PCP 'subscription' charge

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tmitchell

Recycles dryer sheets
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My PCP just sent out a letter saying that going forward in order to make up for the costs of administrative fees and keeping their (excellent) app up to date, etc, there will be an annual $500 fee to be a patient there.

I know about concierge doctors and can appreciate their position, but this is a new twist. I really like my PCP but so far am just a once per year patient (knock on wood) and debating if it's worth the money to stay put.

Wondering if there are any doctors out there who might provide context, or other people's experience with this sort of thing. Is this just a symptom of the insurance companies tightening the screw on docs? I know it can be a struggle for them.
 
My previous PCP group tried that several years ago, with a $200 "fee". Enough of the patients wrote/called complained and threatened to leave the practice that they reversed their decision.

If you like your PCP enough to pay extra, then do so.
I would not, unless they are offering something extra for that $500? Other than app access.
 
adios, au revoir, good bye
 
Mine started charging like that in 2012. It was $350 back then. I was fine with it for a couple of reasons.

First, instead of 15-20 minutes for an appointment, he spent as long as necessary with you, typically close to an hour, and did a really thorough exam.

Second, I liked his comment: "This is the greatest thing, because now all my patients are people who both want to be in the practice, and clearly care about taking care of themselves. The other side of that is that I find that they are just about all people I personally like."

Over the years, I've moved along to other PCPs who also used some sort of concierge system (and the price has gone up), and I've been very happy to pay for it. My second one retired a couple of years ago, and his replacement is just as good. I can call any time, usually get in the same day, and they have been terrific doctors. I guess if they weren't, then they wouldn't have enough patients to pay the bills.

So I see the positive side of the arrangement, although I know many people don't. I've used it both before and after going on Medicare, and I have to say that I've sometimes been appalled at how little they get in payment for many things.
 
I'm a family practice doctor, though I left family practice in 2017 and switched to urgent care.

I'm not a fan of the concierge model as it leaves a lot of patients out in the cold. The ones who are willing and able to pay the fee whether it be $200 or $500 or more get good care, but the rest are left having to find a new PCP in an environment where doing so is harder than ever. While I was still in practice, a couple of other doctors in our area did this and we were suddenly flooded with new patient requests that we simply couldn't accommodate because we were already full. I have no idea what all of those people did.

Of course, I am also very sympathetic to the doctors who feel they have no choice but to go this route because what the insurance companies are paying them is barely enough to keep the lights on.

Primary care is dying and nobody really seems to care or want to do anything about it.
 
braumeister said:
......
So I see the positive side of the arrangement, although I know many people don't. I've used it both before and after going on Medicare, and I have to say that I've sometimes been appalled at how little they get in payment for many things.
Click to expand...

Re: Bold above.

I have noticed the same thing with my docs. Sometimes the Medicare approved amount seems unreasonably low. This one of the reasons I do make sure to have my "Medicare wellness exam". Even though the "exam" is rather useless, I noticed the approved amount for it is substantially more than a normal visit
 
tmitchell said:
... other people's experience with this sort of thing. ...
Click to expand...
Well, we are in our tenth year with a concierge group. Benefits are very comprehensive. For example when I call with an issue, RN Amanda says "What time do you want to come in?" Appointments are scheduled for an hour and one of the docs carries a cell phone 24x7. Plus quite a bit more, even including house calls if necessary.

That said, $500 is a pretty hefty fee for giving the customer not much of anything. I would not pay it.

disneysteve said:
... I'm not a fan of the concierge model as it leaves a lot of patients out in the cold. The ones who are willing and able to pay the fee whether it be $200 or $500 or more get good care, but the rest are left having to find a new PCP in an environment where doing so is harder than ever. While I was still in practice, a couple of other doctors in our area did this and we were suddenly flooded with new patient requests that we simply couldn't accommodate because we were already full. I have no idea what all of those people did.
...
Click to expand...
Frankly, though I see your concern it is not my problem and my signing onto or rejecting a concierge program would have no effect anyway.

As it turns out, our concierge group is embedded inside a large health care organization which has many clinics and several hospitals. So a person who was seeing one of the concierge docs prior to the change is undoubtedly now seeing another doc in that same system.

