Primary care doc - necessary?

[foxfirev5]

I think you're right in most cases. All my blather about project management was about what IMO should be , not what is. @disneysteve is reporting from the battlefront, what is. When the docs are in an environment when they are scheduled for 15 minute patient visits, there really isn't time for a lot of thoughtful project management even if the desire is there. Not inconsequential, too, is that the system probably doesn't pay them for doing this.

So the real world is that we and our spouses have to be the project managers and do the best we can. For DW and me, this includes coaching our concierge PCP towards the project management role, which is out of the norm that he's from.

Sorry to be short - If that's the case I really don't see the need for a concierge PCP. We are fortunate in that our Medicare PCP's perform well within our chosen specialists. Medicare Plan G and instant referrals for critical needs. Maybe we're an exception.

 

[OldShooter]

... I really don't see the need for a concierge PCP. ...

I think that's a different thread. We are very happy with our decision.

 

[foxfirev5]

I think that's a different thread. We are very happy with our decision.

Ok - But I don't think that needing to coach a provider is optimal in the long run.

 

[foxfirev5]

For DW and me, this includes coaching our concierge PCP towards the project management role, which is out of the norm that he's from.[/QUOTE]

Just sayin'

 

[OldShooter]

Ok - But I don't think that needing to coach a provider is optimal in the long run.

No. Not optimal but not difficult. This is a role that the medical industry has (AFIK) never broadly developed and is hence not familiar. In particular, docs do not seem to be used to used to telling other docs what to do, but that is a one role that is needed. So ... a little coaching ...

 

[RetMD21]

We can elect to keep our current PCP who is about 2 hours away with light traffic. He can still perform the “overview” function for us, but doesn’t have relationships with any local hospitals since he is so far away.

I’m hoping DH’s cardiologist can refer him to a good PCP. I guess in the meantime he can continue his relationship with his existing PCP who has been treating him for 25 years.

I will likely try the local doc who has been in practice for a year and see how her approach differs from my long-term PCP. I suppose I can keep both for a few years if I choose to as long as I’m willing to cover whatever insurance won’t pay for.

It’s frustrating that finding a PCP is so difficult. I appreciate Freedom 56’s suggestion to use docs in West Los Angeles. I do have one specialist at Cedars, but the drive over there is horrible and my goal is to have a PCP who can oversee my care if I end up in a hospital in the desert. As my DH’s situation proves, hospitalizations aren’t always planned so having a local doc would be nice. DH’s cardiac surgeon wanted to know who DH’s PCP was, and as soon as we told him his PCP was not in the desert, he immediately tuned out and I doubt he contacted him at all while DH was in the hospital.

For a specialist the primary care doc is the customer. There is no prospect of significant repeat business from an out of town doctor. Realistically in hospital care will be managed by the "team" and the primary care doc will ideally be informed. Disneysteve sent his patients to the best specialists but some primary care docs were referring to the others. Insurance networks and corporate ownership determine referral patterns in many cases. I wouldn't lose sleep over having a primary care doc who was some distance away.

 

[RAE]

Yes, you need a PCP--they will overlook everything for you, especially as you start getting referred to other specialists. (at least thats what they are supposed to be doing)
A Primary Care Provider can be a MD, DO, NP, PA.

I agree with this. I currently use a younger PA as my primary care provider, and he is very good - better than some MD's I have had in the past. My wife also went to a PA for some issues she was having, and was very satisfied with the care she got. Don't rule out PA's or NP's, there are some excellent ones out there.

 

[teej1985]

We live in Palm Springs, CA and DH’s recent hospitalization made us reconsider the wisdom of relying on our current primary care doctor who is on the So CA coast. Before when we thought we were healthy, it didn’t seem like a big deal, but now we are thinking we need local docs.

I spent most of the day yesterday calling around. There are almost NO primary care docs in the entire Coachella Valley accepting new patients, and the few who are have been in practice just 2-4 years. This includes “concierge” programs that cost a substantial amount to join.

It’s just amazing to me that this situation is so prevalent. I’ve gotten referrals from quite a few friends, and none of their docs are taking new patients.

I have a GYN, a dermatologist and an ortho/sports med doc. DH will definitely get set up with a cardiologist following his recent heart surgery. I suppose one option is for one of our specialists to monitor our routine blood work and refer us to appropriate specialists as needed. We could just go to urgent care or the ER if something comes up that warrants immediate attention.

Given that we can’t seem to get primary care doctors who have any reasonable amount of experience, do you think we actually need primary care docs? Is this a problem in your area and if so, what are you doing about it? The docs out here don’t even take waitlists as many have not accepted new patients for over a year.

We have PPO insurance with great coverage so that is not the issue. We are too young for Medicare.

I believe my dad found a concierge PCP at Eisenhower. He seems happy.

 

[Scuba]

I believe my dad found a concierge PCP at Eisenhower. He seems happy.

Right now they are only offering one option in their concierge program. When I researched that person’s credentials and reviews, I wouldn’t have selected that doctor. So for now, I’m passing on paying the $3K/year and looking for another option.

 

[OldShooter]

When I was researching it, "concierge" covered an incredibly wide range of practices. One wild card is Medicare, which has a number of rules intended to keep patients from having to pay surcharges. In some practices I checked into, their answer was to not accept Medicare or any insurance, rather having the patients private-pay for services. These tended to be fairly small/1 doc operations. Other practices did charge but the patient contracts were carefully worded to step over the Medicare tripwires.

Another wild card was the number of docs. Often the number was one, so no backup if the doc is busy or otherwise unavailable. Off-hours access to a doctor via phone call varied as well.

There were lots of other differences; simply looking at the word "concierge" is like looking at the word "car." Lots of differences exist and lots of details need to be understood before making a choice.

 

[ncbill]

No PCP for me anymore, they were getting on my nerves:

"Lose weight, stop using recreational drugs, etc....nag, nag, nag."

 

[RetMD21]

When I was researching it, "concierge" covered an incredibly wide range of practices. One wild card is Medicare, which has a number of rules intended to keep patients from having to pay surcharges. In some practices I checked into, their answer was to not accept Medicare or any insurance, rather having the patients private-pay for services. These tended to be fairly small/1 doc operations. Other practices did charge but the patient contracts were carefully worded to step over the Medicare tripwires.

You are right, there are all sorts of variations. Concierge and "direct primary care" overlap to some degree. Some physicians "opt-out" of Medicare and are free of the rules other than the notification to patients. Those who don't opt-out have to be careful not to violate the rules. Some advisors tell them to bill Medicare even for noncovered services since the best proof that Medicare didn't cover the service is a rejected claim. It isn't too attractive to have a billing department to submit claims for rejection.

The patients of opted-out docs can't be reimbursed by Medicare including MA plans. In contrast if the doc just doesn't sign an insurance company contract, he/she can still provide a claim form for other patients which they can submit.

It's understandable that some solve the Medicare problem by not taking Medicare patients.

By the way "nonparticipating providers" are distinct from opt-out. They participate in Medicare under modified billing rules.

I value my independent primary care doc. I hope he stays in business. I am not sure I would be happy with big box primary care.