How viable is a concierge tele psychiatry practice?

[the5thelement]

If you dont take any insurance and charge patients $100 a month. I want to take the plunge!

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[Psychresy]

$100/month? What would they get for this monthly rate? At face value seems way too low for me.

 

[birchswing]

I'm assuming the $100 is on top of office visits?

 

[the5thelement]

This doctor charges less than that - $50 a month.

Payment – Lorien Psychiatry

Please read the Become A Patient page for more information on how getting treatment at Lorien Psychiatry works. We only have one plan, but we charge three different prices for it. Please check below to see which is most appropriate for you, then click one of the buttons below to sign up. You'll...

lorienpsych.com

 

[Bartelby]

Interesting. If you try it keep us updated.

On its face this does not seem like a workable business model. That site lists $50 per month for one visit but with unlimited crisis visits, it seems they are really focused on serving the underserved in a charitable way rather than starting a business that can offer the psychiatrist a competitive salary / lifestyle.

 

[Psychresy]

This doctor charges less than that - $50 a month.

Payment – Lorien Psychiatry

Please read the Become A Patient page for more information on how getting treatment at Lorien Psychiatry works. We only have one plan, but we charge three different prices for it. Please check below to see which is most appropriate for you, then click one of the buttons below to sign up. You'll...

lorienpsych.com

So for $600/year that guy does a 40 minute intake and a guaranteed 11 20-minute monthly appointments (if desired), unlimited email messaging, unlimited "urgent" appointments in times of crisis.

He has a medication tab on his website that lists ketamine, adderall, "ssris", and wellbutrin. Like are these the only medicines he uses?

Something about this doesn't feel right. Or as mentioned above, this is a social warrior project serving the underserved and this individual is not looking to turn a profit.

 

[Trismegistus4]

So for $600/year that guy does a 40 minute intake and a guaranteed 11 20-minute monthly appointments (if desired), unlimited email messaging, unlimited "urgent" appointments in times of crisis.

He has a medication tab on his website that lists ketamine, adderall, "ssris", and wellbutrin. Like are these the only medicines he uses?

Something about this doesn't feel right. Or as mentioned above, this is a social warrior project serving the underserved and this individual is not looking to turn a profit.

This is the guy behind the erstwhile Slate Star Codex blog, who fretted about being doxed by the New York Times, then switched to writing on Substack as Astral Codex Ten. Definitely a weird guy.

 

[trophyhusband]

If you dont take any insurance and charge patients $100 a month. I want to take the plunge!

The wife considered a concierge practice for a bit (not all telemed) and we couldn't really figure out a good reason to do it over cash pay FFS. It's easier to control people's behavior when they know that you'll charge them for lengthy phone calls outside of appointments and whatnot.

 

[sloh]

This is the guy behind the erstwhile Slate Star Codex blog, who fretted about being doxed by the New York Times, then switched to writing on Substack as Astral Codex Ten. Definitely a weird guy.

I'm curious what your thoughts are on his posts related to psychiatry? Any other psychiatrists here that read his blog can also chime in.

 

[Celexa]

I genuinely cannot think of a reason in psychiatry to do this over straight cash pay. If anyone has an argument for it (with numbers) I'd love to hear it.

 

[Endee]

Sounds like they're just trying to convert the monthly fee DPC model to psychiatry which already has a reliable cash pay model.

 

[dl2dp2]

There's a product-market fit issue.

$100 a month psychiatry has no product-market fit. People who want that type of service are already absorbed by the social-media-NP-crowd.

You want to charge $1000+ a month for doing things that the market actually wants.

 

[michaelrack]

It looks like the Lorien psychiatry doc is mainly transferring his existing patients to the concierge practice, and experimenting with the model. He's going to need raise his rates if he sticks with it

 

[calvnandhobbs68]

There's a product-market fit issue.

$100 a month psychiatry has no product-market fit. People who want that type of service are already absorbed by the social-media-NP-crowd.

You want to charge $1000+ a month for doing things that the market actually wants.

The other issue is that the work/time ratio just doesn't work out. You can already charge people $175 for a followup visit every 1-2 months and they pay it no problem without trying to offer "unlimited messaging" and stuff like that that's terrible for your lifestyle. In psychiatry you'll definitely have patients who take advantage of the "unlimited" provider availability without being charged for this.

This works better for PCPs because they charge people 100 bucks a month to see them a couple times a year. Very few people really WANT to go to their PCP that often especially in the <65yo (non-Medicare) crowd, so they make money because they end up charging people $1200 bucks a year to see them for an annual physical and a few sick visits throughout the year. I mean even if they see them every couple months (which is pretty frequent for primary care), you're still netting $200 cash/15-30 min visit. Not so in psychiatry....I'm sure I have patients that if I offered them visits every week without them having to pay for it, they'd take it in a heartbeat.

 

[calvnandhobbs68]

I've never heard of such a cheap concierge PCP practice.

My PCP converted to half concierge/half regular for a while (except that I'm sure half his panel didn't switch over--just that he offered both). It was $6,000 a year and that was *not* for office visits. You still used your regular insurance and had all your regular expenses. It was for the convenience of them doing all the things you would have expected them to do to begin with, like a same day appointment if you're sick, returning a phone call, etc. But he maintained a two-tiered system. I stayed in the non-paying tier. He dropped it, I assume, because no one was falling for it.

There was another one in town that offered something at an even higher cost but with that cost they did, in addition to the regular cost of visits, extensive testing and exercise assessments, etc. (I can't remember exactly but probably something like VO2 max, nutritional deficiencies, etc.) And then again, the idea that you could get in faster. Basically like a fast pass at an amusement park. But it did not cover the actual visits.

Literally the first two PCP concerige practices near me I google are 199/month for the more expensive one and 115-150/month for the less expensive one based on age.

 

[nexus73]

$100 per month works for pcps because a lot of stuff is super low acuity and not time consuming. Like, I think have a uti, ok check ua at lab and send Bactrim rx if needed. Or my blood pressure has been running high the last 2 months, ok increase lisinopril to 10 mg. Psych requires way too much time and patients will overuse you for $100/month.

 

[clausewitz2]

Scott Alexander makes mid six-figures from his Substack and lives in a group house with 8-10 people. He is explicit about how concierge practice as trying to make his services as financially accessible as possible. He is not setting his rates that low because he really needs the money.

 

[Merovinge]

Agree with above, there already is concierge psychiatry and it's called cash pay psychiatry. People paying high cash rates expect rapid response and emergency appointments and most MD's in this world provide a very elevated level of care as they need less billable hours and less overall patients to make a good living.

Subscription models are essentially hoping for people to sign up and then not cancel them (e.g. gyms) or have little to no marginal cost (e.g netflix). They can make some sense in the PCP world where the need for care can be intermittent and docs try to cultivate a practice of low utilizing patients who still pay monthly. I don't see this benefitting in psychiatry where patients are seen on a regular basis.

What would you be offering that traditional cash pay psychiatrists do not and how does this meet a market demand?