Doctors Charging "Membership" Fees

[fkj2]

All professionals pay or borrow to put themseleves through school. Granted doctors go for longer, but still they know what they are getting into. I agree that doctors deserve to be paid a good salary, but I believe they already are. It is true that insurance pay doctors less than they bill for, but doctors also bill higher knowing that they will not get it.

I should also add that my doctor is in a large practice with several doctors. Overhead is shared amongst all doctors, so overhead is much lower than a one doctor operation.

I undestand that a doctor's office is a business and as such they should make a "fair" profit. The problem is that what they consider "fair" is not always what everyone else considers fair. IMHO, charging your patients a retainer fee is not the way to get more revenue. Doctors should band together and petition the insurance companies.

What I'm saying is that since Medicare/Medicaid is a government run program and the government issues the licenses to the doctors, the doctors should not have the right to refuse to take it. This does not mean that they should have to take every Medicare/Medicaid patient, but they should be required to take some.

Trust me, not everyone graduates college with potentially up to $200,000+ in student loans. You can't seriously believe physicians entering an undergrad program know exactly what they are getting into. And does that argument really justify forcing physicians to take significant pay cuts? Float that idea with an attorney and see how far it goes with him or her.

What difference does it make if doctors bill higher than they will collect? They are paid what the insurance determines they will be paid and that's it. Physicians have "banded together" in large practices BECAUSE of the overhead costs. People lose jobs in that scenario...office people...billing people. As far as physicians banding together, I think they call that the American Medical Association. You don't really think they're not trying to do something about malpractice premiums? Oh wait, there's the topic of lawyers again. No tort reform this year either.

I don't subscribe to the position that states issue physician licenses and, as such, should be able to mandate physicians to accept a given number or percentage of Medicare/Medicaid patients. Physicians pay biannully to renew those licenses; they aren't free either. Most patients are "grandfathered" into a practice. Oh sure, I suppose there are some physicians that would cut them from their clientele.

Aside from that, physicians are already engaged in the socialism of medicine since it is the government who makes the determination the percentage that they will "cut" Medicare reimbursement each year, just as the government decided that seniors are not eligible for SS increases either this year or next. Physicians are already forced by the government to accept lower reimbursements by the government.

 

[Maryr1]

I think this is a new fad in medicine where doctors are looking to have smaller practices and give more personalized care. Some of the doctors in our area are no longer taking medicare/medicaid patients due to the poor reimbusement and high needs of that community (older patients with more health problems that are very time consuming while the payment for such patients is lower). I would gladly pay the fee if it meant my doctor was more available to me. I actually think these practices make less money but the doctors have a better patient relationship and a better quality of life. If I have a better relationship with my doctor and he knows me better I think the care I receive will be better. The better the doctor knows me the easier he or she will be able to evaluate me. (IE-she ALWAYS complains about........ versus Wow, this patient never looks this sick......) I go to a very expensive dentist that I have known for 15 years. Recently he had to cancel me twice in a row-and I didn't mind-because I know him and I knew he wouldn't do that unless he had to and frankly he knows me and he knew I was stable and could wait. He also has seen me on a minutes notice when I needed it.By choice his practice is very small and very select. He is worth the price I pay. No difference than a concierge doctor imho.

 

[dvcgirl]

This is concierge medicine, and it's not a fad, it's just the beginning, especially with family medicine. More and more physicians are going to turn away medicare patients due to decreasing reimbursement rates from the government and so they're turning to this model to increase revenue.

I've seen it in our area more and more. Most docs go to this model and then limit the number of patients that they take in their practice, to say...400 or so. They charge $1,500 a year or so to become a "member" and as a member you get more access to your doctor, longer examination times, special phone number to reach him/her...that kind of thing.

 

[Shelli_5]

The fact that people will say "Well, many doctor's are going to this" is how it is happening. You know what? If everyone said "No, I won't pay this." then they'd stop because they aren't going to sit and twiddle their thumbs, they WILL go back to taking insurance and copays and seeing patients like they always have. Did you know that in many countries doctors are poor? Our doctors would fall over if anyone suggested they live like "common folk", which isn't to say they aren't nice people but more that we, as society, have perpetuated this phallacy.

