PCP 'subscription' charge

[tmitchell]

OP here again.

Well the “good” news is that since—as of now—I’m a once a year patient I won’t have to pay the fee. For now.

Strange times!

 

[davidfin]

I just got a message from my Medicare drug plan administrator WellCare their monthly cost changed from $11.10 to $0. Called to make sure not a mistake. The person I spoke to assured me that the new cost is accurate. Color me surprised and doubtful.

 

[tenant13]

I honestly don’t know what PCP is for. I have a cardiologist, dermatologist and urologist I like and will always prefer going directly to a specialist than talking to a PCP. No wonder they’re a dying breed.

 

[Buckeye]

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

+1 Yes, DH always gets this one in, especially since his doc is a solo practice. Not for specific complaints, just the big picture. Specific complaints are saved for a regular office visit.

 

[Buckeye]

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.

So, if the practice has 1,000 patients who are interested in staying, that's an extra $500,000 in revenue. Not bad!

 

[Koolau]

I honestly don’t know what PCP is for. I have a cardiologist, dermatologist and urologist I like and will always prefer going directly to a specialist than talking to a PCP. No wonder they’re a dying breed.

What if you have a back ache, sprained ankle, "rash," nose bleed that won't stop, bad cold that could be the flue or Covid?? Yeah, there's urgent care, but they don't know you but you know your PCP. YMMV

 

[punkinhead]

What if you have a back ache, sprained ankle, "rash," nose bleed that won't stop, bad cold that could be the flue or Covid?? Yeah, there's urgent care, but they don't know you but you know your PCP. YMMV

I don't know my PCP and he doesn't know me. He's booked out at least a couple months so if I need to see someone it's either a physician's assistant or urgent care. I haven't seen my PCP in over 3 years. For the things on your list the PA is fine.

 

[RetMD21]

*Medicare regs are apparently very sticky when the doc is asking to also get paid outside Medicare. The doc's payment has to be separated from Medicare visit billings, which by law cannot be surcharged to the patient. This affects what the concierge doc(s) can offer for services and charges.

Violating the law can have unpleasant consequences. Some of the advice to physicians who haven't opted out of Medicare is to consider billing medicare for known non-covered services since the rejection is good evidence that you were
billing the patient only for non covered services. That seems cumbersome and I don't think most physicians looking into alternative payment systems are wanting to complicate their lives. Opting out of Medicare or limiting the practice to non-Medicare patients are other alternatives but I think are more popular among the "direct care" group. The extra service of concierge practices will be attractive to some patients. No one is forced to participate if they think it's a scam, of course.

 

[Aerides]

I honestly don’t know what PCP is for. I have a cardiologist, dermatologist and urologist I like and will always prefer going directly to a specialist than talking to a PCP. No wonder they’re a dying breed.

But I didn't have a cardiologist until my PCP ran an EKG and detected PCPs.
I didn't have an endocrinologist until my PCP felt my neck and said I should get my thyroid checked.

Yes, I prefer to go directly to specialists for those things, but it's the PCP who helps you know if/when you need them.

 

[Jerry1]

I don't know my PCP and he doesn't know me. He's booked out at least a couple months so if I need to see someone it's either a physician's assistant or urgent care. I haven't seen my PCP in over 3 years. For the things on your list the PA is fine.

I see my pcp every 6 months. When I was in the hospital, he called/texted my DW daily. His input on some of my decisions was helpful and his agreement with most of the treatments was comforting. I’ve know him for 15 years or so and I’m very thankful he’s on my medical team. He’s the one that discovered that it was my kidneys failing and not COVID though the symptoms were similar enough. I didn’t have a kidney specialist before then. When my thyroid went crazy, he helped me get it under control. No waiting for an endocrinologist. He does regular bloodwork on me and makes adjustments to my supplements as needed. Mostly he drills into me how important it is to eat properly. He also does a complete physical exam every year which includes favorites like a prostate exam, an ekg (I don’t have a cardiologist) and my internals (pushes into my stomach area and feels those organs).

As I said earlier in this thread, he takes no insurance. I pay him $170. So, for under $400 I get access to him. I directly text him with minor questions and could get into his office quickly if needed. I think that he’s a pretty good value.

