Concierge medicine or can't find a doctor

Discussion in 'Medical Topics' started by Rushie, Jan 5, 2017.

  1. Rushie

    Rushie Line Up and Wait

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    I want to know if any of you are having the problem of getting a new primary physician after moving to a new area, or what are your opinions of concierge medicine if you resorted to that?

    We moved to the San Antonio area and are having a horrible experience. I have gotten in with a good doctor but the office staff is a nightmare. They've lost my insurance card, had iPads with personal info stolen, canceled Mark's appointment three times, and now (after 9 mos of nonsense) are telling me they don't take Mark's insurance.

    In trying to find another doctor I keep coming across MDVIP. One of their doctors comes highly recommended. The estimated cost is $1800 per year. For those of you unfamiliar with this model, you pay them that out of pocket just for the privilege of being their patient. Every visit has the normal charges and insurance copays, etc.

    My question for you guys: Is this the new normal? Do we now need to pay retainer to get anything better than abominable service?

    I guess a related question is, as you approach Medicare age, are we going to have to go with this model or be left with only the very worst dregs of doctors who can't get other patients, because all the good doctors are refusing to take Medicare patients?

    Any of you near San Antonio and can tell me anything about any of the doctors here?
     
  2. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    MDVIP is reputable. The answer to all of your questions may be yes. After many years of practice i am looking to change to a 'concierge' model myself.
     
  3. AggieMike88

    AggieMike88 Touchdown! Greaser! PoA Supporter

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    Lou, can you explain the difference between 'concierge' and the "others"?
     
  4. Ravioli

    Ravioli En-Route PoA Supporter

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    I think the concierge model is great for individuals or families who use a lot of health care services.

    For me, it's not worthwhile because I'm single, sorta healthy, and have no children. I can put up with my PPO for what little I use it for. Just wish that was priced the way it was when healthcare was not affordable. (oops.. almost a political statement)

    For reference: My ex-wife is a physician. We looked at the concierge model for her practice and concluded it is better for both the Doc and the patients because she would need fewer patients on the roles, and they would have more timely services.

    It's a win-win all the way around (and that is an intentional use of a moronic statement)
     
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  5. mulligan

    mulligan Cleared for Takeoff

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    Just out of curiosity, is there a local AME that you use that you can have also be your PCP? Kill two birds with one stone? That was a pun by the way as my local AME's name is Stone
     
  6. mfisher

    mfisher Pre-Flight

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    I was told by two people I trust to make sure your AME and your primary physician are two distinct individuals. And to never intersect the two.
     
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  7. Everskyward

    Everskyward Administrator Management Council Member PoA Supporter

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    As you will see, people have varying opinions about this...
     
  8. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    I suspect a lot of the pilots who insist on keeping then separate grew up in the days before everything was entered into computers. Back then it was a lot easier to hide stuff from the AME/FAA. Nowadays keeping them separate doesn't help as much since virtually anytime you consult a doc there is an electronic trail.
     
  9. wrbix

    wrbix Line Up and Wait

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    I am a physician (retired Internal Medicine/Nephrology/Critical Care) and when my Primary Care Physician separated from her practice to do Concierge Medicine with MDVIP, we followed her. My wife is an RN and we therefore know the medical community well - we are both VERY concerned with the declining quality and commitment in the physician population of late. Not many physicians we would trust our healthcare to - sad to say.
    But back to the question: nothing about concierge medicine guarantees quality of care. It does guarantee access and time commitment. Is it worth the cost? - tough to say. If it's what you need to do to get the doctor you feel comfortable with, then yes. If going in blind, probably not, unless you really value time spent with your doctor.
     
  10. Van Johnston

    Van Johnston Line Up and Wait

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    I am in SA. very happy with my PCP, who Is a GP, and I usually see his PA. I have no chronic illnesses, so that makes it easier. When I need the occasional urgent care I've always been offered a same day appointment.

    There is a concierge doc in our subdivision (because he advertises with a magnetic sign on his pickup). Don't know him or anything about him other than his website.

    Both on NW side of town. PM me for details.
     
  11. weilke

    weilke Touchdown! Greaser! PoA Supporter

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    Very few network contracts allow providers to charge a concierge fee on top of charges under the network contract. So when your concierge provider bills you, you are likely to pay any additional charges at the out of network (non-par) level. In most cases, that level will be higher than what you would pay if you saw a network provider. Given the now typical high deductible plans, that can make a big difference in your out of pocket expenses.

