Are you a patient or a customer?

[casualperfectionist]

We just got a notice from our doctor saying that he's switching to a "concierge medical practice" and will be charging a Patient Membership Fee in order to remain in his practice. The cost? $2,600 a year!! NOT COVERED UNDER INSURANCE!!

The yearly fees range from $1,450 to $3,400 depending on your status and age. It's all spelled out in my blog post at The Casual Perfectionist: http://thecasualperfectionist.com/?p=2246

Needless to say, I'm on the search for a new doctor, one that will view us as patients and not dollar-signs.

What do you think? How much would you pay to keep the doctor you have?

[Kagey]

I would expect a complimentary massage with every appointment with this "membership!"

Is this guy trying to work part-time or semi-retire? Are most of his patients self-employed who can count the "membership fee" against some sort of deductible?
I think he's going to lose at least 50% of his patients.

This reminds me of a story my husband told me about an auto mechanic he knew who kept charging higher and higher prices on the jobs he didn't like doing. He had enough business that he liked scaring away the cases he just didn't want to deal with.

This doc only wants rich patients, that's my guess.

[casualperfectionist]

Kagey, that thought crossed my mind, but he just doesn't strike me as someone who is ready to retire. Who knows?

And, because of the way he has this whole thing set up, he's only going to be working with rich patients. He's obviously allowed to make business decisions for himself, but doesn't that seem like a slippery slope?

I feel like I've been kicked to the curb because I'm not willing to pay him for what he should be doing anyway...

At least I have other options. I can only imagine how disconcerting this would be if we didn't. *sigh*

[Kagey]

You should send him a letter that you are saddened when you learn that your annual exams were not comprehensive, that the test results you were told were somehow not correct (since providing the results is a new service), and that none of the preventative care you received was actually preventative. You'll be looking into suing him for not actually giving you accurate care in the past.

I'm kidding, but really, these letters are telling everyone that something wasn't right with his previous level of care.

[casualperfectionist]

Oh, it gets better! I found a new doctor! Yay! But, now my medical records are being held for ransom! Boo!

I am going to be charged $15 per file (one file for me and one for my husband) to have them printed and transferred to a new practice, and that's if I pick them up and hand deliver them. It's an extra $3.50 per file if I have them mailed. Oh, and it could take 3-weeks.

I checked, and apparently, it's within their rights to charge a "reasonable fee" and they have 30-days to turn over my records...so I should be pleased with the 3-week time-frame.

Hmmm...their definition of "reasonable" is a little bit different than mine.

His office is certainly making it easier and easier to leave...

[Born2Shop]

Maybe I should adopt this concept to my household. For the bargain price of $2,600, my family can have home cooked meals, laundry service as needed, custom cookies for the bake-sale, homework consultations, expert advice and encouraging words, ect... and I will chalk it up to Full-Service Personalized Parenting. A steal of a deal if you ask me!

[casualperfectionist]

Born2Shop, that's so true!!

We're not in the wrong line of work, after all...we're just not charging enough for our services!!

[Rodentia]

I can make some guesses as to why he is doing this.
Guess 1
He is sick of 7-minute patient sessions and ending a 12hr workday that is a blur of somewhere like 70 patients each day. Perhaps somebody died because he didn’t notice something in the allotted 7-minute single-complaint regime.
He may also be trying to get to illnesses before they blossom into more difficult and expensive conditions. He may have read the papers on higher compliance by patients if they paid upfront for routine examinations and tests. (Know how many men just don’t get a prostate exam and then die of it later?)

Guess 2
On the other hand, maybe he is tired of medicare patients who cost more to see than the scale pays, and he wants a new Porsche. So he plans to get more of a wealthy-club kind of deal and focus on people who will pay top dollar for individual and proactive attention.

[casualperfectionist]

I can make some guesses as to why he is doing this.
Guess 1
He is sick of 7-minute patient sessions and ending a 12hr workday that is a blur of somewhere like 70 patients each day. Perhaps somebody died because he didn’t notice something in the allotted 7-minute single-complaint regime.
He may also be trying to get to illnesses before they blossom into more difficult and expensive conditions. He may have read the papers on higher compliance by patients if they paid upfront for routine examinations and tests. (Know how many men just don’t get a prostate exam and then die of it later?)