 

[punkinhead]

I see my pcp every 6 months. When I was in the hospital, he called/texted my DW daily. His input on some of my decisions was helpful and his agreement with most of the treatments was comforting. I’ve know him for 15 years or so and I’m very thankful he’s on my medical team. He’s the one that discovered that it was my kidneys failing and not COVID though the symptoms were similar enough. I didn’t have a kidney specialist before then. When my thyroid went crazy, he helped me get it under control. No waiting for an endocrinologist. He does regular bloodwork on me and makes adjustments to my supplements as needed. Mostly he drills into me how important it is to eat properly. He also does a complete physical exam every year which includes favorites like a prostate exam, an ekg (I don’t have a cardiologist) and my internals (pushes into my stomach area and feels those organs).

As I said earlier in this thread, he takes no insurance. I pay him $170. So, for under $400 I get access to him. I directly text him with minor questions and could get into his office quickly if needed. I think that he’s a pretty good value.

Different people are in different situations. It sounds like the OP is one of those people, like me, who goes to the doctor once a year for a wellness check. I'm 57 now and know that my good health isn't going to last forever so there will come a time where I won't accept my current situation of an overbooked PCP who I can't see. I'm willing to pay for convenience and good service so when I start to have more health issues I'll seriously investigate concierge medicine. I'm thankfully not there yet.

 

[Closet_Gamer]

I think the way the PCP just notified the OP of a new annual fee is BS. I'm not even sure its legal. You are not allowed to force a "negative option" onto customers where they have not signed up for a service and suddenly receive a bill. You can increase charges for a service, but you can't invent a service and then send bills. Its nonsense and I would shop elsewhere.

That said, the US healthcare system is terribly broken. The bloated and vertically integrated big firms rake in huge profits while pushing for more "efficiency" through scale, making it harder to access services and outsourcing things to the customer. At BEST they are starting to look like airlines. Its no wonder that things like concierge services (eg., first class seats and lounge memberships) are growing.

DD is currently entering the pharmacy industry. Based on what she has done to learn what she knows and get licensed, she absolutely has earned the right to make a lot of money. Its breathtakingly complicated and far more intensely specialized that I ever would have known.

But the insurance/corporate structure wastes SO MUCH of highly specialized people's time chasing forms and approvals. Its crazy.

 

[athena53]

DD is currently entering the pharmacy industry. Based on what she has done to learn what she knows and get licensed, she absolutely has earned the right to make a lot of money. Its breathtakingly complicated and far more intensely specialized that I ever would have known.

But the insurance/corporate structure wastes SO MUCH of highly specialized people's time chasing forms and approvals. Its crazy.

I agree- when I see the pharmacists at the local drug store they're dealing with tired, sick people who are freaking out at their OOP costs, chasing down doctor's offices for refill prescriptions, searching for better prices on GoodRx... after years spent studying chemistry and biology that are well above above my pay grade.

 

[Koolau]

I don't know my PCP and he doesn't know me. He's booked out at least a couple months so if I need to see someone it's either a physician's assistant or urgent care. I haven't seen my PCP in over 3 years. For the things on your list the PA is fine.

I start with "MyChart" if it's not urgent enough to go to urgent care. Doc never takes longer than 3 business days to get back to me either with a med or instruction or "urging" toward urgent care. In most single-issue "problems" doc can get me in within a few days. Heh, heh, by then, the back-ache may be gone!

 

[dianinco]

My answer is different than it would have been a month ago when I found out my Internist is retiring. Yes I would pay the 500 to keep seeing her. She has been my doc for years and always spent enough time w me for my yearly appts. I now have to find another doc. She is in a major hospital health care system. They require them to carry a 1600 patient load. She has not taken new patients for years and has cut back on how many days a week she worked over the last few years so not sure if that 1600 applied to her. Anyway she was a great doc and I would pay that just to keep her.

 

[ShokWaveRider]

What if you have a back ache, sprained ankle, "rash," nose bleed that won't stop, bad cold that could be the flue or Covid?? Yeah, there's urgent care, but they don't know you but you know your PCP. YMMV

One does what any self-serving person does, you go to the emergency room.

