VIP Medicine

[SumDay]

We both got letters yesterday from our General Practitioner. At the end of the year, she'll be starting a 'wellness' practice under the MDVIP umbrella. Concierge medicine, as I've heard some call it. It's $150 a month for each of us.

I'm struggling to see the value. DH is on Medicare, and I will be in 15 months. My retiree med premiums are high enough without adding another $150 a month to the mix. The letter says that we'll have access to her after hours for phone calls, and there will be lots of one-on-one time to discuss health and diet issues. She's whittling down her practice from 2500 to the first 600 that sign up.

Does anyone avail themselves of such services? What do you think? Pros & cons?

And what happens when all docs go this route?

 

[ShokWaveRider]

No it is not worth it. IMHO DW's ACA is only $60 a month and with Blue Cross she gets reductions to that has been cut to almost Zero for participating in their "Better You" Rewards program. Our doctor offers the same, but she sees him via Florida Blue ACA. She has not been to see him yet this year. His is $150pm also.

 

[njhowie]

Tough call, but having a MD spouse I completely understand the doctor's point of view in doing it.

If you like your GP and would like to stay with her, then do it. If you're of the belief that doctor's are more or less a commodity these days and you can develop a relationship with any of them, are ok possibly waiting a longer period to get an appointment, have the doctor or assistant spend little time with you, and compete with all the other patients they may have, then save the money.

Does your budget/savings have $1800/year that you can readily afford it? Do you visit more than just a couple times a year? If so, then I wouldn't fret about it and just do it.

I don't believe all docs will go this route in the future. There will always be supply and demand for those who will take what the system gives them for all tiers of the healthcare infrastructure - both from the patient perspective and from the doctor perspective.

 

[OldShooter]

... Does anyone avail themselves of such services? What do you think? Pros & cons? ...

Well, "con?" It costs money. Ours is $5K/year for the two of us. $3K/year for one. We have been doing it for 5-10 years. I don't remember.

The first thing to know is that each concierge program is different, especially on how they handle insurance. Some charge the patients and won't bill insurance companies. The number of docs varies, too. In our case, the program is imbedded in a large health care organization. There are three docs assigned, one of them is always in the office during the day. There is also a cell phone that is carried 24x7, rotating among them. We are on a first name basis with everyone in the office, docs, RN, and LPN/receptionist. When I first signed up there were only two waiting room chairs. Now, for some reason, there are four. But I almost never see anyone sitting there.

When DW had her hip replacement our doc monitored her care via the hospital-linked computer system and called her almost every day to check on her. Had there been any reason for a visit, he would have been there. The nurses on the station were blown away but the attention this doc paid to DW. They had never seen anything like it.

Last year I got back from a trip and wasn't feeling well, so I called the office and said I'd like to come in. "What time would you like to come?" was the response. That is pretty neat.

Where we need a specialist referral our doc will recommend a specific name, not just send us to the department to roll the dice.

Is this cost-effective? I have no idea. We get great service now, but my bigger reason for being in the program is that they will be there for us if something really bad happens, accident or disease. We will be able to get advice on a real-time basis and they will monitor the docs and the care we are getting. The biggest flaw in the health care system IMO is that it does no project management. Customers/aka patients and their families are left to deal with a fractured system of specialization with no one in charge. Our concierge doc will be our project manager.

But YMMV widely, as these programs are all different. HTH.

 

[MRG]

My DM did for a while. It was only because mom was demented and really liked her provider and couldn't discuss things very well when she made the decision. This was 15+ years ago and I think it was 2k yearly.

 

[Aerides]

I would have to want/need a super high engagement with my doc to find value in the service described. My need for a PCP is kinda minimal, at least for now, and hopefully for a good long while. If I were maintaining multiple chronic things to where I'd want a monthly visit, I might think differently.