Guess 2
On the other hand, maybe he is tired of medicare patients who cost more to see than the scale pays, and he wants a new Porsche. So he plans to get more of a wealthy-club kind of deal and focus on people who will pay top dollar for individual and proactive attention.

Interesting guesses!



I can only venture a guess as to his real reasons, but his informational packet states that he currently sees 20 patients a day and wants to see 7 or 8. He also states that you need to have medical insurance to be with his practice. He also states that he will continue to see Medicare patients and will continue to bill Medicare for the appropriate services. [Medicare patients, by age definition, will need to pay more on his Patient Membership Fee Scale, and those fees are not covered by Medicare.] His office isn't OPEN for 12-hours a day, but I don't know what goes on behind the scenes or how heavy his workload actually is.

He's obviously wanting to make a change.

Prior to this, I never felt rushed in his office, and never felt as though my healthcare was sub-par.

But, since it's come to this, I'll gladly take my money elsewhere.

[Kagey]

I am going to be charged $15 per file (one file for me and one for my husband) to have them printed and transferred to a new practice, and that's if I pick them up and hand deliver them. It's an extra $3.50 per file if I have them mailed. Oh, and it could take 3-weeks.

I once got around this by saying that I was going out of town and wanted my records in case I needed them while gone. They gave them to me for free. And then I switched doctors. They were going to charge me $15 plus $1 a page to get them otherwise.

But of course, you've already indicated you're switching, so this probably won't work now!

[casualperfectionist]

I am going to be charged $15 per file (one file for me and one for my husband) to have them printed and transferred to a new practice, and that's if I pick them up and hand deliver them. It's an extra $3.50 per file if I have them mailed. Oh, and it could take 3-weeks.

I once got around this by saying that I was going out of town and wanted my records in case I needed them while gone. They gave them to me for free. And then I switched doctors. They were going to charge me $15 plus $1 a page to get them otherwise.

But of course, you've already indicated you're switching, so this probably won't work now!

Kagey, that's pretty sneaky of you! I just looked at the form I need to fill out to get my copies (they require my signature), and if I want my entire record, there is a fee regardless of reason.

[casualperfectionist]

Quite a few people have added their 2-cents.

http://thecasualperfectionist.com/?p=2246#comments

Regardless of whether or not I agree, I love hearing everyone's opinion!

[Rodentia]

I can make some guesses as to why he is doing this.
Guess 1
He is sick of 7-minute patient sessions and ending a 12hr workday that is a blur of somewhere like 70 patients each day. Perhaps somebody died because he didn’t notice something in the allotted 7-minute single-complaint regime.
He may also be trying to get to illnesses before they blossom into more difficult and expensive conditions. He may have read the papers on higher compliance by patients if they paid upfront for routine examinations and tests. (Know how many men just don’t get a prostate exam and then die of it later?)

Guess 2
On the other hand, maybe he is tired of medicare patients who cost more to see than the scale pays, and he wants a new Porsche. So he plans to get more of a wealthy-club kind of deal and focus on people who will pay top dollar for individual and proactive attention.

Interesting guesses!



I can only venture a guess as to his real reasons, but his informational packet states that he currently sees 20 patients a day and wants to see 7 or 8. He also states that you need to have medical insurance to be with his practice. He also states that he will continue to see Medicare patients and will continue to bill Medicare for the appropriate services. [Medicare patients, by age definition, will need to pay more on his Patient Membership Fee Scale, and those fees are not covered by Medicare.] His office isn't OPEN for 12-hours a day, but I don't know what goes on behind the scenes or how heavy his workload actually is.

He's obviously wanting to make a change.

Prior to this, I never felt rushed in his office, and never felt as though my healthcare was sub-par.

But, since it's come to this, I'll gladly take my money elsewhere.

