Doctors Charging "Membership" Fees

[torinsmom]

Well, there's a difference.... As a teacher, you're paid 100% with taxpayer money and as such, need to follow guidelines set by a governing body. Physicians agree to accept medicare reimbursement amounts for care if they agree to take medicare patients, but many docs are deciding to drop medicare patients altogether as they're finding that to keep them is damaging to them financially.

I guess you would have the option to teach only English speaking children if you used your degree to open your own business and tutor children in a specific subject.

I think that the reason this concierge type of model in delivering care is striking up a heated debate is because of medicare, and also because people think that physicians should put patients first, even if that means economic suicide.

Then there's this idea, "well, they knew it would cost hundreds of thousands of dollars.....now they're complaining about what they make....too bad". But it doesn't have to be "too bad" for them ....many have found a way to monetize their exemplary care.

I was just giving an example. I would never stop teaching economically disadvantaged or ESL kids. If I wanted to do that, I would teach at a private Montessori instead of a public Montessori. It's part of my duty as a teacher, in my opinion, to inspire the love of learning in EVERY child

It is just sad that patients who are already paying for insurance, copays, deductibles, etc are being "kicked to the curb" in favor of those who can pay the extra money. I think it is elitist care. Its fine as long as only a few drs do it, but what about when it spreads? Then those who can't afford to have a dr on retainer will have to go to the ER and cause more of a tax burden for all of us.

Most people on Medicare worked for years and paid into the system. It really sucks that they are left to find a doctor that isn't worried about reimbursement. And what about all the kids on Medicaid? Should they be denied the best doctors because they are poor?

 

[fkj2]

Most people on Medicare worked for years and paid into the system. It really sucks that they are left to find a doctor that isn't worried about reimbursement. And what about all the kids on Medicaid? Should they be denied the best doctors because they are poor?

Really? You think there actually are doctors not worried about reimburesements?

EVERYONE in medicine is worried about reimbursements. I don't think you understand that we all have bills to pay, the same as you do. These new docs starting out? MANY have jobs moonlighting. This isn't volunteer work, although there's plenty of time we never get paid for. I get paid $X for every home health visit I make. If I'm there for 30 minutes, I get $X. If a patient has more problems or their medications are a mess and I'm there for 90 minutes, I get $X for the visit. No travel time, so if my visits are half hour, 40 minute trips, I eat that time. It's not an 8-hour, teach (I mean, work) from one location. Physicians are the same; they do far more than they receive reimbursements for that they write down, but the public never sees that, so accustomed is the country to a 40-hour work week.

You know, it's SAD that some providers have been pushed to the point where they no longer accept Medicaid patients but the low amount of renumeration is only one aspect. Someone commented in the office just the other day how often Medicaid patients make appointments and then, simply don't show up--no call or anything--denying someone else, who might really NEED to be seen, that opportunity. And doctors can't afford "empty holes" in the schedule.

Now, if you as a part of the public, are willing to pay more in taxes to ensure that Medicaid patients can be seen, that's something to consider.

If you, as a teacher, don't have a thorough understanding of how scheduling in medicine works or the problems providers face, you ought not to be chastising the profession so easily.

 

[wdwcoltsfan]

I have heard of the the concierge offices, but it hasn't happened in our area. I can only speak for here, but many if not all physicians accept Medicare and Medicaid patients, but they have stopped accepting new patients. They aren't kicking out their current Medicare and Medicaid patients, but they have come to realize that the bulk of their patient load can't be this group due to lack of reimbursement.

People can become very bitter when discussing phyicians and their pay. Some doctors make very healthy salaries, but many here are making between $80,000-100,000. That's not even considered *wealthy* by government standards. Most of those physicans are general practice, peds, internal medicine and geriatrics--the ones who have a private solo or group practice. I know to some, that sounds like a lot of money, but consider undergraduate, medical school and residency loans compounded with increasing malpractie insurance and it doesn't work out to be a financial windfall. It does make a big difference to their practice when the government threatens to decrease reimbursement rates.

I understand the patients's frustration. It can also be frustrating to the physician when people want their doctors to have the *best* education(it's expensive), spend ample time with them in the office, call them back immediately when they call the office, be available whenever they need to be seen and then complain when it doesn't work out that way. On top of that, they don't want to be charged too much and they are the ones determining what is too much. I wish the general public realized how much a business medicine is. It's sad that it has come to that, but it is the reality of medicine today. It's really easy to say, "well, they should see xx patient and it shouldn't matter how much they are reimbursed" because, face it, it doesn't affect that person. Why do they care how much the physician is reimbursed?