 

[Sunset]

I have to wonder, does the Doctor actually limit their practice to the paying VIP people, so in OP's case the doctor now will only have 600 patients ? How would this be monitored/confirmed, as certainly the Doc stating it, makes it seem like part of the value.
The payments from the 600 is worth $90,000/yr to the doctor.

If the Doc still charges for visits, then what is someone getting by paying, other than some promise of quick access.

My Doc gives me named referrals for specialists, but I still look them up to see the ratings as for all I know referral is based on drinking buddy status.

 

[OldShooter]

... The payments from the 600 is worth $90,000/yr to the doctor. ...

My calculator makes is $1.08M. 600 * 150 * 12 That's assuming the doc fills all the slots, which will probably take a while if she is ever able to do it.

 

[Sunset]

My calculator makes is $1.08M. 600 * 150 * 12 That's assuming the doc fills all the slots, which will probably take a while if she is ever able to do it.

Thanks...... I need more than 2 coffee's today

 

[rodi]

This seems like it adds valuel ****IF**** you have a frequent need to see your PCP for ongoing issues.

But as someone mentioned - some of these concierge Docs no longer do insurance billing... So you are paying EXTRA and getting LESS service.... not exactly concierge service to switch the burden to the patient.

I don't go to the doctor a lot, so for me it's not a value. It is a great value for the doctor. Less work, more money.

 

[Scrapr]

After Mrs Scrap's cancer treatment it's tempting to look at the what ifs. Specialized treatments, drugs, etc. And 'maybe' a VIP Doc could help. But how far into the weeds would they go and would they be an expert in treatments? A friend of ours caught a very rare adrenal cancer. She treated at Stanford & then Seattle. Got into a early stage drug trial that saved her life. What value would a VIP Doc bring to that plan?

We were very happy (except for the outcome of course) with the time the oncologists spent with us. They never rushed us & would talk about anything for as long as we wanted.

Maybe with the more common ailments the VIP Doc would be helpful.

 

[braumeister]

My calculator makes is $1.08M. 600 * 150 * 12 That's assuming the doc fills all the slots, which will probably take a while if she is ever able to do it.

It's worth noting that the doctor will only get some portion of that, from which he or she has to pay staff salaries and office rent. The rest goes to the company (MDVIP in this case).

I've talked quite a bit with doctors who have switched to some sort of concierge plan, and they universally seem to love it. One made the comment that instead of dreading Monday mornings, he looks forward to going to work every day because "nearly every one of my patients is someone I enjoy being with, because we have a real relationship. I feel like a physician again instead of a mechanic."

If it's affordable, I think it's a great way to go.

 

[OldShooter]

... What value would a VIP Doc bring to that plan? ...

Having gone through BIL's failed heart transplant, and having spent a large chunk of my professional career in high tech project management I think I can answer this.

The way I explain project management to docs is by asking them to visualize a meeting room with all of the patient's docs present (which will never happen in today's system). Then, at the end of the meeting someone says: "Thank you all for your inputs. Here's what we're going to do ... " That person is the project manager. This, too, will never happen in today's system.

We sat in the family waiting room outside BIL's intensive care room for over a month. We watched docs coming and going. The heart guy. The kindney guy. The infectious disease guy. ... Never meeting or talking to each other. We also watched the young pharmacist come up every day to spread out all the drug orders to make sure the docs weren't screwing each other up. The only one who had the big picture was BIL's day nurse, who worked 12 hour shifts. But the nurse had no authority to lead or guide. All he could do was to very respectfully ask questions as he coached the relevant doc. He was fantastic but the project management was all wrong. There's no way to know whether BIL would have survived had the project been managed better, but ... maybe.

So that's one of the reasons we have hired these concierge docs. One of them is going to be the project manager if/when something serious comes along. The problem is never the experts per se. It is always in the "cracks" between experts where assumptions and plans don't line up. I once hired a technical director for a $100M++ project I was running. The first thing he asked was "What do you want me to do?" I said "Dave, you're in charge of the cracks." And he was and he did a good job of it.

