Concierge Psychiatry?

[prominence]

Has anybody come across any successful psychiatric private practices that utilize the "Concierge/Boutique Model" (i.e. pt pays retainer fee of $1500-2000 upfront at beginning of the year to cover annual expenses & psychiatrist limits practice to about 300 total patients)?

What regions of the country or cities could such a practice possibly succeed in?

Any thoughts on such a model in psychiatry?

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[notdeadyet]

Has anybody come across any successful psychiatric private practices that utilize the "Concierge/Boutique Model" (i.e. pt pays retainer fee of $1500-2000 upfront at beginning of the year to cover annual expenses & psychiatrist limits practice to about 300 total patients)?

I would think an "all-you-can-eat" psychiatry practice would attract the wrong sort of patient and would have the potential to be a fatal business model, no?

 

[OldPsychDoc]

Any thoughts on such a model in psychiatry?

It sounds like a recipe for the patient calling the shots--e.g. "I don't care what YOU think I need--I paid my dues in January, and I want that Xanax prescription NOW."

 

[BobA]

Easier to just do cash-only

 

[Doc Samson]

Easier to just do cash-only

More lucrative too.

 

[dianamd]

agreeing with the above - do cash only.

Part of the draw of concierge medicine is that the patients don't have to wait, get a lot of time with the dr., etc. however, with psych, you can schedule as needed, patients don't really wait, and so some of the benefits of concierge medicine (the patients' benefits) don't translate completely to psych.

 

[masterofmonkeys]

Agree with everyone else. i don't see the benefit of concierge psych as opposed to cash only practices.

That said, I was interviewed by a faculty member at Cornell who basically has a partial concierge model. Some of his patients who no longer need to see him weekly but occasionally have 'crises' keep him on retainer. He even travels across the country or internationally to see them.

 

[billypilgrim37]

Some of his patients who no longer need to see him weekly but occasionally have 'crises' keep him on retainer.

I have to admit I am WHOLLY uninterested in the psychopathology of someone who is so high functioning they can afford to keep a Cornell psychiatrist on retainer.

Or maybe I'm just jealous. I'll have to go see MoM someday to find out. 😉

 

[Manicsleep]

Was thinking about the 250k thread as a psychiatrist and had considered concierge psychiatry. The alternative posited here is the cash model.

There are problems with concierge psychiatry.

1) The drug seeking patient. I think setting boundaries early and consistently will drive this away. It does with concierge medicine. Access to xanax or stimulants is not a reason for concierge medicine. It is access to excellent psychiatric care.

2) The needy patient. I think this will be solved with excellent care as well as negative reinforcement with fees involved with the contacts. Also, a provision regarding overuse in the contract. The needy patient is needy because they are ill and this can be treated.

The positives:

1) More patients than the cash model. Many patients want to use their insurance fully (they want you to be on their panel) and get the extra benefits by paying less out of pocket if possible. Lets face it, cash practices are great but they aren't possible everywhere, especially when you are in a multispecialty group or even a small group in a large city.

2) Fewer total patients. With a cash model you still have to see all the patients, all the time. With the retainer model, its in your interest to keep the patients as healthy as possible. So if you see them 3 times a year or 10 times a year, your income only changes minimally from the insurance.

3) Job satisfaction and patient satisfaction. You get to do everything your way and treat the patient optimally. I have a concierge FP for my family including our parents and it is really great.

4) Preparation for Tier 2 and beyond. This is probably going to happen anyways whether we like it or not. With the increase in mid levels, universal health care and all the other things I won't mention, the second tier is coming to America.

 

[honsano]

Question: I keep reading about cash-only being lucrative. Is this so because A) it will be illegally treated as tax-free/undocumented income
B)provide greater reimbursement than insurerance companies themselves
C)none of the above (please insert answer here)
D)a lil' bit of A with a lil' bit of B

Thanks in advance guys

 

[Manicsleep]

B. Definitely.

Also, you don't have to pay for the overhead of billing and other insurance garbage which is said to be approx 40% of costs.

 

[honsano]

Thank you manic. That makes sense. Glad to hear there isn't frequent tax evasion on this forum.

 

[digitlnoize]

Thank you manic. That makes sense. Glad to hear there isn't frequent tax evasion on this forum.

Cash only doesn't really mean cash only. A better term might be out of pocket. Most places take credit cards at least...

 

[MellowYellowCA]

Question: I keep reading about cash-only being lucrative. Is this so because A) it will be illegally treated as tax-free/undocumented income
B)provide greater reimbursement than insurerance companies themselves
C)none of the above (please insert answer here)
D)a lil' bit of A with a lil' bit of B

Thanks in advance guys

Thank you for asking this, I was wondering the same thing.

Several people have said "cash only" is the most lucrative - did everyone just "out of pocket" (which includes credit card, checks, etc)

What is the benefit of cash only vs all other forms of out of pocket (only asking what is legal)?

Can any physician really say "cash only" to their patients in private practice? It seems to me that the patient would think the practitioner is being tricky or dishonest, no?

I am aware that many many small businesses do say "cash only" or give incentives for paying in cash (no extra credit card fee, 5% discount, etc), but I haven't yet seen this is healthcare, possibly because I have never visited a small private practice medical office??

 

[kugel]

There is a slightly different option:

There are credit accounts specifically for healthcare.
Sort of like a credit card, but it is only valid for payment of healthcare costs to the providers who have signed up as vendors.

