering morbidity of disease to increase productivity, and more.

Personally, I consider it more of an obligation to teach and guide physicians behind me in training rather than seeing the highest # of patients humanly possible...but that's getting kind of off-topic. Concierge is probably not my ideal model, but I think it's good people are trying to be innovative to counteract the hot mess that is medical insurance. People are wondering where all the healthcare $$ is going and will beat the drum of too much testing, expensive drugs, and physician salaries, but you don't see the massive bloat of administration being talked about as much. Med school or maybe age as made me more conservative.. weird.

 

[rbnsafsadgf]

No idea what the misfortune of becoming ill has to do with a physician being allowed the free will to make his/her own choices about when, where, if, and under what circumstances they provide their services. Perhaps you could elaborate?

The demand for health care is fairly inelastic compared to most services due to its nature. Hence, it is overly simplified to say that it is about the free association between pts and physicians (for an exchange of a service). That simplification obscures a major complicating factor in the provision of services from, and fees for, physicians.

 

[cbrons]

The demand for health care is fairly inelastic compared to most services due to its nature. Hence, it is overly simplified to say that it is about the free association between pts and physicians (for an exchange of a service). That simplification obscures a major complicating factor in the provision of services from, and fees for, physicians.

So should physicians be forced to treat someone against their will under some circumstances? I think most of us would agree that the vast majority of physicians would treat someone with a bullet wound or some other such inveterate ailment that is immediately life/death (hence do not need to be told they must care for them). So ignoring such situations (unless you believe there is a preponderance of doctors who wouldn't treat under emergency situations), when in your mind is it acceptable for the state to force a health care provider to treat someone against their will (this result being the logical end of the "healthcare is a right" argument)?

 

[womp]

Word. The socialists who typically write for and read the NYT believe that doctors should be slaves of the state, not individuals who act via free and voluntary association. Of course, many of these same people are slobs on welfare (of one form or another) who contribute nothing to the taxbase. Best to just ignore the wastrels and go about your business.

Yup.

This is a typical and actual New York Times comment:

I don't suppose it has ever occurred to you to charge less for your services? Most doctors have a lot more money than the average person.

Most doctors seem more concerned with the amount of money they are making than with the care of the poor. Why else are they always complaining about getting less in payments from Medicare and Medicaid? ​

People like this NYT poster likely never spare a cent for the poor but feel incredibly righteous about pledging other people's money and time. These people have a twisted sense of fairness where effort, quality and scarcity are never part of the equation. To them, physicians should be paid as much as the average American person: a college dropout or associates holder with an SAT of 1000 who watches TV four hours a day.

Here's the NYT stock performance (in light orange) over the past 10 years:

 

[Slack3r]

95% of the US population can't afford this or wouldn't want to even if they could, so it is and will always be a niche market. It will be interesting if the prices go down for premium service if more and more primary care docs start crowding the limited market.

Hey if you can get this type of gig, good for you. I've no problem with it. But for the vast majority of physicians, it's not really a realistic option.

95% eh? 100% of the quoted post was pulled out of the poster's deluded ass. (I can make up statistics too 😉)

Most concierge models are about $1000-$1500 per YEAR. That's $100-$125/month. People pay more for their iPhone service. This is hardly an upper-upper class phenomena.

 

[jj6vcb]

The demand for health care is fairly inelastic compared to most services due to its nature. Hence, it is overly simplified to say that it is about the free association between pts and physicians (for an exchange of a service). That simplification obscures a major complicating factor in the provision of services from, and fees for, physicians.

I don't think it's that inelastic. There are plenty of welfare families who pay 100/month for cable tv and cellular data plans when it could be going somewhere more useful.

Sure, true emergencies show perfect inelasticity, but as the other poster said, most docs are more than willing to help then

 

[womp]

The number of patients on Medicaid whipping out their smartphones never ceases to amaze me.

It makes me ashamed to be still carrying around a clam shell phone sometimes.