Quick example: The first fuselage section of the A380 was brought in from one factory and its wiring harness was brought in from another. Both pieces were done exactly right, but they didn't fit and could not be made to fit. Something about the two design automation systems was incompatible. That is a problem in a crack between experts. Because of the schedule slip to fix that problem, 100% of the A380 freighter orders were cancelled. 100%!

 

[jollystomper]

We have a concierge in a sense via one of my brothers, who is a GP and runs his own practice. His DW is also a doctor. If any of us have serious medical issue/questions, they are happy to run interference for us. Don't worry, we rarely bother them, we want to start on their good side.

The most important aspect: he gets a better response from other doctors than we would on our own. In fact, sometimes we have just mentioned that we have a doctor in our family and would they mind if we shared information with them, and the attitude changes.

And, as OldShooter mentioned, he or SIL will act, our give us the proper tools to act, as a project manager for care when multiple doctors are involved.

So a concierge makes sense to me from that aspect... I would view it as a "blow that dough" option, if one can afford it, it is worth considering.

 

[MichaelB]

I think primary care physicians are overworked and underpaid, badly underused by our current insurance system, and can offer significant value to patients. A concierge or VIP practice has the appearance of exclusivity, but the value they offer is the knowledgeable, specialized counsel, and if needed, assistance navigating the health care system to obtain specialized care.

 

[Franklin]

Well, "con?" It costs money. Ours is $5K/year for the two of us. $3K/year for one. We have been doing it for 5-10 years. I don't remember.

The first thing to know is that each concierge program is different, especially on how they handle insurance. Some charge the patients and won't bill insurance companies. The number of docs varies, too. In our case, the program is imbedded in a large health care organization. There are three docs assigned, one of them is always in the office during the day. There is also a cell phone that is carried 24x7, rotating among them. We are on a first name basis with everyone in the office, docs, RN, and LPN/receptionist. When I first signed up there were only two waiting room chairs. Now, for some reason, there are four. But I almost never see anyone sitting there.

When DW had her hip replacement our doc monitored her care via the hospital-linked computer system and called her almost every day to check on her. Had there been any reason for a visit, he would have been there. The nurses on the station were blown away but the attention this doc paid to DW. They had never seen anything like it.

Last year I got back from a trip and wasn't feeling well, so I called the office and said I'd like to come in. "What time would you like to come?" was the response. That is pretty neat.

Where we need a specialist referral our doc will recommend a specific name, not just send us to the department to roll the dice.

Is this cost-effective? I have no idea. We get great service now, but my bigger reason for being in the program is that they will be there for us if something really bad happens, accident or disease. We will be able to get advice on a real-time basis and they will monitor the docs and the care we are getting. The biggest flaw in the health care system IMO is that it does no project management. Customers/aka patients and their families are left to deal with a fractured system of specialization with no one in charge. Our concierge doc will be our project manager.

But YMMV widely, as these programs are all different. HTH.

+1

DW and I moved to a new city a year ago and were referred to a new doctor. The doc was nice but getting to see her was a real hassle. Calls were returned normally days later and referrals to other specialist seemed to be forgotten. I later asked the doctor "how many patients she saw a day" The answer was 40. Wells my 12 minutes naturally seemed rushed. On top of that we lost hours sitting in the over crowded waiting room. So......we dropped that doc and joined a new MDVIP program. The treatment is as different as night and day. We have our new doc's cell, we use a private waiting area (stocked with refreshments), we know the staff, they call after visits to check on us, we get an annual physical (tons of test) We do not pay for office visits (but do pay an annual fee of $1800.) The doctor indicates he will assist any relatives who happen to need care while visiting (24/7). Lastly, he invited me to lunch to get better acquainted.
So far we have been very pleased. The only downside I see is the cost. Sorta like flying first class versus coach.