Now, if you're wondering my frustration with this, it's because dh is an emergency room physician. He is in a completely different situation because he has to see whoever comes through the door. The only time he knows if someone has insurance is if he has to refer them. We do have friends who are trying to figure out what they can do to stay in business and not have to lay off staff.

I have always said to dh I wish our lawmakers had to spend a couple of days in the emergency room before determining what changes are best made to healthcare.


Rachel

 

[beansmom]

God Bless Him!!!

ty, but I am the one who is blessed...he's the finest man I ever met.

 

[torinsmom]

Really? You think there actually are doctors not worried about reimburesements?

EVERYONE in medicine is worried about reimbursements. I don't think you understand that we all have bills to pay, the same as you do. These new docs starting out? MANY have jobs moonlighting. This isn't volunteer work, although there's plenty of time we never get paid for. I get paid $X for every home health visit I make. If I'm there for 30 minutes, I get $X. If a patient has more problems or their medications are a mess and I'm there for 90 minutes, I get $X for the visit. No travel time, so if my visits are half hour, 40 minute trips, I eat that time. It's not an 8-hour, teach (I mean, work) from one location. Physicians are the same; they do far more than they receive reimbursements for that they write down, but the public never sees that, so accustomed is the country to a 40-hour work week.

You know, it's SAD that some providers have been pushed to the point where they no longer accept Medicaid patients but the low amount of renumeration is only one aspect. Someone commented in the office just the other day how often Medicaid patients make appointments and then, simply don't show up--no call or anything--denying someone else, who might really NEED to be seen, that opportunity. And doctors can't afford "empty holes" in the schedule.

Now, if you as a part of the public, are willing to pay more in taxes to ensure that Medicaid patients can be seen, that's something to consider.

If you, as a teacher, don't have a thorough understanding of how scheduling in medicine works or the problems providers face, you ought not to be chastising the profession so easily.

I am still trying to find where I "bashed" your profession? I said it sucks that patients have to suffer because their "insurance" is not accepted.

And of course, I know everyone wants to be reimbursed for what they do. But if, say, doctors limited their Medicare/Medicaid patients to 5% or even less, then those patients could get care, while the doctor would get paid for 95% or more of their patients. Doctors should be able to charge a Medicare patient for a no-show, just like they charge another patient. Just put the $50 on their account and they can't come back until they pay it. If there is no consequence for missing an appt., they will keep doing it. Some regular patients would do that too, if given the chance.

I don't really feel like I am chastising the whole profession. I am sad for the patients, and I do think the concierge system is elitist. My son was on Medicaid when he was first born, and I can't imagine having to search high and low for a doctor who would see him when he had a 104 degree fever. If the Medicare system is broken, it needs to be fixed. None of that is the patient's fault though, anymore than it is the doctor's fault. There has to be some middle ground, or people will be forced to go to the ER and it really will break an already struggling system.

LOL if you think my work is 8 hours a day and I get paid for every hour I work I may not have a thorough understanding of the scheduling and problems of doctors, but I don't think you have an understanding of my profession either. There are very few jobs that are 40 hours a week these days. I "moonlight" too every afternoon/evening, as does everyone I know who works for the state. And I don't get reimbursed for my travel time or the wear and tear on my car either.

 

[LovableGluttons]

I have heard of the the concierge offices, but it hasn't happened in our area. I can only speak for here, but many if not all physicians accept Medicare and Medicaid patients, but they have stopped accepting new patients. They aren't kicking out their current Medicare and Medicaid patients, but they have come to realize that the bulk of their patient load can't be this group due to lack of reimbursement.

People can become very bitter when discussing phyicians and their pay. Some doctors make very healthy salaries, but many here are making between $80,000-100,000. That's not even considered *wealthy* by government standards. Most of those physicans are general practice, peds, internal medicine and geriatrics--the ones who have a private solo or group practice. I know to some, that sounds like a lot of money, but consider undergraduate, medical school and residency loans compounded with increasing malpractie insurance and it doesn't work out to be a financial windfall. It does make a big difference to their practice when the government threatens to decrease reimbursement rates.

