Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 10-16-2008, 10:45 PM   #41
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by growing_older View Post
Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.
The average panel size for internal medicine is around 1500. A concierge practice often reduces that to 500-1000 if I recall. There are some family medicine practices that approach 3000 but that often includes kids who require only a 5 minute ear check, etc.

A primary doctor struggling to make 6 figures and working his or her butt off looks at a $350 annual fee, slashes the practice in half, and can net $200k with little struggle. It's not hard to see why this concept is becoming more common.

BTW, aside from these fees, typical primary practices net about 45% of gross revenues.
__________________

__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 10-16-2008, 10:48 PM   #42
Thinks s/he gets paid by the post
Gotadimple's Avatar
 
Join Date: Feb 2007
Posts: 1,760
Quote:
Originally Posted by NW-Bound View Post
I don't know how many patients he is keeping, or what his expenses are, but I know not to judge too quickly. As an engineer, I knew my employers charged a whole lot more to their clients on contract jobs than what they paid me.

Then, when I joined a business venture, I finally understood when I was ultimately involved in writing checks to pay bills. Rent, insurance, utility, attorney and accountant fees, so many things I took for granted before. After working hard for 6 years, we folded. So, it is not what you take in, it's what you get to keep.
Well, you've certainly identified the doctor's income. But what about his/her expenses? Malpractice insurance is not cheap, and then there are the expenses of the office and the medical equipment in it.

Doctors in solo practice don't have the same economies of scale as doctors with multiple physicians practicing together. It's not cheap to deliver medical care in the US -- and as others have noted, sometimes what is delivered isn't good care.

Its our health care gordian knot.

-- Rita
__________________

__________________
Only got A dimple, would have preferred 2!
Gotadimple is offline   Reply With Quote
Old 10-16-2008, 11:40 PM   #43
Thinks s/he gets paid by the post
growing_older's Avatar
 
Join Date: Jun 2007
Posts: 2,608
Regardless of the doctor's expenses, the new fee is completely new income with only the expense of billing (letter writing) for it. All the overhead of office space, receptionist, medical supplies, insurance and so on are still the same as they were before adding this fee.

I used the numbers from the earlier post that claimed typical doctors see 3,000 - 4,000 patients in their practice. Even allowing for the more accurate lower numbers you cite, it's still a substantial amount of income for very little cost (minimal billing, office staff you already had to ask questions, no additional insurance needed, etc)
__________________
growing_older is offline   Reply With Quote
Old 10-16-2008, 11:51 PM   #44
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 19,391
As R-I-T pointed out as an insider, this doctor may be increasing his pay to $200K from the low $100K. He is of course making more money with this move, but not to the outrageous level as it first appears. And perhaps he will be able to spend a bit more time per visit, and be able to accomodate his patient urgent appointments better.

I guess what I am saying is that perhaps this doctor is good at what he does to justify this high fee. If I were him, I would try to sweeten the deal a bit by giving rebate for the annual exam, etc...

We are in our early 50's and still healthy, so our doctor makes little money from us. As I mentioned in an earlier post, we made the point to see him once a year, so he won't throw our file away. On the other hand, he is seeing a lot of Medicare patients, and I heard that pays even less. I don't envy his job.
__________________
NW-Bound is offline   Reply With Quote
Old 10-17-2008, 12:58 AM   #45
gone traveling
 
Join Date: May 2008
Posts: 3,864
If you think health care is expensive now, wait until it is free...
__________________
Westernskies is offline   Reply With Quote
Old 10-17-2008, 06:59 AM   #46
Thinks s/he gets paid by the post
jIMOh's Avatar
 
Join Date: Apr 2007
Location: Milford, OH
Posts: 2,085
Quote:
Originally Posted by Cb View Post
I just received a remarkable notice from my primary care doc.

This guy came highly recommended by a company physician years ago, and I've been very pleased with him since becoming a patient. In the years since I've convinced numerous family members to switch to him, and they've all been pleased as well.

A few years ago he was selected and profiled as one of the "Best Doctors in Cincinnati" in a local glossy magazine and has since made the list repeatedly. We're quite friendly - he was especially intrigued by my early retirement, and talked about how difficult it'd be for him, with his med school debt and ever-lower reimbursements, etc. He said he really could have used the Best Doc's thing years ago when he was trying to grow his practice. Shortly after making the list the first time he stopped accepting new patients himself, sending then to his younger partner instead.

Well, it appears he's on his way now, because he just sent all of his patients a big envelope with a cover letter describing all the time he spends on non-reimbursed administrative activities such as completing forms for school activities, life insurance applications, sick notes for schools & employers, Rx's & refills not accompanied by a paid appointment, etc.

