Our doctor is going concierge....

[Ally]

I'm very frustrated. I went to my primary care doctor last week and I know she has been planning for more than a year to go into private practice, instead of staying with the huge regional medical organization that she has been with for 20 years. We have gone to her for 17 of those years. She is frustrated with their control of her practice and also with what is going on in medicine/insurances/Affordable Care Act, etc. But she told us initially she was arranging to sign up with both my and my husband's insurance as a provider.

Last Friday, she told me that in the summer, she is going into private practice as concierge medicine. She was trying to sell me on it, and it sounded great - lots of personal attention (which she is good at anyway and why we go to her), home visits when needed, diet and exercise small groups, diabetes and cardiac small groups, and more. It would be $2000 a person for a year and she would file insurance for any testing or labs she would do and would work with our specialists. (I have some medical issues that are chronic and I have to see 3 specialists annually.)

However, after checking into my insurance this morning, we can't even consider staying with her, because both of our insurances require us to work through a primary care doctor for testing, specialists, etc. and they don't work with concierge doctors. If she ordered any tests or made referrals, the insurance would not pay.

So, now we are going to have to find a new doctor/doctors by July 30th. I hate changing doctors and hair stylists. (My husband adds "and spouses" haha) It's so hard to get comfortable with either one, so changing is not something I look forward to doing. What do you do to find a good doctor? Ask around to your friends? Read rating sites? Has anyone else had this happen?

 

[REWahoo]

Ally, I don't have any advice on looking for a new doc beyond asking others who they use. However, DW feels your pain. Her primary care physician, who she has been with for many years, did the same thing.

Fortunately for her I'd gone through something similar a few years ago when my doc semi-retired (the nerve of the guy!) and went part-time. Coincidentally, a Dr. in a situation similar to yours opened her own private practice in our area and actually advertised for new patients. I gave her a try and liked her. I even suggested DW give her a try (long before her Dr. announced she was going concierge) since my new doc was considerably closer. Not interested.

That all changed once DW figured out what the new concierge arrangement would cost. She gave my doc a try, liked her as well and when her old doc's office called to sign her up for the concierge service, she declined.

Fast forward three months. Old doc sent DW a letter saying she missed her old patients so much she decided to forgo her plans and stick with traditional pay-for-services. She's still open for business as usual. Translation: she didn't have enough takers to make the concierge business plan work.

DW is sticking with our new doc.

 

[MRG]

No I haven't had the exact thing happen, but my DR. I've seen for 14 years told me he's thinking of retiring.

I found him from a friends reference, after my prior DR. tried to kill me. Obviously one can ask for a reference, my doc didn't seem to have anyone he felt comfortable with. The rating sites I looked at were a joke.

There are basic things I always use, your DR. isn't much better than his staff, so that's an important point. An obvious misdiagnosis another, but then it's too late. Their ability to communicate with you, talking above your head, accents you can't understand, listening to what you're saying are all important.

I'm not much help on this, I hope others have some better ideas.

MRG

 

[Sue J]

When my previous doctor moved away to be near family I was assigned to her replacement. I wasn't thrilled with the change but thought I'd give the new doctor a chance. I liked her well enough to not bother with changing.

When we looked at options for a new ACA plan I found that some of the insurance networks had very few providers in our area. A couple of them had nearby providers but we would have to change doctors. Looking further into this I started to feel very attached to my doctor and my insurance network!

We ended up getting an ACA plan with our same insurance company that uses the same network and we are keeping our doctors. I didn't realize how attached I was to what I already had until we looked at changing.

DH may change doctors just because his current PCP isn't real competent with all the new electronic records and has been making mistakes that cause problems for DH, like not ordering the correct blood tests and DH having to redo. Also, when DH had his routine physical, covered at 100%, the doctor also billed for a regular office visit. DH called to ask about this since it looked like an error to me and the doctor said that he's allowed to do that. That doesn't happen at my doctor's office.

 

[W2R]

What do you do to find a good doctor?

If you have another doctor, perhaps a specialist, that you like, maybe he/she can recommend a primary care physician.

I may be in a similar situation soon. My internist is talking about retiring early someday. My best guess is that he is in his 50's right now. Anyway, I found him fifteen years ago through a rheumatologist that I used to go to, who was very good. He recommended this internist when he saw some things that were beyond his scope.