I understand the patients's frustration. It can also be frustrating to the physician when people want their doctors to have the *best* education(it's expensive), spend ample time with them in the office, call them back immediately when they call the office, be available whenever they need to be seen and then complain when it doesn't work out that way. On top of that, they don't want to be charged too much and they are the ones determining what is too much. I wish the general public realized how much a business medicine is. It's sad that it has come to that, but it is the reality of medicine today. It's really easy to say, "well, they should see xx patient and it shouldn't matter how much they are reimbursed" because, face it, it doesn't affect that person. Why do they care how much the physician is reimbursed?

Now, if you're wondering my frustration with this, it's because dh is an emergency room physician. He is in a completely different situation because he has to see whoever comes through the door. The only time he knows if someone has insurance is if he has to refer them. We do have friends who are trying to figure out what they can do to stay in business and not have to lay off staff.

I have always said to dh I wish our lawmakers had to spend a couple of days in the emergency room before determining what changes are best made to healthcare.


Rachel

I'm so glad you posted! I worked in a small ER in Ca. in a depressed area. Many of our docs were fresh out of school with big malpractice premiums and big student loan debt. What was left after taxes wasn't very much at all. We nurses would even buy their meals at night because they simply had no money.

Very sad.

 

[stitchlovestink]

Really? You think there actually are doctors not worried about reimburesements?

EVERYONE in medicine is worried about reimbursements. I don't think you understand that we all have bills to pay, the same as you do. These new docs starting out? MANY have jobs moonlighting. This isn't volunteer work, although there's plenty of time we never get paid for. I get paid $X for every home health visit I make. If I'm there for 30 minutes, I get $X. If a patient has more problems or their medications are a mess and I'm there for 90 minutes, I get $X for the visit. No travel time, so if my visits are half hour, 40 minute trips, I eat that time. It's not an 8-hour, teach (I mean, work) from one location. Physicians are the same; they do far more than they receive reimbursements for that they write down, but the public never sees that, so accustomed is the country to a 40-hour work week.

You know, it's SAD that some providers have been pushed to the point where they no longer accept Medicaid patients but the low amount of renumeration is only one aspect. Someone commented in the office just the other day how often Medicaid patients make appointments and then, simply don't show up--no call or anything--denying someone else, who might really NEED to be seen, that opportunity. And doctors can't afford "empty holes" in the schedule.
Now, if you as a part of the public, are willing to pay more in taxes to ensure that Medicaid patients can be seen, that's something to consider.

If you, as a teacher, don't have a thorough understanding of how scheduling in medicine works or the problems providers face, you ought not to be chastising the profession so easily.

bolding is mine....
And it is my understanding from practices that we use that this is ONE of the primary reasons many have quit taking medicaid patients. First let me state that I do NOT work in the healthcare industry. But my parents have medicare. Here in MD there seems to be a large distinction between medicare and medicaid. All the Drs I see accept medicare patients (which are almost always the elderly) but most do NOT accept medicaid patients. Apparantly (this is what I have been told by office staff at multiple offices) that medicaid is operated thru the same plan administrator that we have thru my DH's employer (here in MD and there may be other ins companies too). so when I call a specialist to first make an appt and they ask for my ins info and I tell them we have XX,the first thing out of the other person's mouth is "is that thru an employer or the state?" If it's thru the state then they do not accept that insurance.

I am still trying to find where I "bashed" your profession? I said it sucks that patients have to suffer because their "insurance" is not accepted.

And of course, I know everyone wants to be reimbursed for what they do. But if, say, doctors limited their Medicare/Medicaid patients to 5% or even less, then those patients could get care, while the doctor would get paid for 95% or more of their patients. Doctors should be able to charge a Medicare patient for a no-show, just like they charge another patient. Just put the $50 on their account and they can't come back until they pay it. If there is no consequence for missing an appt., they will keep doing it. Some regular patients would do that too, if given the chance.

I don't really feel like I am chastising the whole profession. I am sad for the patients, and I do think the concierge system is elitist. My son was on Medicaid when he was first born, and I can't imagine having to search high and low for a doctor who would see him when he had a 104 degree fever. If the Medicare system is broken, it needs to be fixed. None of that is the patient's fault though, anymore than it is the doctor's fault. There has to be some middle ground, or people will be forced to go to the ER and it really will break an already struggling system.