 

[RetMD21]

We both got letters yesterday from our General Practitioner. At the end of the year, she'll be starting a 'wellness' practice under the MDVIP umbrella. Concierge medicine, as I've heard some call it. It's $150 a month for each of us.

Seems pricey to me. There are different models and some have a lower monthly payment and the doc relies partially on insurance payments. There are complications with medicare.

 

[idledancer]

We both got letters yesterday from our General Practitioner. At the end of the year, she'll be starting a 'wellness' practice under the MDVIP umbrella. Concierge medicine, as I've heard some call it. It's $150 a month for each of us.

I'm struggling to see the value. DH is on Medicare, and I will be in 15 months. My retiree med premiums are high enough without adding another $150 a month to the mix. The letter says that we'll have access to her after hours for phone calls, and there will be lots of one-on-one time to discuss health and diet issues. She's whittling down her practice from 2500 to the first 600 that sign up.

Does anyone avail themselves of such services? What do you think? Pros & cons?

And what happens when all docs go this route?

I haven't done it, but I would if I needed to see a doctor regularly.

A former coworker has frequent health issues and was having a terrible time getting appointments. Over lunch one day he explained he'd signed up with a concierge medical service a few months back. He makes all of his appointments over text message and they're actual appointment, often the same day, with a beginning and end. He arrives at the doctors office at the arranged time, and is immediately shown to a room where a doctor is waiting. He's free to use as much of the doctor's time as he's scheduled for, or make a followup appointment if needed. He still has employer health insurance and is ecstatic about the service.

Between DW and we pay $12k+/year for insurance. If I needed regular care I can't imagine dealing with the terrible service of every PCP I've ever had. I'd pay $150 in a skipped heartbeat for prompt, reliable, comfortable service.

 

[OldShooter]

A former coworker has frequent health issues and was having a terrible time getting appointments. Over lunch one day he explained he'd signed up with a concierge medical service a few months back. He makes all of his appointments over text message and they're actual appointment, often the same day, with a beginning and end. He arrives at the doctors office at the arranged time, and is immediately shown to a room where a doctor is waiting. He's free to use as much of the doctor's time as he's scheduled for, or make a followup appointment if needed. He still has employer health insurance and is ecstatic about the service.

That's more or less what we get, too. Dr. appointments are scheduled for an hour and sometimes I even feel that the doc is hanging onto me unnecessarily to chit-chat. Our docs will also make house calls if there is a need, though we have never had occasion to ask.

 

[Scrapr]

Having gone through BIL's failed heart transplant, and having spent a large chunk of my professional career in high tech project management I think I can answer this.

The way I explain project management to docs is by asking them to visualize a meeting room with all of the patient's docs present (which will never happen in today's system). Then, at the end of the meeting someone says: "Thank you all for your inputs. Here's what we're going to do ... " That person is the project manager. This, too, will never happen in today's system.

We sat in the family waiting room outside BIL's intensive care room for over a month. We watched docs coming and going. The heart guy. The kindney guy. The infectious disease guy. ... Never meeting or talking to each other. We also watched the young pharmacist come up every day to spread out all the drug orders to make sure the docs weren't screwing each other up. The only one who had the big picture was BIL's day nurse, who worked 12 hour shifts. But the nurse had no authority to lead or guide. All he could do was to very respectfully ask questions as he coached the relevant doc. He was fantastic but the project management was all wrong. There's no way to know whether BIL would have survived had the project been managed better, but ... maybe.

So that's one of the reasons we have hired these concierge docs. One of them is going to be the project manager if/when something serious comes along. The problem is never the experts per se. It is always in the "cracks" between experts where assumptions and plans don't line up. I once hired a technical director for a $100M++ project I was running. The first thing he asked was "What do you want me to do?" I said "Dave, you're in charge of the cracks." And he was and he did a good job of it.

