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Old 04-28-2014, 10:19 PM   #21
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As for me, I have no PCP now and am not sure what to do about it. One part of me says "ah the hell with it, I'll just go to specialists when I need it". Or go to places like CVS Minute clinics for when I have minor things come up (which is what I did when I had an ear infection last summer). However another part of me thinks I should find another, younger PCP and establish a relationship, if for no reason they'll be more likely to keep me as a patient when I can go on medicare in 7 years.
Sort of in the same boat. I really liked my old PCP, but he is now 60 miles away and I don't really like him that much. Since we moved to our current house 2 years ago(!) I haven't really needed a PCP. I have a gynecologist and they had a satellite office close enough to me that I went there last time I had a check up. My allergist is area wide so I switched to a local office - different doctor, but same practice group.

We've gone to the urgent care place for a couple of things and got a referral to an orthopedic surgeon from them. DH needed a couple of specialist doctors and got a referral from a former co-worker.

In that case, I did look up the recommended referrals at various rating sites. Those sites used to be terrible but they have gotten to be much, much better. I looked up some of the physicians that I've seen to see if the ratings seemed to match with experience and they overall did.

But, we still don't have a PCP. DH asked one of the specialists for a referral and they gave him the name of someone. I looked him up and he had been disciplined for something that made me not want to see that doctor. So, we still don't have a PCP. I will probably ask a few more of the specialists for referrals and then check them out on review sites. I'm not that happy with it, but seems the best choice. Although, I do wonder how those physicians giving referrals decide who to give referrals on. That is, do they base it on who they think is competent or is it just based upon who sends business to them?
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Old 04-28-2014, 11:40 PM   #22
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I wonder the same thing, but I'm going to ask one of my specialists who I will see in May, to see if he has any ideas. I hope he doesn't just give me the name of the doc who sends him the most business. We are still undecided, so it may be useful to have some names.
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Old 04-29-2014, 12:01 AM   #23
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I am sorry, but the concierge thing is little more than a shakedown. Bring on the single payer model and put an end to this nonsense.
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Old 04-29-2014, 12:11 AM   #24
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I didn't see the concierge model as a shakedown. It looks to me like a legitimate alternative that patients can choose. I can pay more and get more time with doctors. I can pay less and get fully optimized medicine practiced to minimize costs. If all insurance plans are the same, or if we go to single payer, then we all get the same fully optimized system. If we allow concierge (or private patients) then those who can afford to do so can buy a different model of care.
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Old 04-29-2014, 12:23 AM   #25
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I am sorry, but the concierge thing is little more than a shakedown. Bring on the single payer model and put an end to this nonsense.
Concierge, if done conscientiously, gives a free market route to what we all want, and what our good doctors want, a more human-friendly practice.

Single payer will be like our public schools. If you like them, you'll love single payer health insurance.

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Old 04-29-2014, 05:44 AM   #26
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One thing I'll add about my semi-concierge doc, is that they respond super quickly to email, often with a phone call. They are pretty easy about calling in prescriptions without making patients come in to the office too.
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Old 04-29-2014, 07:59 AM   #27
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I go to a concierge physician because of lots of the reasons mentioned above. The main reason though is that he is focused on prevention, and not just diagnose and treat, disease management.
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Old 04-29-2014, 08:18 AM   #28
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That's the story which has yet to be told. Patient compliance and interest in these "concierge benefits" will probably wane, IMHO. Prior patients will drift off to other PCPs and will be reluctant to go back to their original doctor in some cases.

Some doctors will make it and some won't. By then Obamacare will have converted large numbers of previously uninsured patients to insured ones. This is a delicate situation which I am glad I am watching from the sidelines.

When asked, I usually advise staying with the original PCP for about a year and see if you are getting your $2,000 worth. There are a lot of moving parts here.

When in private practice decades ago, it evolved in to a concierge-like practice due to a wealthy demographic. I was much happier with my subsequent university teaching practice: diverse, Joe six-pack followed by rocket science types, lots of fun and great quality of care.
+1

Only a limited number of doctors will be able to successfully make a switch to concierge. They need patients and most won't be willing to cough up the extra bucks. Many years back, DW dragged us off to a concierge doctor when our primary care doc's practice was bought up and the new office staff were terrible. The concierge guy had great staff and was a chatty Cathy but after a few years we did the math and decided to go back to our more convenient neighborhood practice. The staff is marginally improved but still a PITA. But the docs we see seem to provide the same guidance, albeit with a bit less talk.

