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$350 per year to remain a patient?
Old 10-16-2008, 11:49 AM   #1
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$350 per year to remain a patient?

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
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Old 10-16-2008, 12:11 PM   #2
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Yes, it's called concierge care. If you really like him you may want to spend the $350 -- what do you get for it? Besides the privilege of calling for an appointment?

If that's it, I suggest it's time to look for a new physician -- many will do a 15 minutes meet and greet so you can get a sense of the person.

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Old 10-16-2008, 12:16 PM   #3
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Yes, it's called concierge care. If you really like him you may want to spend the $350 -- what do you get for it? Besides the privilege of calling for an appointment?

-- Rita
As near as I can tell, nothing would change, except there was some mention of a lecture series on nutrition and fitness we'd be welcome to attend.
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Old 10-16-2008, 12:17 PM   #4
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Yeah, well, it's possible your health plan also covers nutritional counseling. I'd be shopping for a new doc. This kind of stuff irks me.

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Old 10-16-2008, 12:21 PM   #5
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Shop to be sure you can get another primary care doctor first. It is true that they do not make that much money; fewer young doctors have gone into this practice. I have read that some people could not get health care, even though they have good insurance. Reason: failure to get a primary care doctor in order to get referral to see a specialist.

I have told my wife we need to go get our annual exam religiously, just so that our primary care doctor does not throw our files away!!!
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Old 10-16-2008, 12:22 PM   #6
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My dads doctor did the same thing several years back but the amount was $600 and the guarantee was that the number of patients was limited so you would have better access. Dad died before we had to pony up but I think we would have gone for it.
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Old 10-16-2008, 12:32 PM   #7
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It's increasingly common. In the old days it would have been considered tacky, greedy, and unprofessional. Now it's about economic survival. Remembering that this refers to primary care (pediatrics, general internal medicine, and family medicine):
  • expense up every year very significantly
  • lowest pay scale to begin with
  • inability ot set your own fees, since most are not determined contractually or via federal programs
  • big debt
  • big liability and stress, long hours
  • no supplemental income from labs, x-ray, etc in most cases.
  • tons of paper work not related to direct patient care
So you go for what the lawyers call a retainer. In its full version, it's concierge medicine, a marketing ploy where you charge heavy annual fees ($1500) and provide shorter waiting time and better hours, housecalls if needed, some "Free" preventive counselling services, and a fancy office.

A sign of the times. Fewer med school grads are choosing primary care careers even as demand is rising explosively from aging boomers. It's a crisis. Were I in private practice, I might be considering it myself.
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Old 10-16-2008, 01:27 PM   #8
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So you go for what the lawyers call a retainer.
Rich, isn't a lawyer's retainer applied against future charges? This sounds more like a club membership.

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Old 10-16-2008, 01:47 PM   #9
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This is not new - I read a story about it. Doctors are liminting the number of patients they have and charging a annual fee to cover overhead.
search the internet - you might find some info on it.
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Old 10-16-2008, 01:56 PM   #10
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i'm in the boonies, so "sssshhhhhhh" - don't spread the word!
that sounds akin to the annual tab fee for dinners (eaten or not) that the local golf country club charges. i am not a member.
i have seen sign posted re: a $25 charge for old fashioned insurance claim form processing. not sure if that's kosher. but i don't have to pay it with my particular insurance company.
plus my doc's office is now enforcing the 24 hr cancellation policy for no-shows. i'm glad to see that happen.
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Old 10-16-2008, 01:57 PM   #11
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I had it happen to me a while back and started a thread about it:
Bummed about Having to get a New Dr

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Old 10-16-2008, 02:04 PM   #12
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A doc around here did it. He was on TV every Monday for "Ask Dr. Doug," and that made him look good, so he followed up by going to the concierge thing.

My doc is super good in that he really spends time with you, listens, doesn't make you feel rushed. OTOH, I'm just not impressed with his knowledge or decisions.