 

[dikoerastenie]

In "concierge medicine" I do not see who would benefit besides the doctors. So a doctor basically insures his patients with a $1000/yr premium and offers limited services in return. If you break a leg or have an abnormal ekg or psa you are going to a specialist. Are you then also paying each specialist $1000/yr? I guess it can work if you're a millionaire. But then you can spend money on many things... I understand medicine might not be the most optimal career for making money with all the time and money invested. But if you're such a supporter of free market go ahead and do it, especially in an area where there is healthy competition like nyc. And see how many people will sign up for your "service".

 

[dikoerastenie]

The number of patients on Medicaid whipping out their smartphones never ceases to amaze me.

It makes me ashamed to be still carrying around a clam shell phone sometimes.

And some people on medicaid get laid. U mad? What are you an earl?

 

[IvyHopeful20]

95% eh? 100% of the quoted post was pulled out of the poster's deluded ass. (I can make up statistics too 😉)

Most concierge models are about $1000-$1500 per YEAR. That's $100-$125/month. People pay more for their iPhone service. This is hardly an upper-upper class phenomena.

Hence the phrase "wouldn't want to.". If you see your PC provider once or twice a year, it's a bit overkill. And even if you see them more, in most cases I'd guess you wouldn't want to pay that much more in addition to whatever you pay for insurance anyway.

 

[Pseudopseudonym]

There are also plenty of data out there showing how upfront payment for medical services actually reduces visits, with a fairly strong correlation that it has reduced health outcomes as well.

From a practical perspective, I think it wouldn't necessarily work out any better than anything we have now. To me, it essentially is an open promotion that we are just another good/service and they are customers who get what they want. It has the potential to create as much self-entitlement as anything else.

I'd be interested to see this data, because the stuff I've come across says just the opposite. When people are paying for something out of their own pocket, instead of just sending the bill to some company, they are much more likely to take proactive action to improve their well-being.

Ummm....that's exactly what healthcare is. Since when has it not been a service rendered? Just because it's a service does not mean physicians have to ponder to every patient's wants.

People pay more for their iPhone service. This is hardly an upper-upper class phenomena.

Love this. Think about how much people who smoke a pack a day spend PER MONTH. A pack of smokes is what, close to $5.00 now? I'm more than HAPPY to help (via charity care or taxes) those who legitimately cannot afford their well-being. But turning a "safety net" (which, by the way is exactly what Social Security and Medicaid started out as) into a mechanism to pay for everyone's wants and needs (regardless of the necessity of them -- e.g. cell phones) is something I just can't handle.

A little personal responsibility goes a long way to improve one's own life.

 

[MedicineMike]

Yup.

This is a typical and actual New York Times comment:

I don't suppose it has ever occurred to you to charge less for your services? Most doctors have a lot more money than the average person.

Most doctors seem more concerned with the amount of money they are making than with the care of the poor. Why else are they always complaining about getting less in payments from Medicare and Medicaid? ​

I can't believe people actually think this way. I would love to just "charge less" as a physician as long as someone charged me less time and money to go to school. Let me smack those poor folks with $200k in debt and 12 yrs of their lives and see what they say after that. Even bankruptcy won't help this time. What a joke...

 

[Law2Doc]

The problem with concierge medicine is that it only works if few people are offering this service. If you are the only one doing concierge medicine in a wealthy part of town with no competitors and you can pick and choose healthy, non demanding clients, it's a great business. If there are lots of people offering the same kind of service in the area, you start to have to charge less, and/or accept more demanding and less healthy customers, and suddenly it's not such a good business model. It doesn't take many people in the area to make this model be less lucrative than simply accepting insurance and doing a greater volume business. So the short answer is it's a nice business model if you are the first and only guy offering this kind of service to an elite group of customers. but it is not a sustainable business because inevitably there will be competition and this model more or less depends on there being more demand than supply. With most people already covered by insurance and without the disposable income to pay healthcare on top of existing insurance coverage, the pool of potential customers simply isn't big enough to sustain as many people in this business as may want to be in this business. From a business model standpoint, it's bad on paper.