Now we have a new option a block away - a walk in clinic for urgent but non-emergency care. DW went over for a foot problem when the wait for the regular docs seemed excessive. The urgent care joint was quick and efficient. They use nurses for a lot of services but what the heck, that is often all you need and a nice supplement to Dr Google, who can't prescribe meds.
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Old 04-29-2014, 08:48 AM   #29
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Is this trend for concierge physicians primarily for general practitioners (as opposed to specialists)? The last time we needed to see a GP was for my citizenship physical many years ago. We always try go straight to a specialist -- if we're forced to see a GP it ends up being a waste of time as they will just refer us to the specialist that we knew we needed to see anyway.
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Old 04-29-2014, 09:29 AM   #30
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We always try go straight to a specialist -- if we're forced to see a GP it ends up being a waste of time as they will just refer us to the specialist that we knew we needed to see anyway.
If that works for you, you're golden. But I generally have no idea who a good specialist would be, and the referrals my PCP has given me over the years have always turned out to be outstanding. So that's a big factor for me.
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Old 04-29-2014, 03:03 PM   #31
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I go to a concierge physician because of lots of the reasons mentioned above. The main reason though is that he is focused on prevention, and not just diagnose and treat, disease management.
Some of the reasons we are considering staying with our doctor and paying is that she focuses on prevention, she encourages us to email her (in fact I did that yesterday to have a problem with the pharmacy straightened out) and she gave me her cell phone # years ago. Plus she understands and manages our conditions that can go out of control if not monitored (kidney disease, auto immune disease, high triglycerides, pre-diabetes, asthma, and some more issues.) We have both become much more healthy with monitoring, education and prevention. I think she wants to practice this type of medicine, but is feeling the big squeeze from the insurance companies and the corporation she works under. She said they want her to keep her visits to 5-6 minutes and she said she can't. She said she moved here from Canada 20 years ago to get away from govt. controlling medicine. Anyway, it sounds like for us it may be worth trying it.
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Old 04-29-2014, 03:55 PM   #32
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Does a doctor need to abandon Medicare if he charges a concierge fee?

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Old 04-29-2014, 04:27 PM   #33
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Does a doctor need to abandon Medicare if he charges a concierge fee?

Ha
I checked the Medicare database and a local group of concierge doctors have considerable Medicare billing. It appears that as long as they take Medicare assignment for any treatment or procedure they are free to charge a membership fee.
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Old 04-29-2014, 06:57 PM   #34
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I checked the Medicare database and a local group of concierge doctors have considerable Medicare billing. It appears that as long as they take Medicare assignment for any treatment or procedure they are free to charge a membership fee.
Many "concierge" docs also seem to have some non-concierge patients. PCP's may keep at least some established patients as they age into Medicare system. Does not mean they are paying concierge fees. These patients could be handled under usu Medicare billing procedures.
HHS OIG tells docs that charging concierge fees to Medicare patients for covered services is an illegal practice.

"You may see advertisements offering to help you convert your practice into a "boutique," "concierge," or "retainer" practice. ... If you are a participating or non-participating physician, you may not ask Medicare patients to pay a second time for services for which Medicare has already paid. It is legal to charge patients for services that are not covered by Medicare. However, charging an "access fee" or "administrative fee" that simply allows them to obtain Medicare-covered services from your practice constitutes double billing."
I. Physician Relationships With Payers | Physician Roadmap | Compliance | Office of Inspector General | U.S. Department of Health and Human Services
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Old 04-30-2014, 02:01 PM   #35
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Doctors that have concierge practices can take assignment from Medicare, they just need to be careful not to violate Medicare regs, particularly not charging for something already covered by Medicare. Here's a reference that gives a high level overview. http://www.tha.org/HealthCareProvide...%20Hilgers.ppt

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Concierge Medicine: Key Legal Considerations

Complying with Medicare Regulations, Insurance Laws and the Anti-Kickback Statute

Texas Health Law Conference. October 15, 2012
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