Concierge Medicine

[kevink]

I'm curious to know if anyone here has experiences to share (positive or negative) with this fairly new model for doctor access. For those unfamiliar with the model, here's a good concise explanation:

"What Is Concierge Medicine?

Concierge Medicine is a form of membership in which doctors provide medical care to Patients generally providing 24/7 access, a cell phone number to connect directly with their physician, same-day appointments, visits that last as long as it takes to address their needs and varying other amenities. In exchange for this enhanced access and personal attention, the Concierge Doctor receives a fee (most fees average between $135-$150/mo., which enables them to increase the amount of time they spend with patients."

Source: ConciergeMedicineToday.com, 2014)

Friends of ours in Portland, OR have been very happy with their doctor's switch from a more typical group practice to the concierge model. Looking at how hard it is to get access to primary care doctors in the two U.S. states we've lived in most recently (Colorado and Arizona), due largely to huge increase in demand due to ACA's Medicaid expansion, I've been wondering if signing up for a concierge doc and then managing taxable income to keep within Medicaid eligibility limits and using the latter for hospital/emergency care only might not be a good way to deal with the current state of health insurance madness.

 

[SumDay]

I have a friend who works at an office that switched to this model about 5 years ago. They all went to a "training" to get guidance on how to run the office profitably and efficiently.


THey live a couple of states away, so I don't know anyone who actually uses their services, but they do have a waiting list. One of the things they learned was they had to limit how many patients they could accept. Clients usually also have "hospital" insurance because obviously, they don't cover everything, but it's darned close. I'm very intrigued by this model myself.


Edited to add: I'm not sure my friend's office qualifies as "concierge". Everyone gets the same treatment, and you can't visit that doc unless you're a "member".

 

[braumeister]

My doc uses a modified version he runs by himself. Patients still need their own insurance and billing is handled in the normal way, but we pay him an annual fee on top of this.

What we get for that annual fee is:

• Same day appointment if we need it.
• Email access with response within 24 hours.
• No rush -- he will spend as much time with me as needed during a routine visit. Typically that's anywhere from 30 minutes to an hour, more if needed.
• Some other minor benefits.

He likes it because with his much smaller number of patients he can afford to spend time with us. He also says that since the only ones who chose to stay with him in this plan are those with whom he got along well, he now actually enjoys almost everyone he sees.

He started this about nine years ago and it has worked well. The annual fee has gradually risen over the years, but is still considerably less than other concierge plans around the area.

 

[OldShooter]

We are in a concierge program that operates inside our regular health care system. We pay $5K/year for two people and are very satisfied. Our list is similar to braumaster's:

• Same day or next day appointments.
• Dedicated space; waiting room had only two chairs when we signed up. Now four.
• Dedicated parking very close to the building door and concierge offices just inside.
• First-name basis with whole staff.
• Appointments as long as needed, initially scheduled for one hour.
• House calls and hospital visits if needed.
• Docs rotate carrying a cell phone so we have 24x7 access.
• Help in selecting expert specialists both inside and outside their organization.
• Pre-interfaced with a medical evacuation company in case we have a problem when out of the country.

The big thing I am buying is project management. I am still teaching and coaching this a little bit, but (for example) when my wife had back surgery last fall, her doctor monitored her on the organization's computer system and called her several times to check on how things were going. He would have visited if there was a reason for it, but there was not. Primarily he was watching to make sure all the docs, nurses, PAs, NPs, and other occasional visitors to her room were not screwing each other up or allowing something stupid to happen. Her floor nurses were flabbergasted that her primary care doctor was doing this.

 

[athena53]

I have no ongoing health issues, thank heaven, and my occasional need for medical attention can almost always be taken care of at a Doc-in-the-Box. It's definitely something I'd consider if I needed medical attention on a regular basis.

 

[googily]

There's kind of a entry-level version of this called One Medical, in San Francisco and DC and maybe elsewhere. About $200 a year, and also very centered on its app interface, but still a much calmer process than a lot of "regular" PCP offices. You can't necessarily get same day with your chosen doctor, but if you want to just see anyone in their office, they can get you in. Most also have blood draw capabilities on site, and communication from the doctor via e-mail is commonplace. Plus the waiting rooms are nicely decorated and calm.

