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Medical Concierge Model

Discussion in 'Economics and Financials' started by KB21, Aug 25, 2013.

  1. KB21

    KB21 Almost Never Wrong Club Member

    Dec 6, 2007
    What would you say if you were given the choice of paying $150 a month for health insurance via a managed care PPO or paying $180 a month to buy a medical membership into a concierge medical practice?

    Here's what a membership to a concierge medical practice would give you:

    *24/7 access to your physician
    *A guarantee of either same day appointments or being seen in the next 24 hours
    *Spending more time with your physician when you see him
    *Cheaper rates for lab work and xrays, since in concierge clinics can get these cheaper by cutting out the middle man

    Concierge medical practices typically limit themselves to less than 500 patients per physician. In fact, I recently read that the national average was around 350 patients per physician in a concierge practice. Because of this, instead of the typical 10-15 minute appointments you currently get with your doctor, you will get to spend 45 minutes to an hour with your doctor. What this extra time allows is a more detailed discussion between you and your physician about your medications and your health. You have more time to come up with a detailed medication plan, nutritional plan, and exercise plan that promotes your overall health and wellness. The early data on concierge practices is that there is 79% fewer hospitalizations for patients who are part of a concierge practice than there are with patients who are in a traditional practice these days. Also, the fewer number of patients means that you will be seen when you are sick. As a result, you don't have to wait 2 months to get an appointment with your physician, and you don't have to go sit in urgent clinics where 3-4 hour wait times are the norm.

    Essentially, instead of health insurance, you can use that money towards what I feel is a better plan for you overall. In the concierge model, the decisions are made by you and your physician. Not some pencil pusher that works for an insurance company or works for the federal government. You can also save money by purchasing a catastrophic health insurance plan that has a high deductible but is very manageable to pay for, just in case something does happen to you that is going to run an enormous hospital bill up.
  2. Fin D

    Fin D Sigh Club Member

    Nov 27, 2007
    Ever since my dad became paralyzed, I've learned a lot more about insurance.

    His hospital bills for 3 neck surgeries, 1 reversible colostomy, a couple of months stay at a therapy hospital, various scans, extended PT & OT, bed and power chair, various medical supplies has totaled into 100s of thousands of dollars. He has Medicare and BC/BS Plan F (which is suppossed to be the best gap there is). He still didn't get all the care he should have.

    I don't see how concierge helps with that. Sounds like to me, unless I'm missing something in your explanation, concierge should be an added bonus rich people pay for.
  3. KB21

    KB21 Almost Never Wrong Club Member

    Dec 6, 2007
    I really don't get where people say that concierge medicine is only for rich folks. The numbers I gave earlier and just used as an example. The average membership fee nationwide right now is $1,500 per year. That sounds like a lot, but it is only $135 a month. You can get a catastrophic plan that has a high deductible to cover anything that is catastrophic, which is exactly what the plan says. It's a lot easier to make arrangements to pay for $5,000 or $10,000 in medical expenses than it is to make payments on $250,000 in medical expenses that your traditional insurance company won't pay.

    This model would effectively do several things.

    *It would take medicine out of the hands of the government and insurance companies and put it back into the hands of the physicians and patients, where it belongs.
    *The patient will have greater access to his/her physician on one of these plans, and the result of this would be improved health/less hospitalization/lower medication costs.

    As a physician, I'm thinking about starting one of these practices when my contract with a current hospital system is up. I'm tired of having to cut through all the red tape to get things done. I'm tired of having to do peer to peer discussions on why I think so and so needs an MRI or an ultrasound. I saw a child yesterday that had a knot come up on her breast. The family is freaking out. The child is on medicaid though, so guess what. I have to get a PA to get an ultrasound of her breast. Well, yesterday was saturday, so I have to wait till Monday to start the process for a PA, and then I have to wait till they go through all their BS to get this thing approved. Knowing medicaid, they will deny it.

    I'm also tired of having to get approval for any extra work I want to do outside the system.

    Mostly though, I'm tired of not being able to practice medicine the way I was taught to practice medicine because I'm constantly being told by those around me how I should be practicing medicine to cut costs. The way we currently practice medicine, which is like herding cattle, is not good for the patient. I work in urgent care, and I saw 44 patients yesterday between 8AM and 6:45 PM. I've had two occasions where I've seen 57 patients in the same time span. Urgent care is a little different, but when you have primary care docs seeing 40+ patients a day, exactly how is that good for the patient?
  4. Two Tacos

    Two Tacos Season Ticket Holder Club Member

    Nov 24, 2007
    So, it's say $180 and that covers all of the urgent care type of situations, but with 24/7 access? You'd still need some sort extra insurance for things like your MRI example though, correct?

    I have friends and family that are doctors, and my wife is having lots of medical issues. So, I see just how F'd the system is. My wife has Lupus, her doctors don't want to diagnose the disease, because the minute they do they have to treat the disease, or be liable and risk losing or paying much more in malpractice insurance. The treatment is far worse than her current symptoms. If they proscribe something and she doesn't use the proscription, she is non-compliant and insurance doesn't have to cover any further issues. So, they mark possible lupus in her records and don't order the tests that would be definitive, while keeping a close eye on her organ function. I know some one who had a patient who was bleeding and needed her uterus removed. The patients insurance wouldn't cover the surgery until a minimum about of bleeding occurred. So, the doctor had to wait until she bleed enough, otherwise there was a chance that the insurance wouldn't cover it and the patient would be stuck with a $10k bill.

    We lucky have really good insurance and very good doctors. My wife was having pain and wanted a hysterectomy but her doctors didn't think that would be enough for the insurance to sign off on it right away given her age and other medical issues. Her PC wrote a recommendation siting stroke risks due to migraines with auroras or something, and I forget what her OBGYN added. They still thought it would be a couple of go a rounds with the insurance company, but they approved it right off and scheduled the surgery right away. They found very malignant cancer cells that luckily hadn't spread. She was no more than a month from it getting out of her uterus and being a huge problem. The expected issues with insurance could have made me a widower, I get sick just thinking about it.

    Sorry, went off topic. I just needed to vent on our "system".
    Fin D likes this.
  5. KB21

    KB21 Almost Never Wrong Club Member

    Dec 6, 2007

    When you take out the middle man and eliminate the governmental red tape, you can actually accomplish cutting costs of health care services without cutting the quality of health care services.

    In the case you mentioned, if you need an MRI, I can potentially negotiate with a local imaging center the get you and MRI for around $400-500 instead of the $2,000 they will charge an insurance company. In most cases, your insurance will only cover 80% of the cost of an MRI at best, so you are still going to pay out of your pocket $400-500 for the MRI with insurance.
    Two Tacos likes this.
  6. McLovin

    McLovin Resident Pats fan.

    May 7, 2008
    North Cacalaka
    I heard something about this a few months ago that sounded like it was worth exploring. There was a DR from Kansas whose practice did the concierge based service and it was something like $50 a month. It covered all your basic family practitioner needs, office visits and meds.

    Then, on top of that, he recommended that the person purchase a catastrophic care plan from an insurance company that would cover the rest of the stuff that could happen, such as FInD's father or Taco's wife.


    Here is a link a different interview with the same Dr. he makes some really good points about insurance companies and costs.

    For FinD: I'm not looking for a debate, I just think it's a neat idea and worth looking into.
  7. Eshlemon

    Eshlemon Well-Known Member

    I could definitely see a growth in concierge medicine after the ACA. More Doctors forming their own private healthcare "gym clubs" whose patients receive higher personalized health care service...with the rest not in a clubhouse getting less.


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