PCP 'subscription' charge

[Aerides]

OP in your shoes I'd first ask "what changes?" - what are the new benefits to go along with the new cost? If your doctor's office can't articulate that to you, then they might have put cart before horse.

If it's stuff like Braumeister mentions, it might be worth it, at least to try.

 

[Mark1]

I'd be interested in what the acceptance criteria are. If I were in practice I'd think in terms of:

1. Shows up on time for appointments.
2. Complies with prescriptions/other recommendations; is an active participant in maintaining their health
3. Doesn't call for every sniffle and ache
4. Adequate insurance coverage
5. While some insights into personal life, relationship status, levels of stress, etc. are useful context, not expecting psychotherapy

Some you can tell up front; others you find out only over the long run.

I don't remember the application form exactly, but I suspect it had my list of drugs (none) and list of chronic diseases (none again in DW and my case). I figured it was mostly looking at our age and if on medicare yet. I was in my mid-50s at the time and asked my PCP at my first visit if he was going to "kick me to the curb" once I was on Medicare. He just laughed and said it depended on how ornery I was by then.

 

[tmitchell]

OP here. Did some more digging on this and these are the reasons/benefits for the fee. All of these services have been previously available.

The Annual Fee will enable us to offer, enhance, and keep investing in the support for the following non-covered services:
• Licensing of our Patient Portal and Healow app, which facilitate faster and improved patient-provider online communication.
• Enhanced Care Coordination with outside consultant physicians of your choice.
• Forms and Letters Without Additional Charge, streamlining your administrative needs.
• Medical Records Transfer Without Additional Charge to our patients, facilitating seamless information sharing.
• Online Check-ins and Appointment Request, utilizing the Healow app for convenient appointment management.
• Online Access to Laboratory Results and Medical Records, to empower you with easy and secure access.
• Online Access to Medical Bills, featuring a straightforward online payment function.
• Re-submission of Bills to Insurance, minimizing out-of-pocket costs, where appropriate.
• Expedited preparation and submission of Appeals, ensuring prompt processing for non-formulary medications wherever appropriate.
In addition to these measures that are covered by the Annual Fee, our practice will offer you urgent appointments to help you avoid costly Urgent Care and ER visits. We will continue to offer Virtual Visits (Televisits) to enhance your convenience and flexibility in care. We will maintain our ‘one-stop-
shop’ approach with in-office blood draw and imaging services, providing an expedited pre-authorization submission process for your imaging tests (for PPO and Medicare only).

 

[jim584672]

"Concierge medicine" is a scam, time for a new doc.

 

[athena53]

OP here. Did some more digging on this and these are the reasons/benefits for the fee. All of these services have been previously available.

The Annual Fee will enable us to offer, enhance, and keep investing in the support for the following non-covered services: <snip>

I agree- sounds like the equivalent of a hotel "resort fee". And the over-use of the word "enhance/enhanced" sounds like they're borrowing from the airline and hotel loyalty program change announcements.

 

[RetMD21]

......
• Expedited preparation and submission of Appeals, ensuring prompt processing for non-formulary medications wherever appropriate.
In addition to these measures that are covered by the Annual Fee, our practice will offer you urgent appointments to help you avoid costly Urgent Care and ER visits. We will continue to offer Virtual Visits (Televisits) to enhance your convenience and flexibility in care. We will maintain our ‘one-stop-
shop’ approach with in-office blood draw and imaging services, providing an expedited pre-authorization submission process for your imaging tests (for PPO and Medicare only).

Having the doc go to bat with you for non-formulary meds can be a real benefit. It's easy to tell the patient the insurance said no. There's more effort involved in really pursuing appeals. Telehealth can save everybody time. OTOH you may not really need the various benefits very often or at all. it's easier for the practice to switch everybody over to the new model than having 2 tiers.

 

[Aerides]

OP, that list is pretty weak, and a lot of offices already include much of that for no upcharge (cleveland clinic does all of that). It sounds like your PCP's office is very behind the tech abilities of many others. Do they actually charge for records transfers, forms and letters now?

And while online payments is convenient for you, it is for them too...

That list reads like "We finally have to get updated to compete with other providers and we haven't had anything online like most do, so now we can't afford it and...er... yeah now it's concierge!"

 

[braumeister]

OP, that list is pretty weak

I have to agree; not much value there for $500.
OTOH, it will most likely drive many current patients elsewhere, and that will lighten their workload, allowing better (longer) visits for those remaining. So I guess that's an unstated benefit.

Based on this updated info, I would most likely be looking for a new one.