 

[Animorph]

My doc went concierge. Other than having to pay the yearly fee out of pocket, he still works with my insurance as an in-network provider. I don't see why that would change unless your doctor dropped out of the network altogether, or maybe as an approved PCP.

For now my health is a new hobby for retirement. We'll see how that works out

 

[Ally]

I thank you for all your insights. I see I'm not alone I facing doctor changes. I just received a call from my workplace insurance agent and she said that after talking to both my company and my husband's company, they are both making lots of changes. They are both no longer using the Primary care doctor model. They are just going to have in and out of network docs. In and out of network labs, hospitals, etc. She said that a concierge doctor would be considered out of network, but since they wouldn't be charging us additional fees, it wouldn't matter. And they would pay any labs or tests my doctor orders, as long as she used an in network lab. She said that doctors are currently being allowed 5-6 minutes by most big practices and insurances for an office visit and that there is a lot of unrest. They say they can't practice quality medicine like that. My agent said the insurance companies my husband and I use are no longer requiring pre-authorizations for seeing a specialist, because that is one way to cut down on the frustration. They just decided this last Friday. Interesting!

 

[Ally]

My doc went concierge. Other than having to pay the yearly fee out of pocket, he still works with my insurance as an in-network provider. I don't see why that would change unless your doctor dropped out of the network altogether, or maybe as an approved PCP.

For now my health is a new hobby for retirement. We'll see how that works out

And are you happy with the concierge service?

 

[braumeister]

My doc went concierge. Other than having to pay the yearly fee out of pocket, he still works with my insurance as an in-network provider.

Mine went to this sort of "semi-concierge" model about 6 or 7 years ago. We pay an annual fee at the start of each year, which is not outrageous (a little over $400 each this year). Otherwise, it's business as usual, with insurance (currently Medicare) paying the bills.

The advantage is that we are guaranteed a same-day appointment whenever we want one, and he spends as much time as needed with us. In some cases, that can be considerable, if he's having a slow day.

We like the arrangement, and he loves it. He says that now he not only doesn't have to rush patients through like an assembly line, but just about all his patients are people he likes. It seems to be mutual, as those of us who liked him enough to join are glad we did, and the others found new docs when he made the switch.

 

[ERhoosier]

........both of our insurances require us to work through a primary care doctor for testing, specialists, etc. and they don't work with concierge doctors. If she ordered any tests or made referrals, the insurance would not pay......

This seems to be THE most common situation with ACA Exchange Plans in most regions, and it happens with many non-Exchange HI plans too. The issue generally is not concierge per se, but staying within your plan's network. Tests, drugs, etc. ordered by OON providers are usu considered OON care unless it's emergency care. In my region, big ins carriers have a smaller network for their Exchange Plans and trying to get current network info can be a major PITA. For FIRE's transitioning from COBRA to Exchange Plan this can be a huge issue.

Concierge exists in my area, but most experienced docs here seem to FIRE vs starting up a concierge practice.

 

[Animorph]

And are you happy with the concierge service?

Probably not worth the price now, but maybe when I need more interaction. I have his cell number, I get more of his time, he has spent a lot of time revamping his practice and attending special seminars. So far, so good. It's just that I don't have to see him that often.

 

[Ally]

...just about all his patients are people he likes. It seems to be mutual, as those of us who liked him enough to join are glad we did, and the others found new docs when he made the switch.

Interesting, since I did notice that she went into great detail about the advantages of this plan and how much she would love to keep us as patients, she failed to mention anything about it to my coworker, who had an appointment later the same day. However, my coworker is a difficult person sometimes and once had a screaming fight with one of her staff, after which my doctor gave her a list of doctors and told her to find a new doctor. Only after a few months and an apology to the doctor and staff, did she let my coworker return.

My doctor asked me not to discuss her decision with others yet, since she wanted to send out a letter when she had things set up and she wouldn't be offering it to everyone. I think my coworker will not be offered a chance. I didn't think about it being that she would want to have patients she enjoys. However, my husband and I have seen her and her husband at restaurants and they always ask us to join them, so I know we all get along very well.

