I've been seeing a fair number of these practice types coming online. If you aren't familiar with these they are basically retainer practices that charge upfront for a year at a time, say 2K or so. They restrict membership to 500-600 patients and you have complete access anytime via phone/text/email and they guarantee same day or next day office visit. Some have set up arrangements with concierge practices in other cities in case you get sick while traveling. What are your thoughts about this type of thing? Any of you use these and do you feel the money is well spent?

Sounds like the future.

My parents use one. They like their doc, the staff is excellent.

Their only complaint is they sometimes feel their doc and her office are pushing products (they sell a bunch of crap that they will say you need- supplements, skin creams, etc.)

I used one for a few years when I was in Houston.

Very convenient. And certainly what I would call attentive care. The doc had loads of time to spend with me... there were times I wished he'd speed things up!

In addition to same day appointments, he was able to perform other procedures in office that I would guess most docs either wouldn't do, or would want to have you set-up an appointment at a separate free standing facility for.

The only think I didn't care for: I still had to pay my co-pay. This doc had a very in-depth annual physical. The level of detail and information was really nice. But, it would usually take three appointments to complete. So that's not only the time for three office visits, but then he'd ding me for three copays.

Many providers are moving to this model. I personally don't see the value considering you still have to pay a copay and if your provider is in EPIC you can access your provider 24/7 with MyChart. If you have complex medical problems that would benefit from 30 minute to an hour appointments with your PCP and have extra disposable income to dedicate toward health care you may like it.

If the copays were eliminated and they stopped pushing supplements etc--is it then worth the upfront expense? What if a practice added things like in office ultrasound, bone density testing, mammography?

I thought the majority of those practices eliminated co-pays

Historically yes but as concierge moves down market, they cannot afford to set their prices high enough to attract patients.

Most of the new ones I am familiar with are charging $2000 annually in addition to your copay. Since this is for professional fees ancillaries tend to not be included.

The fee allows the providers to make the same money with fewer patients in their panel. As a consumer my expectation is that I can see my physician when I want to be seen and that the practice answers the phone timely when I call and many practices meet that expectation without charging a direct access fee. I have always seen the attraction to the provider but have never seen the consumer benefit of this model of care.

Huge upside in these clinics. They provide top notch care and are very personalized. I work with several concierge docs and they are the happiest docs you will ever meet. But they tend to be small operations.

Hey Derelict,

I'd like to bend your ear more about your experience working with these practices. Any way I could get in touch with you?

Specialists or PCP?

Primary care mostly. I haven't heard of any specialists where I live that have changed their model to concierge.

Hoist,

My experience with these docs is as referrals. I am a physical therapist who works in a similar setup as these docs and get a fair amount of patients from them. Still want to talk?

Sure, would still like to talk to you. Or email

What's your email address?

LachlanMor78@gmail.com

Oh I forgot, the other thing with my parents that they dislike is that she won't see adolescents. So they have to have another doc for my younger brother who is in high school. But other than that, they like it.

They have on occasion mentioned the cost, but then go on to say that in their 60s, the extra attention is appreciated when it comes to the preventative appointments.

I have considered doing this for ob/gyn. Most people have long appointment waits and want their doc to deliver them. There has to be value in having someone available 24/7. I am trying to figure out what that is worth

You could probably go at least $150/month, so 1800 a year. I think lots of folks would go for that for expanded services and guaranteed availability. I believe they can use HSA dollars to cover their membership. For 600 patients you'd be over a million in gross revenue before you put in your first speculum. Then see yearly as an annual , then a checkup 6 months later, plus any drop in visits for the usual office complaints. You bill the insurance but do not collect copays since you and the patient are already square. For the global pregnancy you and the patient are already square as well, same goes for GYN surgery--you bill insurance but don't balance bill the patient. This might be a real sweet gig if you've got the patient population. Keep your overhead tight and you could make a pretty penny

this is what we are doing with my wife's practice. Only use insurance for very extensive labs through my clinic if the patient request.

Pelayo,
Have you guys been happy with the transition? What specialty? Do you mind sharing some details?

Magnus said:

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Pelayo,
Have you guys been happy with the transition? What specialty? Do you mind sharing some details?

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Be happy to. Email my screen name 1104 at gmail

This sounds awesome from a provider standpoint! However, I wonder if it promotes things like excess antibiotic prescriptions. Like if a patient comes in and basically says "I have a cold, I want antibiotics, give it to me or I'm finding another doctor," do you give it for business sake?

Some healthcare/insurance models are being set up this way. It's called capitation. The health insurance company says "we'll give you X dollars each year to take care of Y amount of our patients." And the physician group has to figure out how to keep that Y population healthy in that much money and still make a profit. It's supposed to promote vigilant use of resources, discourage excess tests, etc.

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This sounds awesome from a provider standpoint! However, I wonder if it promotes things like excess antibiotic prescriptions. Like if a patient comes in and basically says "I have a cold, I want antibiotics, give it to me or I'm finding another doctor," do you give it for business sake?

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Just the opposite. In such practices physicians have time to convince the subscriber why they don't need them and offer alternative symptom control.

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Some healthcare/insurance models are being set up this way. It's called capitation. The health insurance company says "we'll give you X dollars each year to take care of Y amount of our patients." And the physician group has to figure out how to keep that Y population healthy in that much money and still make a profit. It's supposed to promote vigilant use of resources, discourage excess tests, etc.

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it's not a new idea, it was tried in the late 80's and early 90's. Doesn't work, physicians don't have the power to take the Big Mac out of your mouth. Stakeholders don't have equal incentives.

Managed care sucks.

Pelayo said:

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This sounds awesome from a provider standpoint! However, I wonder if it promotes things like excess antibiotic prescriptions. Like if a patient comes in and basically says "I have a cold, I want antibiotics, give it to me or I'm finding another doctor," do you give it for business sake?

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Just the opposite. In such practices physicians have time to convince the subscriber why they don't need them and offer alternative symptom control.

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Interesting, I didn't think of it that way. And I guess when it's that easy to make an appointment you can always say, "if things get worse, just come back or call."

bigtruckguy3500 said:

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Pelayo said:

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This sounds awesome from a provider standpoint! However, I wonder if it promotes things like excess antibiotic prescriptions. Like if a patient comes in and basically says "I have a cold, I want antibiotics, give it to me or I'm finding another doctor," do you give it for business sake?

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Just the opposite. In such practices physicians have time to convince the subscriber why they don't need them and offer alternative symptom control.

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Interesting, I didn't think of it that way. And I guess when it's that easy to make an appointment you can always say, "if things get worse, just come back or call."

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exactly

A friend got rid of his office and employees and does this. His patients pay an annual fee and he makes unlimited house calls. Doesn't take insurance. He's making really good money with no overhead other than his business Tesla he takes door to door.

Lots of time on the golf courses

This is such an emerging market. The potential is so great. The patient and the provider benefit.

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Just the opposite. In such practices physicians have time to convince the subscriber why they don't need them and offer alternative symptom control.

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I can vouch for this. While my provider was always ready to give me a script, he was also very good at looking at trends and suggesting other alternatives. Because he wasn't in a hurry when he saw me he took lots of time asking questions and really trying to figure out the best care for me. He was a very big proponent of managing your health with diet and exercise before meds (where appropriate).