Four times he's sent me to a specialist, who has shown his initial impression to be wrong. For example, he thought something in my ear was some kind of "process," as in tumor. It was just surfer's ear.
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Old 10-16-2008, 02:08 PM   #13
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I know only a few physicians and nurses as friends, but all of them are caring people who truly are in their field because they want to help others. And I think the health insurance industry is probably the root cause of overly expensive health care.

BUT

doesn't my insurance company negotiate with its providers about what they are allowed to charge? Wouldn't a separate charge by the doctor for "concierge services" violate those contracts? Don't all doctors have the same expenses and have the same continuing education requirements? If those are acceptable, why couldn't my doctor just send me a supplemental bill every time I go see her and claim it's for office magazines or clerical uniforms or file folders or energy costs? She can't because she's agreed in advance to what she can charge.

When we get an insurance statement following a medical procedure, it clearly spells out what the doctor/hospital/whatever is allowed to charge and cautions us not to pay anything beyond that.

Maybe the OP's doctor has negotiated different contracts with insurance providers for his practice, but I would be finding a new doctor just because I would worry that the doctor would be billing me extra for everything and hadn't been giving me the best care previously without the "concierge service"....
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Old 10-16-2008, 02:25 PM   #14
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Here in Anchorage, when you hit 65, you can only get primary care from the "free clinic". Most, if not all, primary care doctors here drop you when you get on Medicare, and absolutely none are taking new over-65ers.
So I agree, make sure you have an alternative set up before you drop your doctor.
I remember seeing an article about similar situations in Oregon and California last month in AARP but I can't find it online.
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Old 10-16-2008, 02:26 PM   #15
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Here's page 1 of the cover letter...the wording on the second page makes it clear that it's not a request, but a mandatory payment to remain a patient. In the next reply I'll post the "Benefits" page....

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Old 10-16-2008, 02:26 PM   #16
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Rich, isn't a lawyer's retainer applied against future charges? This sounds more like a club membership.
You may be right, Coach, not sure. In this case it's more of a membership fee for access to the practice.

But you made me curious. If you retain a lawyer for $10K per year and only use $6k of services, what happens to the difference? I would have guessed that you kiss it goodbye.
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Old 10-16-2008, 02:27 PM   #17
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Here are the "benefits" of club membership (max 14 day email replies!):

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Old 10-16-2008, 02:33 PM   #18
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doesn't my insurance company negotiate with its providers about what they are allowed to charge? Wouldn't a separate charge by the doctor for "concierge services" violate those contracts? ..
Not quite. Carriers and Medicare can only enforce fees for covered services, those which they reimburse. If I happen to sell you a nice pair of shoes while you are waiting in my waiting room, carriers have no "jurisdiction" over the price.

Practice Membership Fees are not considered a covered service and thus circumvent such restrictions. When I used to make house calls, Medicare did not cover my transportation time. I charged patients for that, over and above the actual visit since it was a significant commitment of my time. They paid out of pocket, and I was able to break even on house calls (like that's some kind of victory -- at least they didn't cost me money).
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Old 10-16-2008, 02:39 PM   #19
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"I will be asking each of you to begin paying an annual fee..."

This is really wishy-washy wording is it not? If the Doc means "I will require you to pay me $350 annually to remain my patient" why not say so? And if the patient can "begin" paying the fee by paying $1.00 in Jan 2009, has he not complied with the wording in the letter?

This money grab disgusts me as a consumer. Reminds me of a new stadium selling "seat licenses" which allow you to then purchase a season ticket at regular prices!
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Old 10-16-2008, 02:49 PM   #20
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"I will be asking each of you to begin paying an annual fee..."

This is really wishy-washy wording is it not? If the Doc means "I will require you to pay me $350 annually to remain my patient" why not say so? And if the patient can "begin" paying the fee by paying $1.00 in Jan 2009, has he not complied with the wording in the letter?

This money grab disgusts me as a consumer. Reminds me of a new stadium selling "seat licenses" which allow you to then purchase a season ticket at regular prices!
As I said above, the second page of his cover letter makes it clear that if you don't apply and submit your $350 check by Jan 1 you won't be seen. The packet also included a list of other local primary care docs, and gave the name of a gal in his office who will assist with transitions to the new docs...
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