His solution is to have all his patients complete the enclosed application to stay with him after Jan 1, 2009, and pay an annual advance fee of $350 per person. He's encouraged patients to apply early, as room will be limited. The $350 doesn't apply to any subsequent treatments or services, it's just a flat advance annual 'membership' fee.

Seems to me the guy has found a way to capitalize on the Best Docs in Cincy publicity, rake in and extra $350 ea. annually from his deeper-pocketed patients, and ditch the high-maintenance nuisances, whether they're willing to pony up the $350 or not.

Ever heard of anything like that?

Cb
I live in cincy too and have heard of other doctors doing this. Mine has not... but I also haven't seen my doc for 2-3 years.
__________________
Light travels faster than sound. That is why some people appear bright until you hear them speak. One person's stupidity is another person's job security.
jIMOh is offline   Reply With Quote
Old 10-17-2008, 07:30 AM   #47
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
donheff's Avatar
 
Join Date: Feb 2006
Location: Washington, DC
Posts: 8,634
Quote:
Originally Posted by Rich_in_Tampa View Post
A primary doctor struggling to make 6 figures and working his or her butt off looks at a $350 annual fee, slashes the practice in half, and can net $200k with little struggle. It's not hard to see why this concept is becoming more common.
I would be willing to pay this for a very good doctor who made it easy to reach him/her, took time at the appointment to really deal with you, etc., and continued to honor my insurance for the actual medical work. DW had a doctor who provided that kind of service (without the concierge fee) but was not a participating provider in BC/BS. I went for a while and liked him but was not impressed that he knew more than other doc. I switched to a nearby doc who has a mixed medicare/medicaid and regular paying practice. Dealing with the practice staff for appointments and refills is a PITA but he is very good and participates in my insurance plan. It is worth the hassle.
__________________
Every man is, or hopes to be, an Idler. -- Samuel Johnson
donheff is offline   Reply With Quote
Old 10-17-2008, 08:19 AM   #48
Thinks s/he gets paid by the post
Rambler's Avatar
 
Join Date: Jul 2007
Posts: 2,243
I think a major problem is that the insurers spend so much time, money, and effort figuring out how to not pay reasonable claims on the one hand, and beating up the poor docs on the other hand, that the only real winners seem to be the insurance companies. For example, my DW does not work and therefore has insurance only thru my employment/insurance provider. We are pretty healthy, so she typically only sees the doc for her annual exam, and maybe one a year when her allergies are bad. But, each time she goes, we get a letter from the insurance telling us that if we do not certify via their website that she does not have any other insurance within XXdays, they will not pay, and their obligation ends. My DW has not worked outside the home (maintaining a home for me and the kids IS work though) for the last 16 years and my reply to the insurance is always the same, but they are always asking. They also tend to decline payments for such services as blood tests and mammograms, if you don't get on their case (not always, but it happens frequently enough that I remember it happening too often). Its almost as though they automatically throw out a certain number or percentage of claims for denial, just to see if the denial will be contested. No contest means no pay, and then the patient either pays or the poor doc has to eat it.

So, if I knew I would stay relatively healthy and had the doc's full attention, had a catastrophic care/high deductible with a HSA, I would not mind paying a couple/few hundred dollars to secure access to good healthcare. On the other hand, it is hard to justify 12,000 or so for a couple per year for healthcare when you can only get a peremtory look down the throat and in the ears once a year when you have the sniffles. Kinda glad that the little bout I had earlier this year was here in asia where it didn't cost so much and I got good care, but for which I pay for via socialized medicine (the more you make the more you pay, and at a higher percentage of salary...this is mandatory here, even though I have insurance thru employer in the states).

Just my two cents.

R
__________________
Find Joy in the Journey...
Rambler is offline   Reply With Quote
Old 10-17-2008, 08:21 AM   #49
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by growing_older View Post
I used the numbers from the earlier post that claimed typical doctors see 3,000 - 4,000 patients in their practice. Even allowing for the more accurate lower numbers you cite, it's still a substantial amount of income for very little cost (minimal billing, office staff you already had to ask questions, no additional insurance needed, etc)
Maybe so. But from the doctors' perspective, the underlying "justification" is hours and hours of paperwork required by insurance companies, medicare, weekend call, non-paying patients who repeatedly return and must be cared for, etc. for which the doctor receives no income - zilch.

If you define health care as no different from any other small business, you will eventually see the principles acting in their own competitive interest. It's the free market at work: no one criticizes a dry cleaner from raising the price of cleaning a shirt to whatever the traffic will bear.