That's exactly what I was thinking! Yes, I know that medical school is expensive and residency is extremely difficult, but so was my PhD program. Too bad I'm not entitled to a 6-figure salary!

I think these concierge MDs are way out of touch with the everyday lives of most middle- and lower-class Americans. Especially in today's economy, people are struggling just to pay for the basics. Insurance premiums are skyrocketing. The national unemployment rate is 9.2%. Many of us haven't gotten raises in 2 years. To me, asking people to pay $1000 + per person per year for the "privilege" of seeing a MD is extortion. No one likes pay cuts or busy work schedules, but MDs have ethical obligations that are different from other professionals. Do we really want a society in which only wealthy people have access to competent health care?

 

[kaytieeldr]

I actually think these practices make less money but the doctors have a better patient relationship and a better quality of life.

I've seen it in our area more and more. Most docs go to this model and then limit the number of patients that they take in their practice, to say...400 or so. They charge $1,500 a year or so to become a "member" and as a member you get more access to your doctor, longer examination times, special phone number to reach him/her...that kind of thing.

I know dvcgirl's numbers are just examples... but 400 patients at $1,500 per year is $600,000 - guaranteed, before any treatment, before any co-pay, before any insurance payment. If that's "making less money", my entire concept of numbers has just been turned upside down!

 

[arminnie]

I work in healthcare (with the self pay and uninsured) and this is the MOST ridiculous thing I have ever heard of. This is going to push more and more people to use the ER as their primary care facility instead of working to get these people in to practices to help bring the cost of healthcare down.

I would kill to find a doctor that does not accept medicare. Now that I am covered by Medicare it is almost impossible to find a doctor. And I live in a city (180,000 population) with a major medical school.

NO ONE wants to accept Medicare patients as they get about $25 for an appointment. I am only allowed to discuss THREE items when I go for an apppointment. I have long-term health issues GERD, arrythmia, asthma, depression that are NEVER covered as they don't make the top three.

I had a fabulous concierge doctor in CA that I would use again in a minute if it didin't take 8hours to get there.

I've made SEVEN trips to the ER this year. I have Medicare and a great policy from my former employer - but none of this does anygood when you have to wait months to get an appointment.

Medicare sucks big time. I pay over $500 a month for A/B and a supplement. And I can spent months trying to find a doctor to see me. I finally got a gyn. only because she is a friend of my sister and is doing this as a favor. This is only going to get worse.

 

[Cruise]

Keep in mind too that many family doctors - "general practitioners" - are paid well below what a specialist is paid but usually with the same overhead costs (the exception being OBs who have *huge* malpractice insurance premiums). A medical student who comes out of school and residency and goes into general practice has the same amount of student loans to repay as a student that comes out of medical school and residency and goes into dermatology or cardiology.

This may be why some of the younger family doctors are going to this model and not just those getting ready for retirement.

 

[buzz5985]

I used to go to an OB/GYN who charged a $5 "comfort fee" (on top of your usual co-pay) if you wanted a paper sheet to cover yourself during the exam. Now, who is NOT going to pay that?

I wouldn't. Just bring a sheet from home, lot more comfortable.

 

[QuiverofArrows]

We used to live in FL and some of the doctors there were charging over $4k/yr/pt for concierge service several years ago. It was a very affluent area. As a larger family, there was no way we could pay that. The fee entitled you to home visits, direct phone lines and visits any time you were in the hospital. One doctor was accepting 200 patients and most all were elderly. Ever since my son was old enough to speak, he let us know he wanted to be a doctor. He even took some sewing lessons with his younger sister so he could sew nice stitches, after the recommendation from a surgeon. Although he is still a teenager, he has realized for several reasons that it probably isn't a wise choice for him to go into the medical field. He has asked many doctors some point blank questions and every doctor, with the exception of one, has told him honestly to choose another profession. Doctors have so many expenses for schooling and insurance in addition to the overhead costs most people pay for running a company. And that's not to mention the piddly reimbursement from the government or the hoops they have to jump through for some insurance companies. I used to manage an office for a surgeon and he was called up many times for surgery to the hospital. Granted this was many years ago but there were times that the same surgery an insurance company would pay over $10k for and he would get less than $2k from Medicaid. Don't even get me started on Medicaid for illegals. Most every doctor I know is an honest person that does want to help people. If you had a mechanic that charged more than someone else then you might not want to pay more money to see him but if you knew he was great at what he did and he offered better service then you might decide to pay that extra money.