We felt the docs were pretty up to speed on the other specialists. We are Kaiser people. They are pretty good about being able to share across the platform. Once in a while the doc would be reading notes & we would share what a specialist found. The doc in front of us would scroll through & and say yes...I see that here. We have found w/Kaiser you need to be your own advocate. But the docs don't seem to mind. I had one doc that gave me three treatment options & we discussed all of them & arrived at a decision. We would review that decision on following appointments. Now if you were non responsive & being treated that would be problematic

Being the surviving spouse I have lots of what ifs and I wonder if we had tried this or what if we had the endoscopy a month earlier.

 

[grayv]

It's worth noting that the doctor will only get some portion of that, from which he or she has to pay staff salaries and office rent. The rest goes to the company (MDVIP in this case).

I think the usual medical charges still apply. so the patient could have copays and coinsurance and deductibles and maximums to deal with.

from wikipedia , MDVIP doctors "pay a royalty or franchise fee of $500 per patient per year"

 

[Bamaman]

My wife managed large medical laboratories and she worked closely with physicians. She can spot a good/great doctor a mile away.

Her internal medicine doctor retired, and she was referred to a young doctor who took over his practice of aging patients. And the guy is exceptionally well read and up to date. My wife's impressed with the doctor's skills.

After COVID arrived, he changed over to being a telemedicine doctor. And he's been so efficient at it that he says he'll never return to being an in person physician. Of course, he will see a patient when absolutely required. And patients can come in for blood tests, etc.

My wife needed a test, and she went to a big, national laboratory located in our local Walmart store. The doctor pulled up the test results and emailed prescriptions to our pharmacy. That was quick and efficient.

It's likely that this is the future of medicine--more than concierge medicine.

 

[Rocket Man]

Our doctor went to MDVIP two years ago. Both DW and I signed up the first year because we had gone to him for years. I went back to the old clinic to another doctor after one year. DW still with MDVIP. We paid quarterly. Slightly less than O.P.. It was not worth the extra money to me as I typically see him once a year for a physical. Any more specific issue I go to a specialist. I did get a more detailed physical and blood test and he did spend some time going over results. Some of the results come from the Cleveland Clinic and are detailed. I think MDVIP is best for a person that sees their doctor more often and wants some extra time to discuss issues with the doctor. If I doctored a lot, I might have stayed there.

 

[EastWest Gal]

I have lost four physicians in the last 5 years due to FIRE (age 57), physicians moving, practice closing. The last doctor I had only made eye contact with the computer screen and didn’t listen.

I moved to a concierge practice that supports low carb lifestyle and I feel listened to. The docs aren’t stressed out or mind numbing my busy. Not MDVIP though.

My mother in law had a physical sign that turned out to be cancer and was blown off by Kaiser. Finally had a biopsy. Had major surgery and other treatment but was dead within 3 months.

I know what burnout feels like. I fought it many times in my career. Only during the last two weeks of work ever did I really know what it felt like not to care.

Physician burnout rates are very high in primary care. I don’t blame your physician one bit.

 

[sengsational]

Here is a post that's from another thread, but I thought it might be nice to have it here in this thread:

There is a national service that might interest folks. I came across the reference on mr money mustache which I also occasionally reference with regard to FIRE.

https://www.mrmoneymustache.com/2020/11/09/direct-primary-care/

direct primary care locations
https://mapper.dpcfrontier.com/

medical cost sharing, voluntary
https://sedera.com/sedera-faqs-2020/

The interesting part is Sedera. Its a voluntary cost sharing effort across all members. If you add together my DPC cost of 75-100, and the Sedera cost sharing at 300, for less than 5K per year you have coverage over all but the most gruesome expenses. Pharma would be an add on, but most of that is aided by competitive script discounters.

I'm 57, I would imagine this would be around150-200 for younger folks. Covers all but a tiny fraction of the risk. Compared to 21k/year for corporate subsidized HC cost, without deductibles and such and paying premium insurance prices, this is a great deal