    There are different concierge models. Some just charge an access fee but are otherwise normal physician practices. Others charge considerably more (8,10,15k/year) but it is an all-inclusive deal for all primary care services during the contract term. Some concierge providers have actively opted out of medicare and as a result are able to see medicare patients. If they send further properly documented bills to the patient, the patient can submit those to MC for reimbursement. MC will reimburse their 'limiting charge' and the patient is responsible for the remainder of the bill.
     
    Last edited: Jan 5, 2017
  12. bbchien

    bbchien Final Approach

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    Lou, you will never regret that change. You will have enough funds to maintain a decent staff, you can let go the usual 2.5 FTEs who just cope with declining insurance payments. You'll be able to call the patients back when you think it's right, and spend the half hour with one if you think that's necessary. It's about making the link between us, and the patient the primary link. Oh, and BTW the hospital is wanting you to stop attending anyway, they have to pay their hospitalists.....

    And Rush, the reason that is happening is you just can't make it on $37.15 paid for a 25020 visit. It's just impossible. I dare the Prez to send me to the Gulag. Not going there. And the Medicare recovery audits convinced me that staying in was a no-win.
    Everyone practitioner who can, is leaving.

    For everyone else here, usually a primary says, This much per year and you get as much access to me as you need. I call you back in 10 minutes. I fill out forms, call whomever you need, etc. It's "service first" model". WE can't do that under insurance as there is no insurance code for any of what I just mentioned.....and $37.15 just doesn't cut it.
     
  13. wsuffa

    wsuffa Touchdown! Greaser!

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    MDVIP works pretty well around here (DC area) and the doctors seem to either be bought out by the hospital system or go on one of the concierge programs. One of the big benefits is that the number of patients for each doc is limited, appointments are readily available, and the annual exam is more complete than most regular providers.

    When I compare the care my dad got (Medicare and TriCare) with a regular doc (15 patients an hour) to what folks get with MDVIP (15-20 minutes per visit), with reasonable revenue for the doc, it's clear why the best docs are going concierge.

    It's also easy to get an appointment on fairly short notice.

    From what I can tell, to get care, you'll have to either go with a concierge provider or you'll have to go to a doc that's owned by the hospital. All others are hard to impossible to GE an appointment with. It's the new model. And as Bruce points out a lot of docs are retiring, and there are more people in the system because they're paying for insurance and by gosh are going to use it.

    Enjoy Living in San Antonio.... Interesting town and a little over an hour to Austin!
     
  14. SCCutler

    SCCutler Administrator Management Council Member PoA Supporter

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    I use a concierge MD for primary care. Typically can go in sane day, get thoughtful, unrushed treatment and a staff who are motivated and courteous.

    Health insurance now is a joke, because of the amazingly high deductibles, and the crushing burden of bureaucratic nonsense imposed by the ACA. As a result, the money I pay to the concierge Doc is good value.
     
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  15. Ravioli

    Ravioli En-Route PoA Supporter

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    I was told by two people I trust to make sure your AME and your primary physician are two distinct individuals. And to never intersect the two.

    @lbfjrmd and @bbchien -- Any thoughts on this? The 10 yrs I've had a Third Class medical this has been recited.

    Yes/No/Maybe?
     
  16. Let'sgoflying!

    Let'sgoflying! Touchdown! Greaser! PoA Supporter

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    How would this work for those seeing specialists? I rarely go to a PCP, most things affecting people I know need a specialist. You'd have to pay to be a 'member' for each of GI specialist, ENT specialist, Uro specialist? Seems like this is best for those who go to the GP often.


    https://en.wikipedia.org/wiki/Concierge_medicine
     
  17. weilke

    weilke Touchdown! Greaser! PoA Supporter

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    It is mostly a primary care concept. In larger metro areas you are going to find 'take no insurance' specialists who have opted out of medicare and are non-par for all the insurance plans. They just bill what they bill and you pay what they bill.
     
  18. 172andyou

    172andyou Pre-takeoff checklist

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    5% of people have obamacare. You are pointing the gun in the wrong direction on that one.

    Hint: See above for Bruce's comment about needing 2.5 FTEs to deal with declined insurance payments.
     
  19. Let'sgoflying!

    Let'sgoflying! Touchdown! Greaser! PoA Supporter

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    Only good plan is to die. Without being sick before.
     
  20. weilke

    weilke Touchdown! Greaser! PoA Supporter

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    The admin bull#### increased for all patients since the ACA came around.
     
  21. Everskyward

    Everskyward Administrator Management Council Member PoA Supporter

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    I was wondering this too, as I usually only see my PCP once a year. I'm basically healthy, except for my medical adventure of a few years ago when I saw quite a few specialists, so concierge medicine doesn't seem like it would work well in that situation. I will say that my health insurance worked pretty much as advertised during that time.
     