Interestingly, this concierge program is almost a secret inside the organization. They don't advertise or promote it. I think the dilemma is that they like the money (several $K per family) but are terrified about ending up on the front page of the local paper under a headline like "Rich people get premium health care."
 
teej1985 said:
What does that mean? People just wait til something pops up and go to Urgent Care instead?
Click to expand...
Yes, the demise of primary care is definitely linked to the growth of urgent care. Every day in UC I have patients tell me some version of "I called my PCP but they couldn't get me in and told me to go to UC". This is why over the past 10-ish years, urgent cares have opened on every corner and they're always busy. Patient access to primary care has greatly deteriorated and practices switching to concierge is just one of many reasons for this.


I certainly don't know the answer but the problem is only getting worse as older guys like me are retiring and not being replaced in adequate numbers. Urgent care is a great service, but it doesn't come close to being a good substitute for having an established relationship with a PCP.
 
disneysteve said:
Primary care is dying and nobody really seems to care or want to do anything about it.
Click to expand...

I agree. Living overseas much more of our health care was provided by PCPs and much less by specialists, and I prefer it that way. A good PCP is worth their weight in gold.

I think the medical profession brought this upon itself and is now far too over focused on specialization, to its detriment.
 
I'd say pay it if you like your PCP. I figure spending for things I like is why I saved.
 
I would probably look for another PCP, but this might be regional thing and thus unavoidable. When I moved to western CO, I was shocked that in addition to finding a PCP that was accepting new patients, I had to apply and be "accepted" as a new patient. This seemed weird, but this is the norm here.

I would be willing to pay a little extra for my PCP, but like you stated this is a lot of money for 1 or 2 visits a year.
 
braumeister said:
Second, I liked his comment: "This is the greatest thing, because now all my patients are people who both want to be in the practice, and clearly care about taking care of themselves. The other side of that is that I find that they are just about all people I personally like."
Click to expand...

My arrangement with my doctor is different but he feels the same way. My doctor does not accept insurance. I pay $170 per visit after the first visit which was $500 several years ago.

You don’t go to a doctor like that unless you’re committed to improving your health.

One of the things I totally sympathize with in a typical pcp environment is that patient compliance is abysmal. Of course they give you a pill - how many of their patients actually make life style changes. I think very few. My doctor is a holistic doctor and prescribing medication is a last resort. Given my current health condition, he has me on a couple medications. When I first met him several years ago, he got me off all my meds at the time. Unfortunately, I now have a condition that lifestyle will not impact. Still, I maintain a good diet and exercise to give my body its best chance.

I would consider the $500 subscription if I really liked the doctor. I bet you’ll find that service will improve.
 
It would depend on my health. Probably not now when I really need only annual monitoring by my cardiologist, renewal of a prescription to deal with menopause and the usual preventative screenings. I get bloodwork through RequestaTest. Right now, knock wood, Urgent Care works for everything else. I'm guessing telemedicine could also fill in.

If I had multiple specialists, needed frequent monitoring and the specialists needed to talk with each other- sure, I'd consider it. I'd welcome longer talks with the doc because I'm part hypochondriac and part science geek and place a high priority on prevention.

One thought: probably cumbersome to set up but I wouldn't mind making tax-deductible contributions to a charity that pays that fee for people who can't afford it. That way the docs get more income and can devote more than 7 minutes to each patient and it's open to people who wouldn't be able to afford it otherwise.
 
tmitchell said:
My PCP just sent out a letter saying that going forward in order to make up for the costs of administrative fees and keeping their (excellent) app up to date, etc, there will be an annual $500 fee to be a patient there.

I know about concierge doctors and can appreciate their position, but this is a new twist. I really like my PCP but so far am just a once per year patient (knock on wood) and debating if it's worth the money to stay put.

Wondering if there are any doctors out there who might provide context, or other people's experience with this sort of thing. Is this just a symptom of the insurance companies tightening the screw on docs? I know it can be a struggle for them.
Click to expand...
So does the doctor now opt out of accepting new patients for the insurance companies he works with?
I wonder how the insurance companies are handling this.
It would be a real waste of time for a prospective new patient to choose him as their new PCP to find out later about this fee.
 
