$350 per year to remain a patient?

[Coach]

I thought it looked like pretty limited services compared to what I had heard about for "concierge medicine". From wikipedia:

"Concierge physicians care for fewer patients than in a conventional practice, ranging from 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year. All generally claim to be accessible via cell phone or email at any time of day or night. The annual fees vary widely, from $60 to $15,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services. Some concierge practices do not accept insurance of any kind.It should be noted that this annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers."

I must admit though that I really like my doc and would probably pay it. I think it's hard to make a good living in primary care these days.

Coach

 

[shoe]

Personally, I think it's worth it. Think of it as a tip.

 

[NW-Bound]

Since most health ins. is costing 1000+ a month I feel the Dr.'s should charge more to the ins. companies for their services.

I am not upset with the Dr, however. He needs to eat too! And while it may cost the consumer a lot of money, how do we know how much gets to the Dr, meaning the "friction loss" to the ins. co? What are his expenses?

One of my friends had gone to a medical practice for years. It was a partnership consisting of 5-6 doctors. They closed shop last year, not even asking for fees like the OP. They simply threw in the towels, period. My friend talked with his doctor, and the reason was simply that they worked too hard for too little money. Better work for hire in a hospital.

 

[Bestwifeever]

I would not mind paying a co pay and an extra reasonable office charge to a physician but $350.00 a year . What if you only visit him twice a year ? That is quite a mark up .

We have a $30 copay for primary care and specialists, and a 10 percent copay for all services already. I believe our insurance company also pays $10 or $20 to the doctors' offices for submitting forms. And I guess in lieu of Rich's office visit, we like others would be going to the emergency room after hours and most of that would be covered by insurance.

I could certainly see a group of doctors offering self-insurance--personally I would rather have paid health insurance premiums to doctors rather than insurance companies (and since I never get sick the doctors would have come out ahead on that one). I also don't have a problem with paying for services not covered by insurance (of course I don't need cosmetic surgery, but would definitely pay for it if I did ) or for those cute shoes Rich is now selling in his office.

But I wouldn't pay a concierge services fee for a hotel room or a cruise line, and I don't pay for first class air, so the idea of paying this for medical care seems to be quite the anti-lbym development!

 

[73ss454]

I have a hard time with it. We pay for the ins. then pay the co=pay, now they want a tip. Get it from my ins. company.

 

[Rich_by_the_Bay]

I have a hard time with it. We pay for the ins. then pay the co-pay, now they want a tip. Get it from my ins. company.

Understandable. But in most cases, the big insurance company makes you sign a contract in which the doctor agrees to accept their fees; sometimes but not always you can bill the patient for the difference. And since they own large chunks of market share through aggressive business practice, it is hard for a struggling primary care doctor to decline the contract. And I assure you that they're not pulling down $300K per year - more like mid-100s in most areas - a nice living but not exorbitant in context.

I'm not defending the trend. I'm just observing that if you beat up a profession long enough and "let the market work it out" while simultaneously limiting fees, you'll spawn retail behavior. And you still have 45 million without adequate insurance, and ERs filled with homeless and colds, and life-sustaining drugs at $1,000 a month, and a primary care shortage, and all the rest.

For the record, I have been in large academic medicine for decades. I'm not facing a private practice. But I don't judge my colleagues for wanting some type of supplemental payment to help them provide good care and ample time to those who choose to pay. This type of crap is one reason I am glad to be where I am.

 

[NW-Bound]

And I assure you that they're not pulling down $300K per year - more like mid-100s in most areas - a nice living but not exorbitant in context.

Thanks for info. I always wonder about that. Many professions make that much or more, with less schooling, and none of the headaches, fear of being sued...

It always bothers me as a consumer of health care that I do not know the costs of the middle man. Private insurance or guvmint, there is always the middle man.... Sigh...

I heard that in the old days (30s-50s), before medical insurance was widespread, people paid for doctor's visits out of their pockets, and it was cheap. No paperwork, no middle man. I don't know if people could save and pay for big hospital operations. Maybe they did that too. I appreciate info on this, just for my understanding. Thanks.

 

[Bestwifeever]

National health care, here it comes....

 

[A854321]

I haven't read all the other posts, but the one physician who became a "concierge physician" in my area is not at all well regarded by his peers. He doesn't have hospital priviledges, so if you have to be hospitalized, you must pay someone else for the care.

 

[Rich_by_the_Bay]

I haven't read all the other posts, but the one physician who became a "concierge physician" in my area is not at all well regarded by his peers. He doesn't have hospital priviledges, so if you have to be hospitalized, you must pay someone else for the care.

Fancy does not mean good in medicine (or any other field, IMHO). Membership payments or not, do your due diligence.

A tip: during a non-busy time, call the local emergency room, talk to one of the nurses, and ask her who some good internists (or pediatricians) are. It's often a good start.

 

[growing_older]

Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.

