Is tomorrow OK to see the doctor?

[OldShooter]

Seeing the thread title 'Can I see the Doctor please??" prompted me to make this post. For the past few years we have paid to be in a "concierge medicine" program. For those who have not heard of this, I'll provide some details about our program, though there is wide variation from program to program.

Our program is actually housed within the mega health system that we formerly and still use. There are three docs, a med tech/receptionist, an RN, and a manager. They are housed in a quiet and private office area within the main building, very close to the door and to our program reserved parking places just outside. Lab and pharmacy are just down the hall. When we joined there were only two chairs in the waiting area, though they have added a couple since then. I have never seen more than one person sitting there though.

We are on a first-name basis with everyone. Dr. appointments are scheduled for an hour and per our contract, we can have same-day appointments for urgent needs. More usually, one of us will call and schedule an appointment within the next day or two at a time convenient for us. Many needs are handled in a telephone cal with a doc; if we leave a message we'll get a callback within an hour or two. The office staff coordinates labs, scrips, and appointments with other docs in the system or outside.

One of the docs is always carrying a cell phone, 24x7, and we can call any time. They rotate the duty so the doc may not be our regular one, but he/she has access to the other docs and to the clinic records system. Last time we had to call we were at our lake place and DW had run out of some kind of medication. At about 11:15AM we called from the pharmacy and the doc had the scrip in the system within ten minutes. Good thing, since the rural pharmacy closed at noon on Saturdays.

When DW was in the hospital for a back operation, our doc called almost daily to talk to her and, if necessary/if asked, would have visited. One important thiing he did was to monitor her on the computer system to make sure that all the various docs, nurses, and techs involved at the hospital were not forgetting something or screwing each other up. Her nurses were flabbergasted; none had ever heard of a primary car doc paying this kind of attention.

Cost is not cheap: $5K/year for the two of us but we can afford it and the confidence we have in health care matters has skyrocketed. No more waiting six weeks for an appointment with someone who has 15 minutes for us and no more dealing with long waits, crowded waiting rooms, and anonymous people in urgent care.

So for anyone who can afford this type of thing, I'd encourage you to investigate the options that might be available in your area.

I could go on, but you get the idea.

 

[CaliKid]

That sounds great and I would say reasonable cost for the benefits you get.

 

[Rianne]

That sounds really interesting. And 5K/year is not bad at all for two people. I can't get my head around how this works. The docs are housed in a mega health system. Are they covered by the same insurance as the mega system?

For instance, I recently had a twisted small intestine, very big deal and very painful. Went to ER and was in hospital for 4 days. No surgery, but an NG tube for three days. How are all the nurses, technicians, phlebotomists and so on covered? You say there are only three docs and one nurse. How can they handle an ER situation? And what if the medical issue required more testing, blood work? Who reads the e-rays, who analyzes the results?

I like the idea. Can you explain further?

 

[Bamaman]

Congratulations on finding a great concierge physician practice. As we all get older (and sicker), this sounds like a very good alternative for healthcare management. It would even be better if you had one of more really serious physical problems requiring close contact.

We are in a middle size town that is big enough but not too large. Our doctors are still able to see us the same day in most cases, and they operate like a concierge with our insurance paying them. My wife's got complicated issues, and she has great pain management clinic care too.

 

[Jerry1]

That sounds really interesting. And 5K/year is not bad at all for two people. I can't get my head around how this works. The docs are housed in a mega health system. Are they covered by the same insurance as the mega system?

For instance, I recently had a twisted small intestine, very big deal and very painful. Went to ER and was in hospital for 4 days. No surgery, but an NG tube for three days. How are all the nurses, technicians, phlebotomists and so on covered? You say there are only three docs and one nurse. How can they handle an ER situation? And what if the medical issue required more testing, blood work? Who reads the e-rays, who analyzes the results?

I like the idea. Can you explain further?

In most cases, the concierge fee is over and above what insurance pays. It pays for the special service such as getting in quicker, personalized over view when in the hospital, etc. They typically still bill for all services and your insurance covers it as normal. Per your question, in the ER example, that event would be no different than normal except that your concierge Dr. may be there (in person or electronically) to oversee what's going on and guide you through the process (e.g. make sure they don't give you meds that conflict with your overall condition).

What this is not, as your questions suggests, is a per person payment to cover medical expenses. That would be an HMO and without proper licensing and capitalization, Dr's cannot do this. It's an over and above service just as the name suggests - concierge. As OP stated, there is much variation in this but it seems to be coming common if you want to maintain what used to be a bit more common - a Dr that actually knows you and looks after you and spends some time with you.