We know of some people in the insurance industry and the premiums are going up...a lot to prepare for some changes coming in a few years. Some of the insurance plans are going to higher deductibles as well. I'm starting a small business just so we can try to pay off the rest of the debt we accumulated from my daughter's open heart surgery and have an income to cover her additional medical costs.

I sure wish things could change. Our favorite pediatrician practiced medicine for over 80 years. Dr. Denmark only charged us $5 or $10 when we went to go see her in 1999 and let people pay less if they had to or they could bring her something to use to barter services. She didn't take insurance put she didn't have to take it. There was no office staff to make appointments - you just showed up and the wait might be less than 5 minutes or it might be a few hours. Her office was just steps away from her home. She retired shortly after and we really miss her care.

 

[Maryr1]

"I know dvcgirl's numbers are just examples... but 400 patients at $1,500 per year is $600,000 - guaranteed, before any treatment, before any co-pay, before any insurance payment. If that's "making less money", my entire concept of numbers has just been turned upside down" (Quoted from above)


That amount of money doesn't even pay overhead/malpractice for a year-even for a small office!!!! Also, the doctors around here that have concierge service still take private insurance, they just have much smaller practices and if you are admitted to the hospital, they see you, they do not use hospitalists. They also have evening and weekend hours. This is a very common practice in Europe from what I am told and it is just an option for people who want to participate. I think it will become much more common place here as our medical system is overhauled just like it did in Europe.
In my mind health insurance is like car insurance. You can have high deductable, low deductable, full glass, no glass,collision,etc. You get to pick. Why should health care be any different? I don't have dental because I chose not too but I would choose to have concierge. It's all about my choices......

 

[ssawka]

Don't even get me started on Medicaid for illegals.

Quite frankly, I am so sick of hearing this. Are there illegals that get Medicaid? Yes! But there is a larger percentage of people with disabilities that need to be on Medicaid. Take DD for instance, she has Down syndrome and is on Medicaid as a supplemental insurance. Right now it's not a big deal to us whether the doctor will take Medicaid or not since she is on the plan from my employer, but as we all get older, our choice will be for her to go on Medicaid as her primary insurance and hope that a doctor will take her, or for me to give up retirement so I can continue to provide her private insurance.

I can understand that doctors come out of medical school with a large amount of bills not too mention the malpractice insurance and overhead costs, however there must be another solution then asking patients for more money. Many of the patients are already spending a considerable portion of their income on health care.

Our medial system is broken and every time there is an effort to change things people come out of the woodwork yelling that they want to keep things just the way they are. What is so great about the system we have now? If your fortunate enough to have a good health plan and/or a good paying job, consider yourself lucky and have some compassion for the people who do not have it as well. It is much too easy to reduce the less fortunate down to simple numbers on a page!

 

[15isto2]

Seen two posts about PCP's meeting people in the ER. Just wondering why this is and why people would want it.
I am basing this on the assumption that ER already have doctors who you can see and if its something that should be delt with by a PCP that you could probably make an appointment to be seen by them the following day.

 

[powellrj]

My last Dr left his hospital owned practice to start his own concierge practice in another town. I have no idea how he is doing, but I do wish him luck because he was a great Dr!

 

[fkj2]

Our medial system is broken and every time there is an effort to change things people come out of the woodwork yelling that they want to keep things just the way they are. What is so great about the system we have now? If your fortunate enough to have a good health plan and/or a good paying job, consider yourself lucky and have some compassion for the people who do not have it as well. It is much too easy to reduce the less fortunate down to simple numbers on a page!

If the change isn't an improvement, there isn't a point to the change.

There's no doubt this system has flaws, but the reality is medicine is a business. Someone receives a service and someone pays for it. It's an unfortunate reality for someone who has a DD with Down's to make hard choices as to whether to continue working to maintain private insurance or not....just as it was a hard decision for someone like me who quit her job for 7years to care for an infirmed elder with stroke related dementia. Life isn't always fair, and it's filled with hard choices. Everyone has something to deal with.

And as far as pointing to Canada, their system is facing some of the same problems; demographics are against them. Fewer people paying in; more people receiving services.