LOL if you think my work is 8 hours a day and I get paid for every hour I work I may not have a thorough understanding of the scheduling and problems of doctors, but I don't think you have an understanding of my profession either. There are very few jobs that are 40 hours a week these days. I "moonlight" too every afternoon/evening, as does everyone I know who works for the state. And I don't get reimbursed for my travel time or the wear and tear on my car either.

bolding is mine...
I have been told that the % of no shows for medicaid is ridiculous. Yes, they can put their cancellation fee on that account, but they're not going to see that money. When the person calls for another appt and is told about an account balance, they say they'll just go elsewhere and do (such as the ER). It's sad, but it the lack of responsibility on the patients' part, not that all of medicaid patients are irresponsible, but enough have ruined it for the majority.

Yes the medicare system is very broken... Lately, they have been running ads on TV telling medicare patients not to give your info to the DR's office over the phone (give it to them in person at your appt) because of Dr's fraudently billing medicare for services that were NOT rendered. It is broken on both ends. for example, medicare doesn't want to pay O/T rates for PT's in rehab centers. So my dad got to sit around each weekend doing nothing to speed his recovery, BUT they paid room and board each Sat/Sun at the rehab center. Wouldn't it make more sense to pay the O/T rate for the PT to get him out of there sooner and save the more costly R & B fees???!! Guess medicare doesn't see it that way... sigh...

 

[fkj2]

I am still trying to find where I "bashed" your profession? I said it sucks that patients have to suffer because their "insurance" is not accepted.

Doctors should be able to charge a Medicare patient for a no-show, just like they charge another patient. Just put the $50 on their account and they can't come back until they pay it. If there is no consequence for missing an appt., they will keep doing it. Some regular patients would do that too, if given the chance.

I don't really feel like I am chastising the whole profession. I am sad for the patients, and I do think the concierge system is elitist. LOL if you think my work is 8 hours a day and I get paid for every hour I work I may not have a thorough understanding of the scheduling and problems of doctors, but I don't think you have an understanding of my profession either.

You can try and dress your comments up all you want but when you imply that physicians are providing "elitest" care, that's over the top. Let me quote you:

"It is just sad that patients who are already paying for insurance, copays, deductibles, etc are being "kicked to the curb" in favor of those who can pay the extra money. I think it is elitist care."

If those comments don't paint the practice of medicine in a poor light, I don't know what will...the vision of practitioners being so callous that care is refused because of the money. People don't enjoy making these types of decisions.

Charge a Medicare patient for a no-show? That would be considered Medicare fraud. If a Medicare patient has a secondary insurance that might actually pay more, it is illegal to not bill Medicare first. And yes, patients break appointments..over and over again. In fact, I saw a patient who was overdosing herself on an inhaler. When the physician found out, she was ballistic and had to INSIST the patient schedule--and keep--an appointment. The physicians shouldn't have to be babysitters.

My mother was a teacher. I am well aware of some of the challenges the profession faces although her career was ending in the late 1980s. Many was the night she fell asleep with her head on the dining room table while grading her students' homework. Broken homes, the early days of ADD, yes, I'm familiar with much of it. That profession, too, is underappreciated.

 

[dvcgirl]

I was just giving an example. I would never stop teaching economically disadvantaged or ESL kids. If I wanted to do that, I would teach at a private Montessori instead of a public Montessori. It's part of my duty as a teacher, in my opinion, to inspire the love of learning in EVERY child

It is just sad that patients who are already paying for insurance, copays, deductibles, etc are being "kicked to the curb" in favor of those who can pay the extra money. I think it is elitist care. Its fine as long as only a few drs do it, but what about when it spreads? Then those who can't afford to have a dr on retainer will have to go to the ER and cause more of a tax burden for all of us.

Most people on Medicare worked for years and paid into the system. It really sucks that they are left to find a doctor that isn't worried about reimbursement. And what about all the kids on Medicaid? Should they be denied the best doctors because they are poor?

Kids on Medicaid and even seniors with only medicare (and no supplemental insurance) are already receiving sub-par care.