 

[pacergal]

That list looks like they are needing to update their EMR, (or start one, if they haven't already) and wanting patients to pay for it up front.
When I was working, the EPIC brand of EMR was a contract with the company, so the cost should already be baked into their prices.
Insurance Reimbursement is another issue.

 

[OldShooter]

"Concierge medicine" is a scam.

Why would you say that?

 

[Sunset]

After reading the list, I have to state it's a weak stupid argument for a fee.

The "Patient Portal and Healow app" is there to save them money and time from mailing out bills, communicating with patients, and having staff "check-in" patients for appoints. And results in a faster streamlined movement of patients.

If the "Patient Portal and Healow app" is so costly and of no benefit, then they should just stop using it !!

This entire topic makes me wonder how many patients does a PCP have on the books, I estimate 2,000 as that would work out to 10 patients seen per day at a minimum, some would be more often.
So $500 x 2,000 = $1,000,000 seems like that would go a long way to running an office.

 

[ratface]

I just followed the link provided in a previous post and searched for doctors near me, there were about seven, all pretty much charge around $500 every three months, $2000 per year is what it will cost you in the Chicagoland area. $500 a year is a bargain.

 

[RetiredHappy]

If you like your doctor, $500 a year is not alot of money.

My concierge doctor now charges $2500 per person per year. We balked initially when our PCP contacted us that he was going the concierge route. My husband and I said let's try for one year. After one year, we were hooked on the service. Each year we re-evaluate to see if he is worth it. We are into our 3rd year with him and we are still paying. The biggest deal is that he networks, i.e. builds and maintains great relationship with top specialists. We can reach him 24x7, see him same day and get expedited appointment with top specialists.

 

[OldShooter]

... My concierge doctor now charges $2500 per person per year. We balked initially when our PCP contacted us that he was going the concierge route. My husband and I said let's try for one year. After one year, we were hooked on the service. Each year we re-evaluate to see if he is worth it. We are into our 3rd year with him and we are still paying. The biggest deal is that he networks, i.e. builds and maintains great relationship with top specialists. We can reach him 24x7, see him same day and get expedited appointment with top specialists.

I talked a little about our concierge docs earlier in the thread. Here is someone else reporting in. A caution for anyone getting interested in this subject:

When I was shopping providers I found that there was absolutely no standardization in programs, costs, or services. The majority seem to be with one doc. Some will file insurance claims, some will not. Some take Medicare, some will not.*

So I'd recommend that anyone shopping have a good checklist of questions and make very careful notes, especially what the basic fee covers and what is billed to insurance and/or to the patient. Access is very important IMO, so make sure you understand what happens when a solo doc is unavailable or out of town.

*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.

 

[aaronc879]

I just followed the link provided in a previous post and searched for doctors near me, there were about seven, all pretty much charge around $500 every three months, $2000 per year is what it will cost you in the Chicagoland area. $500 a year is a bargain.

$500 is not a bargain it is just less of a scam.

 

[athena53]

The "Patient Portal and Healow app" is there to save them money and time from mailing out bills, communicating with patients, and having staff "check-in" patients for appoints. And results in a faster streamlined movement of patients.

If the "Patient Portal and Healow app" is so costly and of no benefit, then they should just stop using it !!

My PCP has been using those ever since I started going there (5 or 6 years) and doesn't see a need to charge extra for it.

 

[aaronc879]

My PCP has been using those ever since I started going there (5 or 6 years) and doesn't see a need to charge extra for it.

Same

 

[sengsational]

I think the medical profession brought this upon itself and is now far too over focused on specialization, to its detriment.

If by that, you mean the US business model, that's where I land. The corporations came in and bought "all" the doctors. For most PCP's, it makes sense to work for a corporate-owned practice. The corporations do what they do best...sweeten the deal to make their offer just slightly better than the alternative. Then, once in control, put the screws to their employees to be "more efficient". So now the practice has 120% of their former patient load, and the earliest appointment is in 4 months. It's driven by insurance networks. In a geography there are a certain number of practices taking certain flavors of insurance. In that same geography, there are more patients that hold those insurance types than can be managed by the available in-network doctors. They're selling more doctors than they have.

So that goes to the question of paying the fee. It's like paying the DoorDash driver a tip in advance; they won't take your order unless you pre-tip. I don't like the business model, but I certainly won't be using an over-booked corporate slave PCP either (once I'm on traditional Medicare).

One thing I worry about in selecting to pre-tip my PCP is that the corporate types aren't going to let these renegade doctors have an easy time taking business away from the corporate monster. So question number one for any doctor charging a fee would be "who owns the practice?" If it's big business, and the majority are, there's probably little value in paying to play in that environment because they're still answering to the corporate overlords. If it's a set of individuals, then I'd probably play so I'd get consistent access.