Even though I like my PCP, it would be a hard "NO" for me. If people blindly keep accepting and paying these fees, they will just keep bumping up the amounts every year.

I refused to sign a paper accepting a "facility fee" for my last annual checkup. They told me they would bill me for it anyway, to which I replied that I would deal with that if and when. They never did bill me for it. People have to push back or the sky's the limit with this "fee" insanity everywhere.
 
My long-time gynecologist charged around $500 for an annual visit (didn't accept insurance) & to me it was worth every penny. He saw me though a lot of issues, we talked extensively, he made referrals to specialists who take my insurance, & in many ways felt like more like my primary doctor than my PCP. When he retired in 2020, the only ones I could find who took medicare for new patients seemed to be part of large companies & I felt I wouldn't get the kind of treatment I was used to. I ultimately went with one who charges $400 for an annual visit, called a wellness visit.

Health care is increasingly important to me now & I'm not going to skimp on it.

I recently signed up for my long-time PCP's concierge service (which he started a few years ago) because I wanted better access, more attention & more time with him when I need it. I like him a lot, but it always felt rushed (appointments were scheduled every 20 minutes). Will report later on how it goes.
 
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disneysteve said:
I'm a family practice doctor, though I left family practice in 2017 and switched to urgent care......

Primary care is dying and nobody really seems to care or want to do anything about it.
Click to expand...

Primary care docs get asked to do a lot of stuff that isn't reimbursed. Fill out forms, coordinate referrals with insurance, talk on the phone and even justify charges for specialists. I think there is value to having good access and replacing in person appointments with phone call when appropriate.
 
I wouldn't even consider it but $500 is a lot more to me than it is for most people on here so if it's worth it to YOU then pay it. I think it sets a bad precedent.
 
freedomatlast said:
Even though I like my PCP, it would be a hard "NO" for me. If people blindly keep accepting and paying these fees, they will just keep bumping up the amounts every year.
Click to expand...

I see it as part of an evolving two- or three-tier system, depending on how you want to count the tiers. At the low end are people with no insurance or with Medicaid or Advantage plans that not all practices accept and that may restrict some tests or treatment or limit access to specialists. (Not all do, I know- I'm generalizing.) In the middle are people with private insurance or decent Medicare coverage. The top end would be those who can afford concierge care and things insurance doesn't cover, such as more frequent testing (I like to monitor a1c and cholesterol 3 or 4 times a year) and more expensive forms of dental care such as implants.

Even in countries with national health insurance, there's a lot of "medical tourism" in which people travel to less-expensive countries to avoid long waits for non-emergency procedures such as hip replacements, and some employer-provided private insurance that lets them somehow jump the queue, which my London-based manager had.
 
athena53 said:
I see it as part of an evolving two- or three-tier system, depending on how you want to count the tiers...
Click to expand...

I think that's a very good analysis. Of course, even within each of those tiers, there is a very wide range.

For those who might not have thought of it, MDVIP is one of the largest networks of "concierge" physicians, and I know that some of our members here use a doctor in their system. You can see how it works from their website HERE.

You can also Google "concierge physician near me" and get a surprisingly robust set of possibilities in most areas. I have been surprised to see the great variety of plans, costs, and benefits. There is no way to compare them for the "best" one without digging into it yourself.

One thing I found when searching for a new doctor the last time I moved was that many are completely open to giving you a "meet and greet" appointment at no charge where you can chat with them for 15 minutes to see if you're a good fit for each other.
 
Mark1 said:
When I moved to western CO, I was shocked that in addition to finding a PCP that was accepting new patients, I had to apply and be "accepted" as a new patient. This seemed weird, but this is the norm here.
Click to expand...

I'd be interested in what the acceptance criteria are. If I were in practice I'd think in terms of:

1. Shows up on time for appointments.
2. Complies with prescriptions/other recommendations; is an active participant in maintaining their health
3. Doesn't call for every sniffle and ache
4. Adequate insurance coverage
5. While some insights into personal life, relationship status, levels of stress, etc. are useful context, not expecting psychotherapy

Some you can tell up front; others you find out only over the long run.
 
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