 

[cpants]

In "concierge medicine" I do not see who would benefit besides the doctors. So a doctor basically insures his patients with a $1000/yr premium and offers limited services in return. If you break a leg or have an abnormal ekg or psa you are going to a specialist. Are you then also paying each specialist $1000/yr? I guess it can work if you're a millionaire. But then you can spend money on many things... I understand medicine might not be the most optimal career for making money with all the time and money invested. But if you're such a supporter of free market go ahead and do it, especially in an area where there is healthy competition like nyc. And see how many people will sign up for your "service".

It benefits the patients too, a lot. Otherwise they wouldn't pay for it. Obviously for your 1000 you don't get comprehensive healthcare. What you do get is unlimited access. Every time you get the sniffles or need your meds refilled you can call your doctor on his cell phone and get a same day appointment. Even if it is something more serious you can see a doctor same day and get rapid referral. Your average primary care experience offers nothing even close to that level of service.

 

[GoodmanBrown]

I'd be interested to see this data, because the stuff I've come across says just the opposite. When people are paying for something out of their own pocket, instead of just sending the bill to some company, they are much more likely to take proactive action to improve their well-being.

Here's an interesting podcast I listened to recently talking about poor economics. It's from NPR though, so it's probably socialist-tainted. 😉

The just of it: Poor people in India were given vouchers for mosquito nets when they visited the health clinic for another reason. People were given a voucher for a free net, a net at 20% of normal cost, 40% of normal cost, 60%, 80%, and a voucher that simply encouraged them to buy a net but offered no discount.

Unsurprisingly, the people with the highest discounts redeemed the vouchers more frequently and when they were randomly visited, most were using the mosquito nets correctly (not as fishing nets or something random like that).

To me this makes logical sense. If you tell a person the doctor's visit is free, he'll go if he feels ill. If he has to pay $50, he'll wait to see if he gets better. Isn't this the whole worry with single-payer? That everyone will go see doctors willy-nilly if they don't have to cough up some cash?

 

[Slack3r]

And some people on medicaid get laid. U mad? What are you an earl?

If someone is "too poor" to afford even the most basic health insurance and needs to have the state (aka the taxpayer) pay for their medical bills, they shouldn't have $100+/month ****ing PHONES. I'm not subsidizing Angry Birds for these people.

If you've got the money for an iPhone, you've got the money for healthcare.

 

[GoodmanBrown]

If someone is "too poor" to afford even the most basic health insurance and needs to have the state (aka the taxpayer) pay for their medical bills, they shouldn't have $100+/month ****ing PHONES. I'm not subsidizing Angry Birds for these people.

If you've got the money for an iPhone, you've got the money for healthcare.

You do realize that that's not really true, right? If you have any, any pre-existing condition, health insurance is going to be priced completely out of range of almost any family earning less than $50K. A family plan costs $1,000+/month for a realistic family with pre-existing conditions. And health insurance actually doesn't really include any healthcare. When you start paying for copays and meds, you're looking at way more money.

Now, I'm not saying a smartphone is a great use of scant resources, so I'm not saying we should start an inititive to get iPhones in the hands of the underprivaleged. I'm just saying, heathcare costs more than a smartphone.

 

[womp]

A pack of smokes is what, close to $5.00 now?

$9.60 a pack here.

 

[Slack3r]

You do realize that that's not really true, right? If you have any, any pre-existing condition, health insurance is going to be priced completely out of range of almost any family earning less than $50K. A family plan costs $1,000+/month for a realistic family with pre-existing conditions. And health insurance actually doesn't really include any healthcare. When you start paying for copays and meds, you're looking at way more money.

Who said anything about pre-existing conditions?

 

[danzman]

In "concierge medicine" I do not see who would benefit besides the doctors. So a doctor basically insures his patients with a $1000/yr premium and offers limited services in return. If you break a leg or have an abnormal ekg or psa you are going to a specialist. Are you then also paying each specialist $1000/yr? I guess it can work if you're a millionaire. But then you can spend money on many things... I understand medicine might not be the most optimal career for making money with all the time and money invested. But if you're such a supporter of free market go ahead and do it, especially in an area where there is healthy competition like nyc. And see how many people will sign up for your "service".