I think it's really geared more toward millennials (the staff is all *very* young), but I took a flyer and joined up when they were having a deal ($115 for the year), and it has suited my needs well enough. I am keeping an eye out for a real concierge service, though.

 

[gcgang]

Doctors on retainer: Less waiting - tribunedigital-chicagotribune

Above is an article, from 2003, about a friend of mine I grew up with, who was one of the first to use this model. He was initially very happy with this model, but soon became just as overworked. I think he finally added staff/other docs to help.

I've had the same internist for 25 years, don't have the problems with access, time spent in appointments or response time that are often mentioned in promoting Concierge medicine. But if I did, and knew of a competent internist, I'd do it in a second. If I'm going to spend $ on anything, I'd put my medical care at the top of the list.

 

[Richard4444]

My internist of 18 years went Concierge two years ago as he was getting burned out from the 12 minute visits, etc. and chose to practice Medicine the way he had always envisioned practicing it. I had a tough decision to make as I am fortunately healthy and see him usually once annually for my routine annual exam. So I now pay him $1800 annually for the perks mentioned above (plus if I need to be hospitalized, he will be my Doc and not a hospitalist). I did have an upper respiratory infection, which otherwise I would have gone to the local MD Now for treatment, but I called his office and he saw me that day for half an hour.

Rich

 

[Ally]

My doctor of 16 years went concierge about three years ago. I decided to pay $2000 a year to stay with her. However, after about 18 months, she wasn't able to make enough money to make it work. She moved to another area of the state to join a large practice of several doctors.

It took me about five months to find another primary care doctor. Many good ones in our area are not taking new patients. I finally found an internist I really like. However, I can tell that her patient load is much larger than my previous doctor, because I can't always get into her within two or three days. I have had to go to the urgent care a couple of times instead.

At this point, I don't think I would pay $2000 again for concierge service. This is because my husband's retiree insurance is so good, that we never have to pay anything to see a doctor. We no longer have co-pays since we turned 65. I also have more time to spend waiting in the doctors office, since I retired. That was a big plus for the concierge service when I was working. I never had to wait.

 

[kevink]

According to the best data I can find, average wait to see a PCP in the U.S. is 19 days - "enough time to either die or get well" as one person commented.

The concierge model is popular enough that there are chains now - online portals that doctors can be included under that handle a lot of the administrative and marketing work. Some sites I've been on boast of their doctors *only* seeing 500-700 patients rather than the ~3000-3500 of typical PCPs. The latter real-world number makes it abundantly clear why 15 minute doctor visits after a couple of weeks or more of waiting for an appointment are the new normal.

I'm currently looking at this all from the vantage point of Lake Chapala, Mexico, where I can see my doctor within a day for $22 - office or house call - and visits to any medical professional take as long as they need to take. With residency visas in hand we recently enrolled in the government program here for hospital access and catastrophic coverage. Enrollment is free, though facilities are basic.

Would certainly seriously consider going the concierge route in future though. It sounds like the only way in many cases to have the kind of access to care that's routine in many countries. For ER's it sure looks to me like managing MAGI to hit either the subsidy sweet spot for ACA plans or keeping within Medicaid income limits while paying for concierge service is as goos a strategy as any for surviving the ongoing implosion of the U.S. health insurance and care system.

 

[meierlde]

According to the best data I can find, average wait to see a PCP in the U.S. is 19 days - "enough time to either die or get well" as one person commented.

The concierge model is popular enough that there are chains now - online portals that doctors can be included under that handle a lot of the administrative and marketing work. Some sites I've been on boast of their doctors *only* seeing 500-700 patients rather than the ~3000-3500 of typical PCPs. The latter real-world number makes it abundantly clear why 15 minute doctor visits after a couple of weeks or more of waiting for an appointment are the new normal.

I'm currently looking at this all from the vantage point of Lake Chapala, Mexico, where I can see my doctor within a day for $22 - office or house call - and visits to any medical professional take as long as they need to take. With residency visas in hand we recently enrolled in the government program here for hospital access and catastrophic coverage. Enrollment is free, though facilities are basic.