I must admit, I have little use for my PCP these days with the exception of renewing my BP meds, and I am not about to pay a subscription for that privilege, however, the specialist can do that too with a simple phone call or the pharmacy does it automatically. I like others go direct to a specialist if I have a real issue. We do not go to the doctor for minor things and all our other ailments are covered by specialists.

We do like our PCP though; we always have a good chat about life in general when we go. We have to do that once a year for some reason otherwise he cannot renew our meds.

 

[mickeyd]

annual $500 fee to be a patient there.

Sounds like a money grab by the doctor. Will the fee be $600 next year? $1000 after that? Are other patients (second class) happy that their Dr. is treating them differently than those who slide him an extra $500 annually?

So glad that I have all of these "benefits" with Tricareforlife that is paid for by my fellow Americans (thanks fellow Americans).

 

[Koolau]

Sounds like a money grab by the doctor. Will the fee be $600 next year? $1000 after that? Are other patients (second class) happy that their Dr. is treating them differently than those who slide him an extra $500 annually?

So glad that I have all of these "benefits" with Tricareforlife that is paid for by my fellow Americans (thanks fellow Americans).

Yeah, we pay for it, but you earned it.

 

[athena53]

Are other patients (second class) happy that their Dr. is treating them differently than those who slide him an extra $500 annually?

Well, I look at it this way: I paid far more for Medicare A via payroll deductions through a 38-year high-paying career than someone who worked 40 quarters at minimum wage. And now I'm paying IRMAA surcharges. None of this gives me any extra service whatsoever. (And maybe it shouldn't- I understand that keeping health care coverage mostly affordable for all seniors should be a priority.) If I have ongoing issues that require frequent monitoring and I can pay more to get upgraded service, yeah, I'll do it and I hope the people who don't pay for "concierge" treatment understand that if you pay more, you generally get more.

 

[disneysteve]

I honestly don’t know what PCP is for. I have a cardiologist, dermatologist and urologist I like and will always prefer going directly to a specialist than talking to a PCP. No wonder they’re a dying breed.

PCP here (well former PCP now doing Urgent Care but 24 years as a Family Doctor).


When new patients came to me I was often shocked by how many of them were seeing multiple specialists for routine problems that their PCP should have been managing. Cardiology for high blood pressure and cholesterol. Urology for enlarged prostate. Dermatology for eczema or psoriasis. Endocrinology for diabetes or thyroid issues. I reined that in as much as possible. Patients loved not having to run around to 3 or 4 or 5 different doctors anymore to get their care. THAT is what a PCP is for. Certainly I referred people to specialists when appropriate but for the most part, I managed my patients' medical issues except for the really complex ones.

 

[RetiredHappy]

PCP here (well former PCP now doing Urgent Care but 24 years as a Family Doctor).


When new patients came to me I was often shocked by how many of them were seeing multiple specialists for routine problems that their PCP should have been managing. Cardiology for high blood pressure and cholesterol. Urology for enlarged prostate. Dermatology for eczema or psoriasis. Endocrinology for diabetes or thyroid issues. I reined that in as much as possible. Patients loved not having to run around to 3 or 4 or 5 different doctors anymore to get their care. THAT is what a PCP is for. Certainly I referred people to specialists when appropriate but for the most part, I managed my patients' medical issues except for the really complex ones.

I take an opposite position. We have a concierge doctor (PCP) and he prefers to defer to specialists. I have serious chronic urticaria my entire life and was mistreated by PCPs and Allergists (dermatologists said it's not in their area) for decades and it was so bad that I preferred to be dead. My current PCP referred me to the top rate Allergist and Immunologist and he treated me with one drug that changed my life. After being alive and suffering for 56 years, I finally had a specialist who actually treated me with the right drug.

My husband is type 2 diabetic and refused to see an endocinologist for the 20 years since becoming diabetic. Two steroid shots to his shoulder sent his blood sugar out of control, and we did not correlate the out of control blood sugar to the steroid shots. His orthopedist and our PCP certainly didn't know. In a crisis state, my PCP got him to an endocrinologist, who gave him insulin to bring his blood sugar down quickly and told us that it was caused by the steroid. Subsequently the endocrinologist gave him a different drug from what the PCP had prescribed, and his blood sugar is in much better control than before.

I believe that for difficult chronic conditions, a top specialist is better than a top PCP.

 

[athena53]

I believe that for difficult chronic conditions, a top specialist is better than a top PCP.