I find all the above scenarios to be unfortunate and have chosen my career path accordingly. But since health care is expected to be available to anyone (we can't and shouldn't deny it to anyone who is ill or injured) and since it is still stunningly expensive to get through college+med school+residency+delayed FIRE saving, doctors won't work for low salaries, and someone has to pay for it.

Universal coverage is a good start. National health care, I'm not so sure.
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 10-17-2008, 08:35 AM   #50
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Dawg52's Avatar
 
Join Date: Feb 2005
Location: Central MS/Orange Beach, AL
Posts: 7,432
Quote:
Originally Posted by shoe View Post
Personally, I think it's worth it. Think of it as a tip.
I ain't tipping a high paid doctor. If I ever get one of these letter's, I'm gonna tell him to shove it up his a$$.
__________________
Retired 3/31/2007@52
Full time wuss.......
Dawg52 is offline   Reply With Quote
Old 10-17-2008, 09:23 AM   #51
Thinks s/he gets paid by the post
Rustic23's Avatar
 
Join Date: Dec 2005
Location: Lake Livingston, Tx
Posts: 3,624
I just got the medicare bill for a Colonoscopy.
Doc charged $2,500. Medicare paid $400, I think TriCare paid about $200. I have not gotten the tricare statement yet.

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.
__________________
Rustic23 is offline   Reply With Quote
Old 10-17-2008, 09:32 AM   #52
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,612
Supply and demand, I guess. If particular doc is so highly sought that demand for his/her services outstrip the number of hours in the work day, might as well milk it.

Still, traditionally such a doc would simply stop accepting new patients. I guess this is the brave new world of capitalism and medicine.
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline   Reply With Quote
Old 10-17-2008, 09:38 AM   #53
Thinks s/he gets paid by the post
 
Join Date: Jan 2008
Posts: 2,020
Quote:
Originally Posted by Rich_in_Tampa View Post
If you define health care as no different from any other small business, you will eventually see the principles acting in their own competitive interest.
In light of that, one of the trends in retail is to fire your worst customers. A small percentage of customers cost retailers an inordinate amount of money. Sprint recently cancelled accounts for a handful (maybe 1,000?) customers that were a net negative.

Maybe one reason for the fee is that, in addition to getting some money to pay off those student loans, you end up with a client base that is, obviously, more willing to pay for service. This means you are able to drop the people that consistently go 90 days late on paying their bills, the complainers (I'm guessing that mental bias will shift once someone willfully pays $x and they'll start to assume they made the best possible decision), the people that were primarily after high-touch, low-profit services, etc.
__________________
Marquette is offline   Reply With Quote
Old 10-17-2008, 09:52 AM   #54
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by Marquette View Post
In light of that, one of the trends in retail is to fire your worst customers. A small percentage of customers cost retailers an inordinate amount of money. Sprint recently cancelled accounts for a handful (maybe 1,000?) customers that were a net negative..
As in any business open to all comers, 5% of the patients account for 90% of the maintenance - demanding, threatening, don't pay, drug seeking, doctor hopping all the time rather than sticking with the agreed-upon plan, calling after hours for routine refills, etc.

While patients are occasionally asked to find a new doctor, it is problematic. First, the reasons behind such behavior often relate to fear, vulnerability, the underlying illness, depression, loss of control, and displaced anger. Culturally, the profession tries to address those things as part of the patient's health so the threshoold for "giving up" is very high. Second, abandonment during an active illness is both unethical and legally dangerous even if due process is followed.

It's hard to predict how an annual fee would affect that. I guess you'll still have that small group of "problem patients," but they'll at least pay their bills. .
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 10-17-2008, 10:02 AM   #55
Thinks s/he gets paid by the post
growing_older's Avatar
 
Join Date: Jun 2007
Posts: 2,608
We have a pediatrician who is wonderful. He's been limiting his practice to no new patients for many years and if he instituted such a fee, I would gladly pay it.

If I were seeking a new doctor and I had to pay the concierge fee before I even got the know the doc or before I had a chance to see the kind of care that was delivered, I'd be pretty reluctant to do so. I've had to change doctors several times due to limits on who accepts what insurance plans and of all the doctors I've seen, I cannot think of one who would be worth such a fee. Maybe that means I need to look for another new one again and not settle for adequate.
__________________
growing_older is offline   Reply With Quote
Old 10-17-2008, 12:34 PM   #56
Thinks s/he gets paid by the post
Gotadimple's Avatar
 
Join Date: Feb 2007
Posts: 1,760
Quote:
Originally Posted by Rustic23 View Post

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.
Rustic, can you clarify this statement (in bold)? People drop insurance? or People drop doctors?