 

[Rich_by_the_Bay]

That all changed once DW figured out what the new concierge arrangement would cost. She gave my doc a try, liked her as well and when her old doc's office called to sign her up for the concierge service, she declined.

Fast forward three months. Old doc sent DW a letter saying she missed her old patients so much she decided to forgo her plans and stick with traditional pay-for-services. She's still open for business as usual. Translation: she didn't have enough takers to make the concierge business plan work.

DW is sticking with our new doc.

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.

 

[MichaelB]

Hopefully your physician will reconsider or at least offer some consideration for current patients.

This also isn't an ACA issue, it has been growing steadily over the past decade (or two). Primary care doctors are in a terrible squeeze as insurers impose lower costs and specialists take an increasing share of the total health care spending.

DW's PCP does not take insurance, and I think it is an acceptable option. The visits are not covered but everything else is, they are comprehensive and not hurried. A good primary care physician is worth more than gold.

 

[timo2]

I realize this is a serious subject, but I can't help hearing the phrase 'concierge doctor' without wondering if they know the location of a good restaurant. (Sorry for being so juvenile)

 

[MRG]

It's not a new thing either, my DM'S Dr. went that way close to 10 years ago.
MRG

 

[ERhoosier]

.....This also isn't an ACA issue, it has been growing steadily over the past decade (or two). Primary care doctors are in a terrible squeeze as insurers impose lower costs and specialists take an increasing share of the total health care spending.
.

A simple web search shows that many, many PCP's would not share that view. The squeeze did not start with ACA, but ACA has certainly accelerated the squeeze as its provisions have kicked in (e.g. lower reimbursements, requirements for increased "provider efficiencies" (less time per pt), increased bureaucratic overhead, etc.). Although only time will tell how things eventually play out in next few years, for many doc's ACA was (will be?) the big straw that broke the camel's back.

Fed Up With Obamacare, Doctors Increasingly Prefer Cash For Care - Forbes

New Poll Confirms IBD's '09 Finding Of Doctor Exodus Under ObamaCare - Investors.com

Will the ACA Act Worsen the Primary Care Doctor Shortage? - CNN iReport

Elderly patients sick over losing doctors under ObamaCare | New York Post

 

[Silver]

A simple web search shows that many, many PCP's would not share that view. The squeeze did not start with ACA, but ACA has certainly accelerated the squeeze as its provisions have kicked in (e.g. lower reimbursements, requirements for increased "provider efficiencies" (less time per pt), increased bureaucratic overhead, etc.). Although only time will tell how things eventually play out in next few years, for many doc's ACA was (will be?) the big straw that broke the camel's back.

I agree with your statement. Blaming ACA is just a way that health care providers can more easily focus their dissatisfaction in a way that consumers can better understand. The issue has been the insurance industry taking more control through managed care, and this is not new....it started in the 1980's. That's how HMO's started.

 

[LarryG]

Our PCP went to the concierge model a year ago. My wife was "asked" to join (at $1600 per year), and I was not. Not sure why, other than I think I saw him maybe 5 times in 17 years.

Anyway, wife loves it for the reasons others have cited already (ease of access to him, has his cell number, lengthy, non-rushed appointments when needed, etc.). Is that worth $1600/year? In my view, no, but wife insisted on staying with him regardless of the cost.

From what my wife tells me, the doctor really loves the new model, and he had no problem getting enough former patients to sign up for the concierge plan. When we called the organization he uses (MDVIP) last year to get her set up, they told me that he had previously had well north of 3,000 patients, and was limiting his new concierge practice to I think 600 patients (or it may have been 500).

So far he has remained in our (COBRA) health insurance plan through former megacorp, and has coordinated all insurance submissions/etc when needed. So no issues/problem there. My COBRA expires in June so I need to check to make sure that he will be part of the BCBS plans my former company allows me to buy into (at full boat price) - I sure hope so.

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.

 

[growing_older]

So, 600 patients at $1600 each is a million bucks. The rest of the insurance paperwork and reimbursements can be significant loses and the doctor still has a thriving practice.

 

[Katsmeow]

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?

 

[Ally]

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.

 

[brewer12345]

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.

 

[growing_older]

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.

 

[haha]

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.

Ha