Concierge medicine

I received a message from my doctor today informing me that he is planning to convert his practice to a concierge model. Does anyone have any experience with this service model.

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My GP’s practice went all-concierge last spring. He’s a great doc but he refused to treat my diabetes and I had only been seeing my him once a year for physical. We were looking at $8K yearly fees concierge fees to stick with him, so it was a no-brainer that I was not going to sign up for the concierge deal.

At this point I see several specialists (including my endo) several times a year, and I am seen by my new GP (who is not so good, and the practice is not so good, but it is not concierge) just for physicals. With my insurance I do not need my GP to sign off on specialist visits so I hardly ever see him.

In my area the trend towards concierge is largely in the GP’s and obstetrics, and not in the endos and other specialties.

If the doc that had been treating your diabetes is the one going concierge and you liked him/her, you do have a tough choice to make.

Tim.

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Concierge medicine is a qualifying deductible IRS expense, however, I have yet to find a specialist on the concierge model that accepts insurance or Medicare. I could afford the fees I had been quoted, but they are not for the faint of heart and the doctors I was interested in are out of state adding additional challenges so I did not go ahead with any of the few offers received.

My current primary care doc, an MD who practices functional medicine, uses a concierge model that I find affordable. The practice charges me $150 per month retainer fee then bills me for all the typical visits after Medicare and the supplement insurance have paid.

After a couple of years, it has worked very well for me. The functional medicine piece, for example, means that our unorthodox views of such things like cholesterol and statins mesh quite well. This has been a bone of contention with almost every other medico I’ve interacted with over the years.

Like me, the doc and her other practitioners all believe that true lifestyle practices (good diet, sleep, and stress relief) are much more important than the usual “throw a drug at it and be done with it” approach of the typical doctors.

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If you have a fortune to pay for it and the doc is ok maybe you can try it. There is no guarantee you will get the care you really need when you need it. Otherwise find another doctor.

I would not do it. One of my father’s doctors went to concierge and wanted him to stay on but he didn’t. His gp of 40 years who had abandoned him when he had covid and needed extensive homecare, a few years before that, asked his patients- asked my father if he would do the concierge thing and pay him $2000 a year I think. My father said no way, I guess all of his other patients felt the same so he never did it- the doctor.

So he could have abandoned my father, which is malpractice, after he had paid him a lot of money if it was concierge etc.

I also remember going to a functional type of doctor’s office at the time I was desperately trying to figure out what was wrong when I was heading to dka. They told me it would cost about $1-2000 at least for all of their tests etc. with no guarantee they would have figured it out. They did not accept insurance and i saw it as as a scam of some sort.

I briefly researched Concierge after I saw that they have it at Mass General Hospital in Boston. But when I looked at it, it was basically for GP services only and didn’t cover any of my diabetes care, and frankly at this point that is the extent of my medical needs. If Joslin (or Mass General) did Concierge for diabetes care, then I would seriously consider it, but as far as I’ve been able to find, they do not.

Didn’t make sense for my wife either - both of us see our GP for annual physicals and not much else.

As insurance companies make it more and more difficult, doctors and hospitals are going this direction.
it’s expensive enough as it is. Although I’ve never tried one, I see the ads for them all the time.

I have not used concierge services, and probably never would. I don’t have that many issues, and no doctor I see is so essential that I could not, or would not, find another.

Obviously, the biggest impediment for most is the cost. I don’t blame the insurance industry so much as see the problem as a failure of the American medical system. It is not just because doctors want to get paid, but like dermatologists that change from skin care to ‘Botox docs’, I think it has more to do with American inequality and a dysfunctional for-profit healthcare system. Serving the affluent and wealthy is where the money is.

On the other hand, a friend we spent time with used a concierge doctor or services when she was going through a rough patch and she found that worthwhile, but it was only temporary.

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Wow, how prices do vary. I was quite interested in working with a functional cardiologist from San Diego as we know diabetes is a 3 legged stool where we need to control our blood sugar, cholesterol and atherosclerosis. This doctor had the approach I was looking for but was strictly 100% self-pay concierge service. I am in Massachusetts where we have some of the best cardiologists available but none of them offer functional cardiology. They are great at doing stents, cabbage surgery etc, and say come see me when you experience symptoms like chest pains or shortness of breath. I live in rural MA so I would long be dead before I could actually get on a table once many of those symptoms show up.

There is also little money in functional cardiology, so not a great financial incentive for doctors to go into that field. This doctor said that I needed to fly to CA for an initial consult for $1495 and then my annual fee would be $12,000. Not impossible, but when Covid came along it all became more than I wanted to handle at that time.

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My PCP changed to a concierge practice more than 10 years ago. The practice setit’s fees at 1
$1650 per year. 12 years later the annual fee is the same. I usually contact him before the meeting and indicate the things that I want to talk about. Several times he has booked my meeting to be for over an hour. By the way I am on original Medicare and this practice does accept Medicare. If I thought I was getting shortchanged I would switch back but it probably depends on the doctor and not necessarily the practice.

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The insurance system, mainly the private one, is part of the failed for profit system. They largely control, often in cohort with pharma, what treatments we can get and how much they cost etc.

Not that I disagree, but I remember an economics book I read way back, and it described the problem similar to whack-a-mole, a three-part system of insurers, device/pharma, and hospitals. You can add sectors, or change the constituents, but the main point was that trying to regulate one of the parts fails, and one needs to deal with the entire system to effect change.