In the case of Medicare, the fee schedule is designed to cause a loss of income -- to be made up from patients who are on group or individual policies and are younger than Medicare age. The government expects industry to subsidize it's programs -- that includes the insurance companies who process the claims and answer the phones for Medicare beneficiaries. No one benefits in government administered health care programs (unless they're committing fraud!).

Physicians have a fee schedule of what they would really charge (called usual and customary) -- insurance companies negotiate a fee DOWN from the UCR because they are providing the physician with a stream of patients where payment is certain. Medicare, OTOH, is a take it or leave it proposition -- if you're a doctor and want to see Medicare patients, you take the fee schedule or you don't see them at all. Which is why many physician practices no longer see Medicare patients.

At any rate, I'd be interested in you clarifying your statement above.

-- Rita
__________________
Only got A dimple, would have preferred 2!
Gotadimple is offline   Reply With Quote
Old 10-17-2008, 12:38 PM   #57
Thinks s/he gets paid by the post
jIMOh's Avatar
 
Join Date: Apr 2007
Location: Milford, OH
Posts: 2,085
Quote:
Originally Posted by Rustic23 View Post
I just got the medicare bill for a Colonoscopy.
Doc charged $2,500. Medicare paid $400, I think TriCare paid about $200. I have not gotten the tricare statement yet.

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.
The biggest problem with healthcare is people want something (health care) and are NOT willing to pay for it.

I know of no other industry with as much price controls and middle men as health care. Maybe my gas and electric bill... maybe.
__________________
Light travels faster than sound. That is why some people appear bright until you hear them speak. One person's stupidity is another person's job security.
jIMOh is offline   Reply With Quote
Old 10-17-2008, 02:57 PM   #58
Thinks s/he gets paid by the post
Rustic23's Avatar
 
Join Date: Dec 2005
Location: Lake Livingston, Tx
Posts: 3,624
While I used a recent procedure which was covered under Medicare, in the past couple of years I have seen statements from Medicare and from a private insurance. In both cases the amount charged was greater than 50% of the amount the doctor accepted.

I doubt if any lay person not affiliated with the medical field could give you a true idea what a procedure actually cost. And, by that I mean what the client pays, not what the medical industry says they spend.

I have never seen your statement that Medicare fees are designed to force the doctors to operate at a loss in writing. Is there a reference for this? I am not looking for a p*ssing contest. Your post sounds well informed, I was just wondering what is the source. If it is true, then obviously a national medical care program along the lines of medicare is doomed from the start.
__________________
Rustic23 is offline   Reply With Quote
Old 10-17-2008, 06:32 PM   #59
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by Rustic23 View Post
I have never seen your statement that Medicare fees are designed to force the doctors to operate at a loss in writing. Is there a reference for this? I am not looking for a p*ssing contest. Your post sounds well informed, I was just wondering what is the source. If it is true, then obviously a national medical care program along the lines of medicare is doomed from the start.
I do not believe they are systematically designed to cause the provider to lose money, but there are many situations where that is the case. And of course, a breakeven situation is a losing situation due to overhead or the opportunity cost of additional time.

MC used to reimburse about $40 for a house call. A loser. $75 for a comprehensive office visit. A loser. Don't have the exact numbers but it was not rare for this to happen. A national program would have its challenges in that regard, agree.

But National Health Care isn't even remotely on anyone's agenda for the foreseeable future. Lets get everyone covered first, including the unemployed and indigent. Then we can work on tweaking the system.
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 10-17-2008, 06:49 PM   #60
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 19,391
Quote:
Originally Posted by Rich_in_Tampa View Post
MC used to reimburse about $40 for a house call. A loser. $75 for a comprehensive office visit. A loser.

Thanks for info. Until recently, when I stopped being covered by my employer's insurance, I did not bother to know about true medical cost. Not my problem!

Well, now that we are on $10K /annual deductible, I care, and really want to know how the system works.

You did not state the time for those numbers. However, I remember > 25 years ago, a Sears repairman charged me about that (or more?) for a house call. It was just to diagnose the problem, after which he gave me the part number to buy and replace myself.

And people always think all medical doctors are getting rich. Thanks goodness I am an engineer (not that I have ever had any interest or inclination in a medical training).
__________________

__________________
NW-Bound is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Hear is your Selfish TB patient................. Cut-Throat Health and Early Retirement 14 06-03-2007 10:34 PM

 

 
All times are GMT -6. The time now is 04:39 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.