And this is simply the truth. No one really benefit from this other than upper crusters who don't want to wait for an appointment. I could maybe see this being profitable for a physician in a large city (NYC Boston) where there are already a glut of PCPs there anyway, so again, only the docs benefit. Modern medicine is a team sport whether you like it or not. Imagine trying to sell this to the middle class. "All you need to do is pay 200 a month per person in your house and you can call a real doctor all day long"
"So what if I need to go to the ER?"
"Your screwed"
What if I have a heart attack?"
"Your screwed"
How about pregnant?"
"Screwed"
"Any surgery?"
"Screwed"

"So what can you do for me?"
I can manage BP/Sugar/Weight and give Abx
"The same thing any PCP can do for a 60 office visit?"
Yes.

The only people who could benefit from this are the old and sick who have so many specialists that they have to have insurance, thus negating the reason to have concierge medicine.

Still, if an upper cruster wants to pay this so they can avoid the office, more power to the PCPs who can convince them.

 

[MedicineMike]

And this is simply the truth. No one really benefit from this other than upper crusters who don't want to wait for an appointment. I could maybe see this being profitable for a physician in a large city (NYC Boston) where there are already a glut of PCPs there anyway, so again, only the docs benefit. Modern medicine is a team sport whether you like it or not. Imagine trying to sell this to the middle class. "All you need to do is pay 200 a month per person in your house and you can call a real doctor all day long"
"So what if I need to go to the ER?"
"Your screwed"
What if I have a heart attack?"
"Your screwed"
How about pregnant?"
"Screwed"
"Any surgery?"
"Screwed"

"So what can you do for me?"
I can manage BP/Sugar/Weight and give Abx
"The same thing any PCP can do for a 60 office visit?"
Yes.

The only people who could benefit from this are the old and sick who have so many specialists that they have to have insurance, thus negating the reason to have concierge medicine.

Still, if an upper cruster wants to pay this so they can avoid the office, more power to the PCPs who can convince them.

geez. somebody must have been molested by a concierge doctor as a child...

 

[artemis680]

If you've got the money for an iPhone, you've got the money for healthcare.

Concerning the first point, from what I gather, prices start at about $1500-2000 per person per year, so individuals who can't afford an extra $125/month are priced out

Looks to me like if you've got money for an iPhone, you've got money for concierge care! Am I the only one here who thinks that from a patient perspective, this plus a disaster insurance plan looks like a good deal? It's cheaper than most insurance plans (so is paying out of pocket per visit). Oh, and all of my pre-existing conditions (asthma, allergies) are treated through primary care. Obviously this won't be true for everyone.

 

[danzman]

geez. somebody must have been molested by a concierge doctor as a child...

Molested may be a bit harsh. I got nothing against them making a buck, I just don't see how it "helps" the greater good, or for that matter how its sustainable.

 

[JaggerPlate]

If someone is "too poor" to afford even the most basic health insurance and needs to have the state (aka the taxpayer) pay for their medical bills, they shouldn't have $100+/month ****ing PHONES. I'm not subsidizing Angry Birds for these people.

If you've got the money for an iPhone, you've got the money for healthcare.

My mom is a high school teacher in an "eh" area and she said she's always blown away when she walks through the cafeteria at lunch and sees a line of kids texting on their iphone 4s while using their state provided, "financial needy," everyday free lunch cards.

 

[Pseudopseudonym]

Molested may be a bit harsh. I got nothing against them making a buck, I just don't see how it "helps" the greater good, or for that matter how its sustainable.

Where is it written that physicians have to be in medicine for the "greater good?" What does that even mean?

 

[danzman]

Where is it written that physicians have to be in medicine for the "greater good?" What does that even mean?

I was responding to another poster who was asking if anyone actually benefited from this kind of a setup, and never said anything about physicians being altruistic. I simply do not think that patients benefit from concierge medicine, and only a few physicians would ever be able to. I stated twice however, that I was all for PCP's making cash over this.

Please don't turn this into a "we should make money for all our hard work" discussion, as if I could make dough by giving out marijuana scripts all day I would.