 

[Nords]

I think it's simple supply and demand. The magazine awards (and his skills and reputation) maxed out his practice years ago, and this is about the only way to raise his prices.

You're being told that he's worth more than you're paying him...

I'll go hunt for a younger doc. I was seeing the current doc 1-2 times per year, often just for referrals to specialists for issues with my knee and cornea. I'd also call maybe once or twice a year to ask him to call in an Rx refill "on the house".

... and now you're telling him that you don't agree.

But perhaps it would be better to be signed up with the new doc before you share this opinion with the old doc...

 

[Cb]

You're being told that he's worth more than you're paying him...

... and now you're telling him that you don't agree.

But perhaps it would be better to be signed up with the new doc before you share this opinion with the old doc...

I'd pay something to stay with him, but not $350 x 2 annually. For the first year...

 

[NW-Bound]

Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.

I don't know how many patients he is keeping, or what his expenses are, but I know not to judge too quickly. As an engineer, I knew my employers charged a whole lot more to their clients on contract jobs than what they paid me.

Then, when I joined a business venture, I finally understood when I was ultimately involved in writing checks to pay bills. Rent, insurance, utility, attorney and accountant fees, so many things I took for granted before. After working hard for 6 years, we folded. So, it is not what you take in, it's what you get to keep.

 

[SkisALot]

CB: If you're anywhere near Medicare age, find a new doctor now. Otherwise you might not be able to get one who will accept Medicare. Even if he does accept it, the treatment - as DH and many of our friends have found - can be subpar. As baby boomers retire, if they still can retire, and become Medicare eligible, there will be fewer and fewer doctors who will accept it. I'm assuming the same will be true of Universal Health Care: a great idea if you can see a doctor. But don't count on it.

 

[Rich_by_the_Bay]

Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.

The average panel size for internal medicine is around 1500. A concierge practice often reduces that to 500-1000 if I recall. There are some family medicine practices that approach 3000 but that often includes kids who require only a 5 minute ear check, etc.

A primary doctor struggling to make 6 figures and working his or her butt off looks at a $350 annual fee, slashes the practice in half, and can net $200k with little struggle. It's not hard to see why this concept is becoming more common.

BTW, aside from these fees, typical primary practices net about 45% of gross revenues.

 

[Gotadimple]

I don't know how many patients he is keeping, or what his expenses are, but I know not to judge too quickly. As an engineer, I knew my employers charged a whole lot more to their clients on contract jobs than what they paid me.

Then, when I joined a business venture, I finally understood when I was ultimately involved in writing checks to pay bills. Rent, insurance, utility, attorney and accountant fees, so many things I took for granted before. After working hard for 6 years, we folded. So, it is not what you take in, it's what you get to keep.

Well, you've certainly identified the doctor's income. But what about his/her expenses? Malpractice insurance is not cheap, and then there are the expenses of the office and the medical equipment in it.

Doctors in solo practice don't have the same economies of scale as doctors with multiple physicians practicing together. It's not cheap to deliver medical care in the US -- and as others have noted, sometimes what is delivered isn't good care.

Its our health care gordian knot.

-- Rita

 

[growing_older]

Regardless of the doctor's expenses, the new fee is completely new income with only the expense of billing (letter writing) for it. All the overhead of office space, receptionist, medical supplies, insurance and so on are still the same as they were before adding this fee.

I used the numbers from the earlier post that claimed typical doctors see 3,000 - 4,000 patients in their practice. Even allowing for the more accurate lower numbers you cite, it's still a substantial amount of income for very little cost (minimal billing, office staff you already had to ask questions, no additional insurance needed, etc)

 

[NW-Bound]

As R-I-T pointed out as an insider, this doctor may be increasing his pay to $200K from the low $100K. He is of course making more money with this move, but not to the outrageous level as it first appears. And perhaps he will be able to spend a bit more time per visit, and be able to accomodate his patient urgent appointments better.

I guess what I am saying is that perhaps this doctor is good at what he does to justify this high fee. If I were him, I would try to sweeten the deal a bit by giving rebate for the annual exam, etc...

We are in our early 50's and still healthy, so our doctor makes little money from us. As I mentioned in an earlier post, we made the point to see him once a year, so he won't throw our file away. On the other hand, he is seeing a lot of Medicare patients, and I heard that pays even less. I don't envy his job.

 

[Westernskies]

If you think health care is expensive now, wait until it is free...

 

[jIMOh]

I just received a remarkable notice from my primary care doc.

This guy came highly recommended by a company physician years ago, and I've been very pleased with him since becoming a patient. In the years since I've convinced numerous family members to switch to him, and they've all been pleased as well.