Maybe there's a middle ground. In Dad's last years my brother was taking him to a crazy number of specialists- most of his issues were just typical things that happen when you get old. DisneySteve mentioned high BP and cholesterol management- if a prescription is keeping them under control do you really need a specialist? I agree that the conditions you mentioned are a lot less common and took someone with deep expertise to figure out what was wrong and how to treat it, but I hope that as I get older my life doesn't consist of specialist appointments. I'm almost 71 and so far have "only" a cardiologist who monitors my mitral valve prolapse annually.

 

[tmitchell]

PCP here (well former PCP now doing Urgent Care but 24 years as a Family Doctor).


When new patients came to me I was often shocked by how many of them were seeing multiple specialists for routine problems that their PCP should have been managing. Cardiology for high blood pressure and cholesterol. Urology for enlarged prostate. Dermatology for eczema or psoriasis. Endocrinology for diabetes or thyroid issues. I reined that in as much as possible. Patients loved not having to run around to 3 or 4 or 5 different doctors anymore to get their care. THAT is what a PCP is for. Certainly I referred people to specialists when appropriate but for the most part, I managed my patients' medical issues except for the really complex ones.

DisneySteve what do you think of the annual fee to remain at a PCP's practice? Is this just a way to make more money or a legitimate issue with insurance companies stiffing doctors? This seems to be a creeping issue that's been going on for years here in CA.

 

[disneysteve]

Two steroid shots to his shoulder sent his blood sugar out of control, and we did not correlate the out of control blood sugar to the steroid shots. His orthopedist and our PCP certainly didn't know. In a crisis state, my PCP got him to an endocrinologist, who gave him insulin

That's awful. I hate hearing stories of incompetent doctors and the fact that your husband encountered two at once is even more appalling. How could an orthopedist who gives cortisone shots daily not know the common side effects of the drug he's injecting? How could a PCP not know that steroids spike blood sugar or be prepared to treat it when it occurs? The PCP should have started insulin immediately when your husband's levels shot up. There was no need to involve an endocrinologist.


If a PCP wants to abdicate all acute illness to Urgent Care and all chronic conditions to specialists, they deserve to be driven out of business. What a disgrace to the profession. I'm sorry your husband (and you) had to deal with that. I hope he has a much better PCP now.

 

[disneysteve]

DisneySteve what do you think of the annual fee to remain at a PCP's practice? Is this just a way to make more money or a legitimate issue with insurance companies stiffing doctors? This seems to be a creeping issue that's been going on for years here in CA.

It is totally a response to steadily decreasing reimbursement from insurers along with ridiculous increasing demands on a doctor's time. The system can't pay PCPs less and less each year while also requiring them to track and report more and more ridiculous metrics, do ever-increasing paperwork, and jump through endless hoops to get even the most basic care approved.


PCPs have had their hands tied. They can't afford to keep their doors open in many cases. A lot of the older doctors who are still hanging on are doing it out of loyalty to their patients and respect for the profession even though they are likely losing money in the process, but once people like them (and me) are gone, they aren't being replaced by new young providers. The independent PCP is a rarity today. Most are now part of big healthcare systems and don't provide anywhere near the level of service that I and my colleagues did.


If you call a PCP right now and say you're sick and need to be seen, odds are you will be sent to Urgent Care. If you called my office and said you were sick, we told you to come over and we'd squeeze you in. If we discovered you were diabetic or that your sugars had risen out of control, we started you on insulin on the spot with me giving you your first shot and setting you up to see a Certified Diabetes Educator the next day at my office. If the CDE wasn't available for a couple of days, I had you come back each day for me to give you your dose until you could be trained to do it yourself (or I trained you).


The subscription fee/concierge model arose to address all of this. Instead of being beholden to the insurance companies, doctors wanted a way to stay in private practice and provide the level of care they are trained to provide for their patients. They don't want to see a patient every 10 minutes. They don't want to refer out every little thing. By finding a way to limit their patient load via a subscription fee, they can spend a lot more time with each patient and manage things in-house which is far more efficient and yields better outcomes for the patients than being treated by multiple doctors in various specialties who don't necessarily all communicate with each other.


Sorry to rant but the demise of primary care is a sore subject for me.