 

[cbrons]

Quick 1 page article on a physician who runs a cash-only practice.

 

[tigress]

To the OP, if you want to provide concierge-like, high quality medical care, check out medical homes. E.g., http://www.npr.org/templates/story/story.php?storyId=129432707 and the many peer reviewed articles about the same.

I agree, definitely read about medical homes. We have a family practice guy who comes to give us lectures once in a while and who has spent a lot of time plugging for this model. The more I hear/read about it, the more it seems like a great idea.

Most concierge models are about $1000-$1500 per YEAR. That's $100-$125/month. People pay more for their iPhone service. This is hardly an upper-upper class phenomena.

This is true. It's only an option for somebody with a certain amount of disposable income, but it's not only available to people in the very highest income brackets.

In "concierge medicine" I do not see who would benefit besides the doctors. So a doctor basically insures his patients with a $1000/yr premium and offers limited services in return. If you break a leg or have an abnormal ekg or psa you are going to a specialist. Are you then also paying each specialist $1000/yr? I guess it can work if you're a millionaire. But then you can spend money on many things... I understand medicine might not be the most optimal career for making money with all the time and money invested. But if you're such a supporter of free market go ahead and do it, especially in an area where there is healthy competition like nyc. And see how many people will sign up for your "service".

Well, it is a benefit to people who have complex needs in their primary care. I am approaching this whole topic right now from a practical rather than theoretical viewpoint, because it's one that came up recently in my own life. My elderly grandfather was not being well-served by his regular primary care physician and specialists, who refused to work together in any way (and I can understand why, since doing so would be extra work they don't have time for, and they wouldn't get paid for). He is taking 15+ medications, some of which are contraindicated, and his health has been deteriorating. For somebody like this, especially in geriatrics but I could see it in any person with a complex condition, concierge care is actually a wonderful option to have available. Now he has a doctor who is able to spend quite a bit more time with him, and is willing to communicate with his specialists regarding his medications.

Until the past few months, I would have said that my first instinct is that concierge care only furthers health care disparity. But now I've had more time to think about it and to see how it works in person, and I'm not so sure anymore. A struggle between my ideals and the reality of medicine in this country, I suppose. This thread is certainly an interesting read.

(And FWIW, I'm one of those awful leftie socialist welfare recipients who reads the New York Times, which isn't liberal enough for my taste.)

You do realize that that's not really true, right? If you have any, any pre-existing condition, health insurance is going to be priced completely out of range of almost any family earning less than $50K. A family plan costs $1,000+/month for a realistic family with pre-existing conditions. And health insurance actually doesn't really include any healthcare. When you start paying for copays and meds, you're looking at way more money.

Now, I'm not saying a smartphone is a great use of scant resources, so I'm not saying we should start an inititive to get iPhones in the hands of the underprivaleged. I'm just saying, heathcare costs more than a smartphone.

Forget pre-existing conditions. I have 3 kids on Medicaid, and I am pretty sure I have things that peg me as middle class (I don't own a smart phone, but I"m sure there are other things). But the cost of adequately insuring all 3 of my children is ridiculous, and impossible for me. Kids get sick and need medicine, or ER/hospital care, or regular visits to the doctor. I can't gamble and not have them properly insured. I've had a kid in the hospital before, and even with insurance it's a struggle to pay those bills. So yes, healthcare costs much more than a smartphone.

 

[tigress]

Where is it written that physicians have to be in medicine for the "greater good?" What does that even mean?

Isn't it theoretically part of the fundamental principals of medical bioethics--Autonomy and Justice? I suppose not specifically "for the greater good," but there is the concept that one must benefit your patients and take the whole community into account. If it were true that concierge practice only benefits the physician (which I do not think is the case), one could argue that it is ethically inappropriate.