 

[teej1985]

If by that, you mean the US business model, that's where I land. The corporations came in and bought "all" the doctors. For most PCP's, it makes sense to work for a corporate-owned practice. The corporations do what they do best...sweeten the deal to make their offer just slightly better than the alternative. Then, once in control, put the screws to their employees to be "more efficient". So now the practice has 120% of their former patient load, and the earliest appointment is in 4 months. It's driven by insurance networks. In a geography there are a certain number of practices taking certain flavors of insurance. In that same geography, there are more patients that hold those insurance types than can be managed by the available in-network doctors. They're selling more doctors than they have.

So that goes to the question of paying the fee. It's like paying the DoorDash driver a tip in advance; they won't take your order unless you pre-tip. I don't like the business model, but I certainly won't be using an over-booked corporate slave PCP either (once I'm on traditional Medicare).

One thing I worry about in selecting to pre-tip my PCP is that the corporate types aren't going to let these renegade doctors have an easy time taking business away from the corporate monster. So question number one for any doctor charging a fee would be "who owns the practice?" If it's big business, and the majority are, there's probably little value in paying to play in that environment because they're still answering to the corporate overlords. If it's a set of individuals, then I'd probably play so I'd get consistent access.

I wonder why this happens with PCPs but not dentists or optometrists. Their are a ton of corporate owned dentists and optometry shops, but it seems relatively easy to find an independent practice.

 

[OldShooter]

If by that, you mean the US business model, that's where I land. The corporations came in and bought "all" the doctors. For most PCP's, it makes sense to work for a corporate-owned practice. The corporations do what they do best...sweeten the deal to make their offer just slightly better than the alternative. Then, once in control, put the screws to their employees to be "more efficient". So now the practice has 120% of their former patient load, and the earliest appointment is in 4 months. It's driven by insurance networks. In a geography there are a certain number of practices taking certain flavors of insurance. In that same geography, there are more patients that hold those insurance types than can be managed by the available in-network doctors. They're selling more doctors than they have.

So that goes to the question of paying the fee. It's like paying the DoorDash driver a tip in advance; they won't take your order unless you pre-tip. I don't like the business model, but I certainly won't be using an over-booked corporate slave PCP either (once I'm on traditional Medicare).

One thing I worry about in selecting to pre-tip my PCP is that the corporate types aren't going to let these renegade doctors have an easy time taking business away from the corporate monster. So question number one for any doctor charging a fee would be "who owns the practice?" If it's big business, and the majority are, there's probably little value in paying to play in that environment because they're still answering to the corporate overlords. If it's a set of individuals, then I'd probably play so I'd get consistent access.

Well, even paranoids have enemies I guess. In our case our concierge group of three docs is actually inside one of these "corporate monsters" filled with "overlords." We get excellent value received for the price we pay and are very happy.

 

[braumeister]

There are many varieties of concierge medicine, with a great many differences between them.

For example, this is from the MDVIP website I posted a link to earlier:

DOES MDVIP EMPLOY MY DOCTOR OR OWN MY DOCTOR'S PRACTICE?

No. Your doctor and his or her staff are independent from MDVIP and are not MDVIP’s agents or employees. Your doctor runs his or her practice, and MDVIP does not own or manage your physician’s practice.

 

[punkinhead]

Interesting how this thread drifted into concierge medicine, which appears to have nothing to do with the OP's situation. The OP isn't paying for extra access or longer visits, but is being asked to pay extra for things that are standard at pretty much any Primary Care office.

 

[sengsational]

I wonder why this happens with PCPs but not dentists or optometrists. Their are a ton of corporate owned dentists and optometry shops, but it seems relatively easy to find an independent practice.

Good question. It might be the complexity of the insurance situation, privacy and other regulations means hanging out a shingle for an MD is a higher bar than a dentist or optician. Corporations can have one compliance team for hundreds of practices. If they make sure their systems are compliant and make sure their employees do exactly as they're told, the problem is solved. Having a team dedicated to following ever-changing rules is a big advantage when compared to a doc or two and a receptionist. That might pass in the eye doctor space, but probably an uphill battle in the MD space.

 

[GhostofTomJoad]

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.

Run away. Maybe it's not a scam, but it is certainly, totally, utterly, completely, entirely unethical. I call "bullshit."

 

[Turbo29]

I wonder why this happens with PCPs but not dentists or optometrists. Their are a ton of corporate owned dentists and optometry shops, but it seems relatively easy to find an independent practice.

It's getting harder to find them. Same with veterinarians.