  22. bbchien

    bbchien Final Approach

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    You are healthy until you are not.....
     
  23. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    So we totally jacked up the medical system for everybody to benefit 5%?
     
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  24. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    2 movements:

    DPC ( direct primary care) - doctors take cash only ... no 3rd party payments

    Concierge - for a fee usually about $100 a month become a member in a doctor's practice getting exclusive to him/her and services in rendering healthcare to you. It usually focuses on preventative medicine
     
  25. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    until you come down with cancer heart d or diabetes. In the concierge model you would be getting preventative health care instead of waking up one day 1/2 dead and seeking a doctor.
     
  26. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    many of my pilots are also in my concierge practice
     
  27. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    obviously DR B is pro airman ... i like to think i am to. i say yes ... it is up to the airman though.
     
  28. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    you go when you have an ouchie! you think a urologist will look for lung cancer?
     
  29. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    good doctors with large practices and high rating are the the ones going to concierge medicine ... they have enough satisfied patients that want more proactive care and will pay the cost of a starbucks double caramel latte a day!
     
  30. wsuffa

    wsuffa Touchdown! Greaser!

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    Within MDVIP, there's a way to be referred to other MDVIP doctors without being members of both. So if you're a member of one, you can generally get referred in to see another.

    Yep. And up here even the small guys are going to concierge rather than dealing with the aggravation of a small/solo practice.
     
  31. airdale

    airdale Cleared for Takeoff PoA Supporter

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    My wife and I are in a concierge program operated inside a big health care organization. I think there is no "standard" model, so here is some of what we get:

    • 24x7 access to two or three docs (internists) with whom we are on a first name basis. One of the docs is always carrying a cell phone to take customer calls.
    • Reserved parking near the main door with the private concierge office area just a few steps inside. Receptionist/Medical Assistant and RN inside who also greet us by name. When we started there were only two chairs in the waiting area. Now four, but there is almost never anyone waiting.
    • Standard appointments are scheduled for an hour. Appointments can normally be scheduled the day after I call. Same day if it is urgent. They will also make house calls, hospital visits, and accompany us to other doctor appointments as needed.
    • Above-average docs and staff are selected for this program. They will also give us recommended names of known-good specialists within the larger clinic or outside, so we are not rolling the dice trying to select a specialist on our own or, worse, taking whomever the scheduler has available.
    • Pre-arrangements with a medical transportation organization that will get us home from an international trip if an emergency arises.
    • Last night I emailed my doc about refilling a prescription. This morning, 8:37AM, he responded and had already contacted the pharmacy.
    • Like what was said in a prior post, we pay for access. $5K/year for the two of us. Office visits are billed to insurance in the normal fashion.
    Is all this luxury and pampering worth the money? I would say no, except: Modern medicine is a hydra-headed monster, particularly in a hospital setting. Docs, PAs, RNs, techs of various flavors, etc. are running in and out but there is no single individual responsible for looking at the whole picture and making sure that all the part-time players aren't overlooking something or screwing each other up with conflicting orders. Our concierge docs do that for us. A couple of months ago my wife had a back operation and her doc monitored the whole pre-op/op/post-op/transition care process using the clinic computer system. He never actually had to intervene and he never actually had to visit the hospital, but if those were necessary he was ready to jump in. He did talk to her on the phone almost daily. That is why the concierge program is worth it to us. It's insurance, really, for the day something really bad happens and we need a medical project manager.
     
  32. Rushie

    Rushie Line Up and Wait

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    Wow so many great responses and all very helpful.

    There's been a couple new developments. Yesterday I made an appointment with the local rural good ole boy doc five minutes from my house (we actually live in a small town 30 miles out from SA). We had wanted the SA doc because she came very highly recommended by a trusted source, and she's associated with all the big city hospital resources in the same building. The plus with the local guy is he's right here. My experience with the country docs, they have their pros and cons. Pros, the docs are very personable, want to get to know you, spend a lot of time with you, staff is friendly, they're nearby, and a HUMAN answers the phone. Cons, not up to speed with electronic record keeping (did me real damage here), and maybe not plugged into the resources of big city medicine or the convenience of all the labs and imaging in one building. I was ready to forsake the big city doctor. The level of rudeness and incompetence shown me by the staff is just not worth it.