Would certainly seriously consider going the concierge route in future though. It sounds like the only way in many cases to have the kind of access to care that's routine in many countries. For ER's it sure looks to me like managing MAGI to hit either the subsidy sweet spot for ACA plans or keeping within Medicaid income limits while paying for concierge service is as goos a strategy as any for surviving the ongoing implosion of the U.S. health insurance and care system.

With electronic medical records the model may move to going to urgent care for the short notice situations, and seeing the PCP only for scheduled checkups. (urgent care gives longer and at least Saturday hours)

 

[OldShooter]

With electronic medical records the model may move to going to urgent care for the short notice situations, and seeing the PCP only for scheduled checkups. (urgent care gives longer and at least Saturday hours)

Not picking on @meieride at all but there a couple of false premises baked into the system, inherent in this post:

All docs are equally competent, so it does not matter who you see. When stated this way I think the fallacy is obvious. One of the reasons I like our concierge option is that the docs have been selected especially for the program and IMHO are going to be above average in all skills.

Health care can be compartmentalized and dealt with by a large number of specialized providers, and there is no need for anyone to maintain cognizance of the big picture. As a longtime project manager I know from experience that the biggest problems arise in the "cracks" between functional areas. For example, the nephrology guy doesn't know what the infectious disease guy's issues are because they have never met and, hence, he makes a wrong assumption. This is why I am trying to coach our concierge doc in the art of project management. This idea is really alien to a system where each doc considers him/herself to be an autonomous island. I've told my guy about a hypothetical meeting where at the end someone says: "Thank you for all your inputs. Here is what we are going to do ... " That person is the project manager and that scenario is rare to nonexistent in our health care system. I want our doc to be ready and able to step into that role if/when something really bad happens to one of us.

(There is an emerging concept called "case management" but the people given those jobs are "facilitators" not decision makers. It's probably politically incorrect to say it, but from time to time a project manager needs to be able to kick ass and take names. Today's "case manager" concept does not include that.)

 

[Doc0]

MyDirectMD, Liberty Healthshare

Our conceirge plan consists of 2 components MyDirectMD for primary care and Liberty Healthshare for major medical. For a family of 3 it is $399 per month and qualifies as ACA complaint. The deductible is $1500 per year ($500 per insured). The primary care is concierge with referral as need for specialist care. I'm on medicare and needed a non Obama care (rip off) plan to cover my wife and kids and found this to be entirely adequate with a manageable expense. My daughter goes to school out of state, and this covers her at school as well but the consultation is done via skype. My biggest concern for her would be breaking an arm or something and the insurance covers all of that. Between their healthcare and my medicare, my health costs are about 8K per year for 4 people, and thus far are stable. Whatever you get make sure it is ACA compliant.

Best

 

[Just_Steve]

According to the best data I can find, average wait to see a PCP in the U.S. is 19 days - "enough time to either die or get well" as one person commented.

I don't know where that stat came from but I nor anyone I know has to wait more than a day or two to see their PCP except maybe for routine physicals two weeks tops. My PCP has sick hours every morning before his regular office hours M-F, Weekends are another story.

 

[Bamaman]

I have no ongoing health issues, thank heaven, and my occasional need for medical attention can almost always be taken care of at a Doc-in-the-Box. It's definitely something I'd consider if I needed medical attention on a regular basis.

Are you getting full yearly physicals including a chest xray and a full blood chemistry lab work?

Lung cancer is the big killer right now. Those not getting physicals often find out they are at stage IV when they find out they even have cancer. We have a close friend that's down 100 lbs. in weight and his days are short.

My wife was found to have a very aggressive uterine cancer on a routine physical and had she would have been terminal in 6 months had a good PAP smear not been done when it was done.

Doc In A Box is okay for some ailments, but they are not a substitute for quality physicians.

 

[Beldar]

I guess I'm the odd person out. These concierge services are what our family doctor's practice provides (more or less), outside of a 24 hour cell phone attached to him. We never wait more than a few minutes waiting during our appointment, and can get in in a few days depending on the reason (triage I suppose).

In fact, since we like him so much (for 20 yrs), and our current insurance plan (ACA) isn't accepted by his practice, we just pay a discounted cash price for each visit / procedure. In the case of lab work, it comes out be less than our copay used to be. Go figure.

I can see the unlimited visit feature some boutique practices may provide for those who have chronic conditions that may require ~very~ frequent visits as a tangible benefit though.

_B