You sign up with such an entity, like CareCredit.com, and then you can tell your patients that they have to have a valid account to see you on an ongoing basis. They deal with collections and payment plans, etc. so you don't have to. You just see the patient and swipe the card. As long as the charge is approved, you are good to go.

http://money.blogs.time.com/2010/09/01/what-the-heck-is-a-health-care-credit-card/

You probably have to give up some percentage of your fee (6-8%?), but it means you never have to discuss "I really need to see you but my water heater burst last week and . . ." or "I know you want to see me before you give me a refill, but I don't have the cash for an office visit. Can't you just give the refill and I'll see you in 3 months. I promise, everything is fine."

I have absolutely no experience with these things, so please don't take this as an endorsement or encouragement. Just another option.

 

[michaelrack]

Thank you for asking this, I was wondering the same thing.

Several people have said "cash only" is the most lucrative - did everyone just "out of pocket" (which includes credit card, checks, etc)

What is the benefit of cash only vs all other forms of out of pocket (only asking what is legal)?

Can any physician really say "cash only" to their patients in private practice? It seems to me that the patient would think the practitioner is being tricky or dishonest, no?

I am aware that many many small businesses do say "cash only" or give incentives for paying in cash (no extra credit card fee, 5% discount, etc), but I haven't yet seen this is healthcare, possibly because I have never visited a small private practice medical office??

Checks are accepted by essentially all practices, and most are also set up to accept credit/debit cards.

If any of my patients wanted to make their payments in gold/silver (easily identified forms, such as US coins or 10 oz silver bars, NOT jewelry) I would be ok with that and would value the gold/silver at the current spot price (and would report that amount as income to the IRS)

 

[Manicsleep]

If any of my patients wanted to make their payments in gold/silver (easily identified forms, such as US coins or 10 oz silver bars, NOT jewelry) I would be ok with that and would value the gold/silver at the current spot price (and would report that amount as income to the IRS)

Then he melts it down and makes chains and rims.

 

[michaelrack]

Then he melts it down and makes chains and rims.

I am stockpiling physical silver (not obtained from patients 🙂) for the day when the dollar is worthless.

I am also speculating/investing in Gold and silver ETF's and precious metal/mining mutual funds.

 

[Manicsleep]

I was just kidding. I was surprised that you were taking commodities from patients however.

On another note, your practice must be doing very well. Stockpiling just sounds impressive, I picture mounds of precious metals in a cave in Mississippi. I bought some commodities early on and did well although I have stopped for a while now because I think we are in a bubble. But thats a discussion for a different forum.

 

[michaelrack]

I was just kidding. I was surprised that you were taking commodities from patients however.

On another note, your practice must be doing very well. Stockpiling just sounds impressive, I picture mounds of precious metals in a cave in Mississippi. I bought some commodities early on and did well although I have stopped for a while now because I think we are in a bubble. But thats a discussion for a different forum.

so far no patients have offered my gold/silver, and I doubt they will. I was kind of joking, but would welcome it if a pt offered..

I bought, over several months, approx 300 ounces of silver earlier in the year (approx $5,500 at the time). I also have a lot of silver that I got much earlier in life from relatives (who hoarded it when US coinage was debased in '64). I don't actually have any physical gold.

 

[nancysinatra]

I love the idea of patients paying with gold or silver bullion, though I personally would prefer palladium. Being paid in commodities guarantees a very high functioning clientele and a haven from malingering and disability requests. Never again will I have to write "malodorous" in my MSE!

(One potential problem with this scheme is that if someone told me they had bars of gold at home and wanted to pay with them, I would probably be tempted to think "delusional d/o" and my differential might get all skewed.)

What about being paid in other tradables like art (for the more cosmopolitan patient) or large stocks of wheat (in more rural areas)? I'm not talking about gifts but say you had a psychoanalytic concierge service priced out 5-10 years at a time or something along those lines where the price was so high no one would have that kind of cash sitting around--then would it be acceptable to take a form of payment besides insurance, out of pocket, or precious metals? Anyway, where should the line be drawn? I know this is off topic but it very interesting!

Is foreign currency ok? A money order? Wiring a payment or direct monthly payments like I use to pay my electric bill? Paying with only pennies? Canadian coins? Can a psychiatrist have a "bill" slot in their office door for people to drop by with like my landlord does?

 

[nancysinatra]

I was just kidding. I was surprised that you were taking commodities from patients however.

On another note, your practice must be doing very well. Stockpiling just sounds impressive, I picture mounds of precious metals in a cave in Mississippi. I bought some commodities early on and did well although I have stopped for a while now because I think we are in a bubble. But thats a discussion for a different forum.

Continue the discussion here! Continue it here! It's either that or yet another "how much money can I make if I see 6 med check patients per hour?" type discussion takes over.

At the end of medical school our financial aid office set us up with a talk from a financial advising company. They handed out a pamphlet called "investing in your future." It was all about 401Ks and mutual funds. It was so boring. I was hoping we'd learn about stockpiling gold or silver, or how to get in on the art or antiquities market, or how to become established as a real estate tycoon.

Of course, it's two years later and I have the 401k plan.

 

[Sneezing]

Guns seldom, if ever depreciate, and will either retain their value or appreciate. Plus, if the economy ever collapses to the point where commodities would be freely traded again, chances are you'll need guns. This is why there is currently an ammo shortage and guns have been purchased in larger quantities since Obama came into office.

When I open a private practice in a few years I will accept barter. Why not?

 

[billypilgrim37]

Vintage guitars never lose a dime. I have bass guitars from the 70s that I bought for under 500 bucks in high school that are now worth 2-3k a piece. I want to go back in time and kick myself for all of the under-500 dollar Les Pauls I could have bought in the mid-90s that would now go for 3x that.

 

[Manicsleep]

Guns, Guitars and Gold.

The follow up to guns, germs and steel? More alliterative as well.


UGH, i cant sleep.