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So far this seems like a no go for me. I haven’t seen his exact pricing model yet.

So far, all the information I have seen came from a text message he has sent me. He has not yet provided any specifics, just that he is changing. He promises more information will be coming in September.

My primary care physician converted to a concierge practice several years ago. Let me give you a little personal background to show how I came to my decision.
Prior to the concierge dilemma.
My PCP was just 6 years my senior in age and I knew retirement was a possibility so I began looking around for a new PCP. That was a complete bust.
I had this PCP for nearly 40 years. I trusted him, liked him, and he would call me by name if we ran into each other in the grocery store. I did have a few other PCP’s during the 40 years because of insurance changes but was back with him as soon as I had insurance that covered his practice.
He decided to go into a concierge practice because he wanted to be able to spend time with each of his patients and not be forced into the 15 minute and 30 minute visits. He also wanted to reduce his patient load in order to accomplish the additional time with each patient. I could not afford the fee but I also could not find a replacement. I borrowed the $ in order to stay in his practice, at least until I could find another doc. I continued to look for a new PCP for several years without any success.
Then, my doc, that had saved my life in 1990 and had always been there for me, suddenly died two years ago. Yes, I had other specialists, eight at the time, but it was my PCP that kept me alive.
The advantages I had with the concierge practice:
Appointments for an acute issue could be made same day or next at the latest.
Extended time with doc during an appointment.
No going through others when you need to speak to your doc. He gave his patients his personal cell phone and you could call him 24 hours a day, 7 days a week.
Annual check ups were thorough and were 3 hours long. Plenty time for ALL your questions and review of health.
He was well worth the money I borrowed to continue to see him.

Not all concierge practices offer the same benefits and are not for all patients. It all depends upon what you are looking for in a PCP, is it affordable, and will you get what you are paying for.

I now have a new PCP and his practice is a total nightmare but that is what I have available. It is not a concierge practice. Would I use another concierge practice? Not unless the doc was so superior that he/she would make it worth the fee.

I just learned last month that my area no longer allows docs to admit patients to the hospital. If hospitalized, the patient must use the “hospitalists” provided by the hospital. Only surgeons have admitting privileges. That means when I need my doc the most, I don’t get to see him or be treated by him. Why pay an additional fee to a doc if they are forced to abandon me when I need them the most. This goes for PCP’s and specialists in my area. All the hospitals in my area (of which there are plenty) have been bought up by one of two huge corporations.

I have been very upset since I learned this last month.

Good luck with making your decision. Only you can determine if a concierge practice is right for you. Wishing you the best.

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There are some interesting points, and a few thoughts occurred to me while reading:

Concierge services cost extra money, but with that comes more immediate access to services, and can provide time and money for doctors to enjoy their lives, as well as provide better care. As with many things, the additional cost allows many to ‘skip the line’, and although a benefit to participants, both provider and customer, we can see around us how unfair this can seem to others, when wealth and affluence get special treatment.

The other issue has to do with hospitals. When doctors are squeezed between selling their practices to hospitals or becoming part of a concierge service, some will choose concierge. Hospitals can drive out good practices, forcing many into less good service.

Even before concierge services, one of my endos liked to spend 90 minutes (about 1 and a half hours) with me. I would schedule as the last patient on a Friday. He felt that he learned from me, and I found him to be an excellent doctor, helping tweak my insulin for better control. Although always respectful of his time, there were instances where I needed to email him - on vacation, far from home, without insulin - and he would respond almost immediately.

At some point, he sold his practice to a local hospital. I kept seeing him, but the hospital ruined aspects of his care. He no longer got emails from me, even when put through the system. They forced him to cut appointments down to 30 minutes, or even fifteen (15), although he was able to carve out 60 minutes for me and one other person. At some point, the pressures of working both at NYU and the VA forced him to choose - he chose the VA - and with that, I had to find the next endo.

Hospitals have come to dominate our healthcare landscape. In some ways, I think this can be good, as I believe that taken together hospitals can improve the quality of care, making sure that the best treatments are chosen. On the other hand, they can be efficient with time but aggressive about billing, reducing some good aspects of care while increasing costs.

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Bingo! Thank you Timothy! This is just another example of how broken healthcare in the US is and health insurance has been and continues to be the primary driver of this failure. Probably the biggest reason for the emergence of concierge doctors is because they too have been squeezed by a system that drives wedges between patients, doctors and care.

I hate the idea of concierge doctors and think it contrary to the physicians oath but I understand the position doctors have been put in, ultimately by the health insurance industry. I understand it and have seen it in action at our Endo’s office. Who by the way no longer takes any insurance and would never consider going concierge. Same with our GP who we have been with for a few decades.

Rather than “concierge” I’d call it “personalized” health care and opt out of accepting any insurance at all, if the insurance companies make it do damn hard to deal with them.

I see a concierge doctor (Primary Care) and am happy with the care, and time (at least hr/visit) spent with me. The group utilizes Cleveland Clinic Cardiac protocol for labs. My pcp helps with my diabetes care in that she writes the rx’s I need as well as orders for pump/ supplies.I manage my own diabetes and just let her know what I’m doing. I follow TCOYD info and discuss it with her.
To me, money well spent.
I have 24 hr access to her, same or next day visits, if hospitalized, she manages my care.

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