A few years ago he was selected and profiled as one of the "Best Doctors in Cincinnati" in a local glossy magazine and has since made the list repeatedly. We're quite friendly - he was especially intrigued by my early retirement, and talked about how difficult it'd be for him, with his med school debt and ever-lower reimbursements, etc. He said he really could have used the Best Doc's thing years ago when he was trying to grow his practice. Shortly after making the list the first time he stopped accepting new patients himself, sending then to his younger partner instead.

Well, it appears he's on his way now, because he just sent all of his patients a big envelope with a cover letter describing all the time he spends on non-reimbursed administrative activities such as completing forms for school activities, life insurance applications, sick notes for schools & employers, Rx's & refills not accompanied by a paid appointment, etc.

His solution is to have all his patients complete the enclosed application to stay with him after Jan 1, 2009, and pay an annual advance fee of $350 per person. He's encouraged patients to apply early, as room will be limited. The $350 doesn't apply to any subsequent treatments or services, it's just a flat advance annual 'membership' fee.

Seems to me the guy has found a way to capitalize on the Best Docs in Cincy publicity, rake in and extra $350 ea. annually from his deeper-pocketed patients, and ditch the high-maintenance nuisances, whether they're willing to pony up the $350 or not.

Ever heard of anything like that?

Cb

I live in cincy too and have heard of other doctors doing this. Mine has not... but I also haven't seen my doc for 2-3 years.

 

[donheff]

A primary doctor struggling to make 6 figures and working his or her butt off looks at a $350 annual fee, slashes the practice in half, and can net $200k with little struggle. It's not hard to see why this concept is becoming more common.

I would be willing to pay this for a very good doctor who made it easy to reach him/her, took time at the appointment to really deal with you, etc., and continued to honor my insurance for the actual medical work. DW had a doctor who provided that kind of service (without the concierge fee) but was not a participating provider in BC/BS. I went for a while and liked him but was not impressed that he knew more than other doc. I switched to a nearby doc who has a mixed medicare/medicaid and regular paying practice. Dealing with the practice staff for appointments and refills is a PITA but he is very good and participates in my insurance plan. It is worth the hassle.

 

[Rambler]

I think a major problem is that the insurers spend so much time, money, and effort figuring out how to not pay reasonable claims on the one hand, and beating up the poor docs on the other hand, that the only real winners seem to be the insurance companies. For example, my DW does not work and therefore has insurance only thru my employment/insurance provider. We are pretty healthy, so she typically only sees the doc for her annual exam, and maybe one a year when her allergies are bad. But, each time she goes, we get a letter from the insurance telling us that if we do not certify via their website that she does not have any other insurance within XXdays, they will not pay, and their obligation ends. My DW has not worked outside the home (maintaining a home for me and the kids IS work though) for the last 16 years and my reply to the insurance is always the same, but they are always asking. They also tend to decline payments for such services as blood tests and mammograms, if you don't get on their case (not always, but it happens frequently enough that I remember it happening too often). Its almost as though they automatically throw out a certain number or percentage of claims for denial, just to see if the denial will be contested. No contest means no pay, and then the patient either pays or the poor doc has to eat it.

So, if I knew I would stay relatively healthy and had the doc's full attention, had a catastrophic care/high deductible with a HSA, I would not mind paying a couple/few hundred dollars to secure access to good healthcare. On the other hand, it is hard to justify 12,000 or so for a couple per year for healthcare when you can only get a peremtory look down the throat and in the ears once a year when you have the sniffles. Kinda glad that the little bout I had earlier this year was here in asia where it didn't cost so much and I got good care, but for which I pay for via socialized medicine (the more you make the more you pay, and at a higher percentage of salary...this is mandatory here, even though I have insurance thru employer in the states).

Just my two cents.

R

 

[Rich_by_the_Bay]

I used the numbers from the earlier post that claimed typical doctors see 3,000 - 4,000 patients in their practice. Even allowing for the more accurate lower numbers you cite, it's still a substantial amount of income for very little cost (minimal billing, office staff you already had to ask questions, no additional insurance needed, etc)

Maybe so. But from the doctors' perspective, the underlying "justification" is hours and hours of paperwork required by insurance companies, medicare, weekend call, non-paying patients who repeatedly return and must be cared for, etc. for which the doctor receives no income - zilch.

If you define health care as no different from any other small business, you will eventually see the principles acting in their own competitive interest. It's the free market at work: no one criticizes a dry cleaner from raising the price of cleaning a shirt to whatever the traffic will bear.

I find all the above scenarios to be unfortunate and have chosen my career path accordingly. But since health care is expected to be available to anyone (we can't and shouldn't deny it to anyone who is ill or injured) and since it is still stunningly expensive to get through college+med school+residency+delayed FIRE saving, doctors won't work for low salaries, and someone has to pay for it.

Universal coverage is a good start. National health care, I'm not so sure.

 

[Dawg52]

Personally, I think it's worth it. Think of it as a tip.

I ain't tipping a high paid doctor. If I ever get one of these letter's, I'm gonna tell him to shove it up his a$$.