I don't think anyone's response has "reduced the less fortunate down to simple numbers on a page." I think it's easy to forget that physicians, especially PCPs, are the ones who spend a great deal of time sorting through the signs and symptoms of disease, working far more than the 40-hour work week. Factor in all the unpaid time, um...wouldn't be worth it to me.

And although non-for-profit hospitals must accept patients into Emergency because they accept government dollars, that's may be about the extent of treatment. While hospitals have to provide some indigent care, anything other than emergency care may be refused.

The agency I work for refused a patient recently; no payer source.

 

[fkj2]

Seen two posts about PCP's meeting people in the ER. Just wondering why this is and why people would want it.
QUOTE]

I think the average wait in an ER is around 4 to 6 hours. It's not "first come, first served, in an ER; patients get triaged, and sicker or gravely injured patients come first.

 

[sam_gordon]

I see nothing wrong with dr's going to the "concierge" model. That's entirely up to them. I can see (thanks to posters here) some potential benefits to that system for both doctors and patients. However, for my family, the costs outweigh the benefits. If our pediatrician (who we've been with for 12 years so far and three kids) went to this model... "good luck, sorry we can't afford you."

I would like my doctor to see me if I go to the emergency room because my doctor would know my history and have access to my medical records. Obviously if you're going to the ER for a broken leg/arm/cut/etc, the ER docs can handle that. But if it's something related to your medical history, your PCP would be better.

And I can't feel sorry for doctors educational bills. They made the choice to be in that profession. If they didn't do their homework to find out what that entails, why is that my fault? MANY MANY MANY people in my profession go to college, rack up student loans, then end up working for little more than minimum wage while they start out. If they're really good and can move up, MAYBE in 10-20 years they're comfortable, but that's not guaranteed.

 

[fkj2]

MANY MANY MANY people in my profession go to college, rack up student loans, then end up working for little more than minimum wage while they start out. If they're really good and can move up, MAYBE in 10-20 years they're comfortable, but that's not guaranteed.

"If they didn't do their homework to find out what that entails, why is that my fault?"

Yup, plenty of that to go around in many professions. Not much out there that's a panacea, is there?

 

[torinsmom]

For me(and for many Americans), its not a matter of I wouldn't pay it, its a matter of I couldn't pay it. I don't have an extra $600/year to cover a fee like that for me and DS. Maybe if it was a matter of up to six co-pays per year being waived(which would be $300 worth at most), in addition to the other perks, I might be able to swing it. We use a doctor's office that also has a walk in aspect, so we have evening and weekend options already. They have also gone to an online records system that doesn't cost any extra. I don't feel I need my personal doctor to meet me at the ER. The drs there are plenty capable of taking care of us in an emergency.

 

[Cruise]

Seen two posts about PCP's meeting people in the ER. Just wondering why this is and why people would want it.

I think the average wait in an ER is around 4 to 6 hours. It's not "first come, first served, in an ER; patients get triaged, and sicker or gravely injured patients come first.

Not only that, but if you walk into an ER, you're seeing someone who's never seen you before and has no idea about your medical history other than what you tell him/her. Some people are on so many medications today that they can't even remember them all. There may be small nuances to your past medical history that your PCP can add to the situation.

 

[ssawka]

Not only that, but if you walk into an ER, you're seeing someone who's never seen you before and has no idea about your medical history other than what you tell him/her. Some people are on so many medications today that they can't even remember them all. There may be small nuances to your past medical history that your PCP can add to the situation.

Sometimes though, that is a good thing. It sometimes helps to have another set of eyes. For example, I had stomach problems for years and my PCP treated me for everything from diverticulitis to ulcers and I saw no improvement. It wasn't until I went to the ER for the second time that I finally had an ultrasound done that they found gall stones. Why the PCP didn't recommend an ultrasound is beyond me.

I'm sorry if it sounds like I am bashing doctors in this thread, I do not mean to come off that way. I also understand that a doctor's office is a business and needs to be profitable. It is just that it makes me sick the way this country is going where we care more about the money in our pockets than about human life. I'm not sure what the answer is, but IMHO elite doctors, outrageous health care premiums, escalating health care costs, and only treating people that can afford it is definitely not the answer!