    Surprise! They called me back this morning. They talked to the actual doctor and she said, yes she intended to keep Mark, she understood last year that we were seeking a new primary for both of us and so Mark isn't considered a "new" patient in 2017 because it wasn't his fault his appointment kept getting pushed back, so the new policy of not taking new patients with his insurance won't apply, and they reinstated his appointment. Complete tone change. From "Go away you stupid idiot patient," to "Whoops, you're one of the ones the doctor likes so I'll be nice to you".

    Put me through a day of hassle, but now, I'm going to keep my appointment with the good ole boy doctor anyway and at least meet him. And Mark will meet Dr. Big City Excellent But With Rude Staff, and I guess we'll go from there.

    It is so stressful to have to meet new doctors and try to develop trust all over again, especially when you're old. I do have a direct payment specialist back in NC that I've known for over 30 years. He is 70 and I love him to pieces, he spends two full hours with me every visit, bills me directly, but he's not a primary. He has no plans to retire and loves what he does. I think you all are right, the really good doctors are moving to these new models. My old PCP back in Raleigh recently quit his practice and sent me a letter asking me to follow him to his concierge, in fact, I think he is with MDVIP himself, but I'm not flying back to NC for a primary, just that specialist, and my neuro, whom I've also been seeing for 30+ years.

    All your posts are so helpful, in getting me to understand the state of medicine today. I'm old now and came along in a day when your doctor giving you time and attention was normal. Now I see it is becoming two tiered. The masses are being squeezed out of this kind of great care because the reimbursements are too small to keep doctors in business unless they pack a lot of patients into the day, but for the wealthy, or at least those who will budget for it, you can pay a concierge retainer, or go DPC, and get the level of attention that used to be par for the course. (Thank God we are free to do so. May the politician who suggested making going outside the system illegal never again rise to power.)

    The exception seems to be the rural doc. With fewer patients he has the time to give you attention, but with low reimbursements, he isn't making money. But with mostly working class rural and small town populations, he can't make it under the concierge or DPC model. Maybe these doctors are aging out or closing shop, or moving to the city, and their patients are having to drive longer distances to get any care. Maybe we're lucky to still have one here, and maybe I'll like him better. We shall see. But in the long run either way, I think we'll end up with the concierge, particularly after Medicare kicks in. You guys' input is really helpful. Thanks!
     
  33. AggieMike88

    AggieMike88 Touchdown! Greaser! PoA Supporter

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    So if I wanted to come in to you more than once a year to get an "official" A1C done, under concierge this is an easier thing to request? Does this provide for more affordable tests such as the A1C, Lipids, Cholesterol, etc?
     
  34. 172andyou

    172andyou Pre-takeoff checklist

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    True. You used the word "since", instead of "because", so your statement is accurate. I've worked in medical billing. It was a catastrophe before, it's a catastrophe now. Obamacare wasn't the cause nor did it accelerate things.
     
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  35. 172andyou

    172andyou Pre-takeoff checklist

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    Nope. The system was jacked up before and remains jacked up now. Remember, Bruce's comment was the he needed 2.5 FTEs dealing with *insurance rejections*. That's not an Obamacare issue, it's greedy capitalists rejecting claims to maximize their profits.

    But, you're right that 20M or so people did benefit *substantially* by being able to get insurance for the first time.
     
  36. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    yup!
     
  37. Rushie

    Rushie Line Up and Wait

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    You are right, Obamacare didn't directly cause the problem, but it's been caused by earlier Federal meddling, specifically Medicare, and tax law which made employers offer insurance as compensation and made employers (not patients) the customer, and not being able to compete across state lines, and then the electronic records mandate which iirc isn't actually in the ACA. All of these things together have been slowly worsening things. Obamacare certainly didn't help though.

    But the benefit of the people who got insurance, isn't that being negated by the huge increases in premiums those folks are now seeing?
     
  38. 172andyou

    172andyou Pre-takeoff checklist

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    There is some truth to that. We should just adopt universal care, like every single other first world nation, and move on.

    [​IMG]
     
  39. airdale

    airdale Cleared for Takeoff PoA Supporter

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    Or greedy capitalists attempting to overcharge the insurance companies. Or, probably, both.

    I have a cardiologist friend who was considering moving to another group where he would be part owner of their equipment and would thus benefit when he ordered tests using said equipment. Also, did you see recently where doctors were upset because they were paid 6% of a drug's price to administer it and were objecting at the government's attempt to drive down drug prices. Stories of insurance company denials are rampant. Greed, to one degree or another, is genetically wired into us. The greedy homo sapiens was the one who had food adequate to survive the famine and to feed his/her family, hence his/her genes survive in the pool.
     
  40. 172andyou

    172andyou Pre-takeoff checklist

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    Fair point.