Autonomy: respect for the individual and his ability to make his own decisions

Beneficence: physicians are obligated to benefit the patient or others

Non-maleficence: actions should not harm or bring harm to patients

Justice: physicians must consider "fairness" to the community when considering the consequences of an action

 

[cbrons]

Isn't it theoretically part of the fundamental principals of medical bioethics--Autonomy and Justice? I suppose not specifically "for the greater good," but there is the concept that one must benefit your patients and take the whole community into account. If it were true that concierge practice only benefits the physician (which I do not think is the case), one could argue that it is ethically inappropriate.

Lemme stop you right there. If it were true that concierge & cash-only practice only benefit the physician, there would be no market for concierge & cash-only practice and said models would not exist.

 

[tigress]

Lemme stop you right there. If it were true that concierge & cash-only practice only benefit the physician, there would be no market for concierge & cash-only practice and said models would not exist.

Yeah, I agree. Just responding to the previous:

Where is it written that physicians have to be in medicine for the "greater good?" What does that even mean?

I was responding to another poster who was asking if anyone actually benefited from this kind of a setup, and never said anything about physicians being altruistic. I simply do not think that patients benefit from concierge medicine, and only a few physicians would ever be able to. I stated twice however, that I was all for PCP's making cash over this.

 

[alwaysaangel]

Am I the only one here who thinks that from a patient perspective, this plus a disaster insurance plan looks like a good deal? It's cheaper than most insurance plans (so is paying out of pocket per visit). Oh, and all of my pre-existing conditions (asthma, allergies) are treated through primary care. Obviously this won't be true for everyone.

I think you're slightly misunderstanding how concierge medicine works. You pay the $1000/year for the privilege of seeing that doctor. It doesn't pay for your visits. You need insurance or to pay cash for services rendered ON TOP of the annual fee.

The best argument I've heard for concierge medicine was from an FM doctor who had gotten to the point where he had to see 80 patients per day to make a reasonable salary ($100k/year). Reimbursement had just become ridiculous. He was unsatisfied with seeing each patient in 5 min so he became a concierge doc. Howevere, it was extremely reasonable. As I recall it was like 350/year. Just enough so that he could have fewer patients and spend more time with each and still cover his expenses. Made a lot of sense in that setting.

 

[cbrons]

I think you're slightly misunderstanding how concierge medicine works. You pay the $1000/year for the privilege of seeing that doctor. It doesn't pay for your visits. You need insurance or to pay cash for services rendered ON TOP of the annual fee.

No, the retainer fee almost always covers unlimited routine checkups. You do not have to pay anything on-top of that annual fee for just talking or going to see the doctor unless you get special procedures/labs/whatever ordered that aren't included (and some things are included in the annual price).

The whole purpose of C-medicine is to avoid the headache of dealing with 3rd-parties (private insurance, government insurance). So, a typical patient would pay an annual fee and probably purchase a so-called "catastrophic" insurance policy.

 

[alwaysaangel]

No, the retainer fee almost always covers unlimited routine checkups. You do not have to pay anything on-top of that annual fee for just talking or going to see the doctor unless you get special procedures/labs/whatever ordered that aren't included (and some things are included in the annual price).

The whole purpose of C-medicine is to avoid the headache of dealing with 3rd-parties (private insurance, government insurance). So, a typical patient would pay an annual fee and probably purchase a so-called "catastrophic" insurance policy.

Must vary based ondoc and location. All the concierge docs I've seen are the annual retainer on top of insurance/cash for services.

Although, I guess it makes sense that many of the more expensive ones (eg$5000+ per year) would include services.

All the ones I've seen were $500-$1000/year.

 

[tigress]

Must vary based ondoc and location. All the concierge docs I've seen are the annual retainer on top of insurance/cash for services.

Although, I guess it makes sense that many of the more expensive ones (eg$5000+ per year) would include services.

All the ones I've seen were $500-$1000/year.

The ones I have known actually filed insurance for visits. This is both in Philadelphia and where I currently live in South Carolina. The annual retainer gives the patient the privilege of long visits and some outside work by the doctor (maybe communicating with specialists about med lists or similar). I don't remember if the woman I knew in PA still had people paying copays for visits or if she just billed insurance (she was in family practice and did a lot of OB). I'm sure the details must vary by location and practice, but this is what I've come across.