My Dr. works a bit differently. He doesn't take insurance at all and has a closed practice. I pay him per visit but he knows me. He's not as involved as the OP described, but he's been very good to handle a lot of things over the phone at no charge, talk to DW as she went through a major medical event and generally be someone we can trust to consult with on all of or medical treatment.

 

[RunningBum]

Is it $5K + a charge for each visit, or does that $5K include visits? Any limit?


I assume they are GPs. If you need to see a specialist, you are subject to the same availability as anyone else? Still, I can see an advantage to have your GP closely monitoring what the specialist is doing.

 

[Jerry1]

Is it $5K + a charge for each visit, or does that $5K include visits? Any limit?


I assume they are GPs. If you need to see a specialist, you are subject to the same availability as anyone else? Still, I can see an advantage to have your GP closely monitoring what the specialist is doing.

Typically, they'll still charge for the visit. Again, there's a lot of variation. It could be that the concierge fee covers the out of pocket, but with all the high deductible plans, that would be a challenge. The fee is typically for the extra (concierge) service. They have to be careful not to provide care for a set fee - that's being an HMO. Not to say that model isn't out there, but it's not typical for a Dr. to be able to do that due to capitalization issues.

In a specialist situation, often the concierge Dr has a relationship with specialists and can get you in quicker and make sure the care is coordinated better.

 

[OldShooter]

That sounds really interesting. And 5K/year is not bad at all for two people. I can't get my head around how this works. The docs are housed in a mega health system. Are they covered by the same insurance as the mega system?

We have our normal insurance, Medicare with Blue Cross. So our insurance gets billed for visits, just like if we were seeing any other internist.

One difference is that regular docs are not paid for returning phone calls and talking to patients, so IMO unnecessary office visits get scheduled simply because that's what is paid for. We talk to our docs all the time, often they call us when there is a lab result.

Concierge practices must be very careful to avoid medicare rules intended to keep care providers from surcharging medicare patients and extracting money from them. It's kind of a legal tightrope as I understand it. One concierge practice we looked at would not take medicare. The basic fee was lower but all visits were private pay. We didn't pursue that one because it was only one doc and we wanted more depth than that, so I can't tell you more.

For instance, I recently had a twisted small intestine, very big deal and very painful. Went to ER and was in hospital for 4 days. No surgery, but an NG tube for three days. How are all the nurses, technicians, phlebotomists and so on covered? You say there are only three docs and one nurse. How can they handle an ER situation? And what if the medical issue required more testing, blood work? Who reads the e-rays, who analyzes the results?

Really no difference from what you see if you have a regular internist except that our doc does not do the normal handoff-and-disappear when there is a bigger issue like your twisted small intestine. The handoff-and-disapper move is necessary for normal docs, of course, because they aren't compensated for paying attention while other docs, etc. are handling the patient and collecting the money.

Is it $5K + a charge for each visit, or does that $5K include visits? Any limit?

No limits. They are getting paid per visit by the insurance company, of course, plus the annual fee. I suppose there could be a problem if they got a hypochondriac who kept calling on the 24x7 cell, but they tell me that calls on the cell are few and far between. I'm sure there is somewhere in the contract where they can cut a problem patient loose. I would certainly have that if I wrote the contract.

I assume they are GPs. If you need to see a specialist, you are subject to the same availability as anyone else? Still, I can see an advantage to have your GP closely monitoring what the specialist is doing.

We do not, unfortunately, get priority in other departments but our RN can often get us slotted into one of the "urgent" appointments that are left open so we don't have to wait in the long line. She makes the calls; we don't.

Yes, having our doc monitoring is important but there is another very important thing too: Simply being hired into the concierge group means to me that be are seeing docs from among the best. But also, when we have to see someone in another group or even outside the big clinic walls, we ask our doc to tell us who the best choices are or, if he doesn't know, to check around a little bit. So we are not making random choices like we would be if we just called a department and took whomever they gave us. The top performing medical student and the bottom one both have the same title: "Doctor," though the big-clinic-model wants us to believe that they are all interchangeable.

One caution for those who are interested: There is no standardization to concierge medicine. You'll have to look in detail at every one of your options. You'll probably have to look pretty hard to find them too, as there is a political-correctness risk that people will criticize programs where people with more money get better medical treatment. So they tend to be a little under the radar in my experience.