I have an uncle who is disabled....he's 50 years old. He lives on SS disability and after a couple of years has finally been put on medicare. His income is so low that medicaid is now picking up the medicare premium as he can't afford it. He's had tons and tons of medical issues and only since he's on medicare is he even receiving what I'd call "decent" care...but not great.

I'm not saying any of this is fair, it's just the way it is....

Unfortunately, with the state of Medicares finances, things are only going to get worse. People really have no idea what they're in for....its' one thing to hear about it and read about it, but it's coming our way.

 

[torinsmom]

You can try and dress your comments up all you want but when you imply that physicians are providing "elitest" care, that's over the top. Let me quote you:

"It is just sad that patients who are already paying for insurance, copays, deductibles, etc are being "kicked to the curb" in favor of those who can pay the extra money. I think it is elitist care."

If those comments don't paint the practice of medicine in a poor light, I don't know what will...the vision of practitioners being so callous that care is refused because of the money. People don't enjoy making these types of decisions.

Charge a Medicare patient for a no-show? That would be considered Medicare fraud. If a Medicare patient has a secondary insurance that might actually pay more, it is illegal to not bill Medicare first. And yes, patients break appointments..over and over again. In fact, I saw a patient who was overdosing herself on an inhaler. When the physician found out, she was ballistic and had to INSIST the patient schedule--and keep--an appointment. The physicians shouldn't have to be babysitters.

My mother was a teacher. I am well aware of some of the challenges the profession faces although her career was ending in the late 1980s. Many was the night she fell asleep with her head on the dining room table while grading her students' homework. Broken homes, the early days of ADD, yes, I'm familiar with much of it. That profession, too, is underappreciated.

Well, requiring a patient to pay a "retainer" if they want to remain a patient, when they already pay for insurance, and your office is being paid by that insurance(not Medicaid or Medicare) IS basically setting things up where those who CAN pay get better treatment , while those who cannot pay extra are told they will have to leave the practice. To me, that can't be called anything buy elitist. Not all drs are doing this, so I don't think the whole system is elitist. Maybe they aren't doing it to be callous to patients, but it is not going to be taken well by those who can't afford to spend $300 extra per year per person(or more if you are older). In the OP's case, it appears that the patients will be "kicked to the curb" if enough people subscribe to the service, and the OP decides not to pay.

I don't understand how a charge on the patient's account could be considered Medicare fraud. I am not saying to send that bill to Medicare. It would be the same kind of charge as this "concierge" charge. If the patient has a balance, they have to pay it before they can come in for another appt. If they leave b/c of that, so be it. That doctor wouldn't have to deal with that non-compliant patient again, right?

I'm sorry. I guess I took your post wrong where it mentioned working(teaching) and the 8 hour day. It sounded like you were saying teaching was not work and that we work 8 hour days.

I definitely appreciate doctors. I have had some pretty good ones, and I admire that they work all hours and have to worry about being sued, etc. I wish the system wasn't so broken, so patients could get the care they need and doctors could get the reimbursement they work hard for

 

[fkj2]

I don't know how this so-called concierge medicine works with Medicare pati ents. I can hardly imagine the government would permit it. It's hard to tell with the system in such a state of flux.

My basic point is this: Medical providers only have so many resources which are payer sources. Their reimbursement is severely restricted by both the state run insurers and the for-profit insurers, which follow what Medicare pays or doesn't pay for. I believe many physicians have absorbed about as much of the expense of providing care, thus the monthly stipend, or whatever you want to call it. And We the People, we get to pay high premiums for coverage we're not very happy with.

Because so many adjustments and cost cutting have been made by physicians (and other providers) over the years, the public at large hasn't felt the impact first hand. It's at the tipping point. DVCGirl just said it: Things are going to get worse in the care delivery system. Unless people have a senior who's already heard, "Sorry, Medicare doesn't cover that," they don't know. We've got bureaucrats determining much of our care. That's just wrong. But the physician's hands are tied as well.

That's why so many primary care docs are going to really large practices; they have more time off (as in not covering call), share office staff (meaning layoffs through consolidation), and splitting office expenses. We have such an office locally. I can barely get through in a work capacity to speak to a real human being. But, it is what it is.

Frankly, I think some of the sentiments expressed through this thread must make insurance execs squeal with delight; physicians get to look like the bad guys for having to resort to "concierge" fees and patients get mad because of the "money-grubbing docs". And the insurance execs...out of sight for the most part.