 

[RunningBum]

Yes, having our doc monitoring is important but there is another very important thing too: Simply being hired into the concierge group means to me that be are seeing docs from among the best. But also, when we have to see someone in another group or even outside the big clinic walls, we ask our doc to tell us who the best choices are or, if he doesn't know, to check around a little bit. So we are not making random choices like we would be if we just called a department and took whomever they gave us. The top performing medical student and the bottom one both have the same title: "Doctor," though the big-clinic-model wants us to believe that they are all interchangeable.

One caution for those who are interested: There is no standardization to concierge medicine. You'll have to look in detail at every one of your options. You'll probably have to look pretty hard to find them too, as there is a political-correctness risk that people will criticize programs where people with more money get better medical treatment. So they tend to be a little under the radar in my experience.

I wonder how true this all is, importantly the bolded part. How do you know a concierge doc is among the best? What's to keep four semi-slacker docs from starting a concierge practice and figuring the "concierge" label will be a draw? As you say, there is no standardization, which also would seem to me that there's no qualification criteria. They don't even have to be slackers. Probably more likely would be big ego docs who think they know all and have confidence to start this kind of practice, but really aren't as good as they think they are.

 

[OldShooter]

I wonder how true this all is, importantly the bolded part. How do you know a concierge doc is among the best? What's to keep four semi-slacker docs from starting a concierge practice and figuring the "concierge" label will be a draw? As you say, there is no standardization, which also would seem to me that there's no qualification criteria. They don't even have to be slackers. Probably more likely would be big ego docs who think they know all and have confidence to start this kind of practice, but really aren't as good as they think they are.

Well, hat's a fine theory and points to some possible situations, but it's not applicable in our case. Remember, our docs were on staff within the bigger clinic and were recruited specifically for this program. Further, having known them now for a while confirms to me that we got some good ones. One of the things I did when I worked for a living was to manage projects with "rocket scientists" at JPL. I'm pretty used to making evaluations of people who are smarter than I am. It's a survival skill for a hi-tech project manager.

But for the random, self-selected concierge practice I agree that there is no implicit quality control.

 

[marko]

This is almost identical to what I have. The exception is that my Dr doesn't take insurance of any kind. Instead I pay just $100 a month for almost unlimited visits. Period.

I still have insurance for everything else of course.

But he or his associate is available 24/7, they make house calls ($35 extra per visit), check in/follow up on you by phone/Skype or email if you've got something serious. I can send him a photo of some boo-boo and he'll tell me what he thinks etc.

 

[Carpediem]

Regarding the "Simply being hired into the concierge group means to me that be are seeing docs from among the best" comment, I found this to not necessarily be true where we live.

I had a routine exam with a local doc who I was hoping to establish as my primary 'go to' guy since we were new to the area. Based on my visit with him, I was less than impressed to say the least. A few weeks later we start receiving all these mailings and recorded phone calls about this doc moving to MDVIP, a national concierge outfit, for an annual fee of $1650. I just had to laugh and shake my head because he would have to pay ME for me to see him again.

YMMV of course.

 

[OldShooter]

Regarding the "Simply being hired into the concierge group means to me that be are seeing docs from among the best" comment, I found this to not necessarily be true where we live. ...

Actually, it might not be true anywhere except for our specific situation.

The general problem, IMO, is that we tend to not do enough research and investigation prior to selecting professionals that we need to trust. Doctors especially. I had an "aha!" moment a number of years ago when I broke an ankle. Everything turned out OK, but in reviewing the process I realized that I had blindly taken the doc that was assigned to me and I knew nothing about her educational or professional background. The contrast hit me as I thought about the fact that not long prior I had sought out a weekend shooting clinic taught by the US Olympic pistol coach. I had invested hours and dollars in making that happen and had invested zero in selecting the doc -- arguably a more important decision. So I now do the best I can to check resumes, references, etc. any time I need to see or change a doc.

Edit: From Wikipedia I see that MDVIP is a franchise, so no surprise that there is apparently little or no quality control on franchisees.

 

[PatrickA5]

I'm getting ready to go to my doctor in about an hour. I have a list of 5 important issues I'd like to address. I'm very organized and probably can get through them within his 15 minutes. But, I imagine he'll be standing up after 5 minutes (and two issues) asking me if there is anything else - like he always does. He's a nice man and I like him as a doctor, but I can't stand how busy they are these days.

I might have to look into this type of program even if it costs more.