Not to be difficult, but I am not sure I understand your motivation for leaving.
You seem to be happy with the doctor’s service, you didn’t seem unhappy with his ability to diagnose or his currency of knowledge. Is your objection then only a financial one? – if so, I am unclear on how the billing would work and whether you actually wind up paying more than you currently do.
Does the membership fee get charged over and above a full consultation fee?
If he charges less than the max insurance rate per consultation, or lower copay, does it come out the same at the end of the year, or are you actually paying more overall?

[casualperfectionist]

Not to be difficult, but I am not sure I understand your motivation for leaving.
You seem to be happy with the doctor’s service, you didn’t seem unhappy with his ability to diagnose or his currency of knowledge. Is your objection then only a financial one? – if so, I am unclear on how the billing would work and whether you actually wind up paying more than you currently do.
Does the membership fee get charged over and above a full consultation fee?
If he charges less than the max insurance rate per consultation, or lower copay, does it come out the same at the end of the year, or are you actually paying more overall?

I go into more detail on the original post, but just to clarify, we are actually being required to pay him $2,600 upfront, in addition to insurance. We are still required to have insurance to be seen by him, because he will be billing our insurance for our visits (labs, tests, whatever-other-medical-mumbo-jumbo gets charged to insurance).

It's purely a Yearly Patient Membership Fee. We will still pay our insurance premiums. We will still pay a copay. His fee is extra money on top of everything else. We can either pay one lump-sum now or 1/2 now and 1/2 in September. Ummm, thanks, but no thanks!

Does that make sense?

[Kagey]

I guess it comes down to the fact that he wants to reduce his patient load, and this is a sure-fire way to accomplish it. Of course, I believe he's looking at his bottom line, too. With this membership fee he can see fewer patients without devastating his income.

If he's making a financially motivated decision, you can too.

[Crazy Canuck]

I honestly cannot think of anyone who would switch over unless money was not object. For most of us it is, especially for a service you can find elsewhere at a more reasonable cost. And holding your medical records for ransom? That is when I would start contacted the consumer reporters and getting your story told!!!

[Tosha Ihly]

THIS DOCTOR IS NUTS!!! Especially, in this economy!! Who has that kind of money? I would definitely be looking for a different doctor, because this one has dollar signs on all of his patients!!!

[doh]

I guess it comes down to the fact that he wants to reduce his patient load, and this is a sure-fire way to accomplish it. Of course, I believe he's looking at his bottom line, too. With this membership fee he can see fewer patients without devastating his income.

If he's making a financially motivated decision, you can too.

Oh for shame!! The poor doctor wants to have more time to volunteer his services to the poor and sick and all you can do is criticize. There he'll be, out in the jungles of Central America taking modern medicine to the needy and his poor family back home will have to read all this back biting.[/sarcasm]

[Pho for Five]

This is such a tough topic. I am beginning my medical residency in June, after 2.5 years of being a SAHM, and have a lot of experience with the practice of "concierge medicine." Although I have always been a die hard supporter of primary care and providing care for the underserved/ uninsured/ underinsured, I also understand the dilemma primary care docs now face in the setting of lower reimbursements rates and a very broken healthcare system. For the record, a LOT goes on behind the scenes for a doc whose office hours may only say 8-5 or whatever. There are HOURS of dictations, chart reviews, lab follow-ups, hospital rounds, etc., but that's the stuff that doctors don't get paid for, keeps them from their families, and no one sees them doing.
I have watched so many doctors have to sell-out to "membership medicine" in order to preserve some semblance of sanity, family life, and profitability after years and years of seeing increasing numbers of patients because reimbursement rates have gone down relative to overhead cost. It takes any and all reward out of medicine when you are either 1) cramming far too many patient visits in your day to may ends meet, thereby sacrificing patient care AND the doctor-patient relationship that drew you to medicine in the first place, or 2) maintaining a manageable number of patient visits per day, but watching your profitability tank and actually not being able to make ends meet for your practice or your family (the overhead of running a private practice is insane and every doc has to hire employees just to chase down payment from insurance companies that "negotiate" costs and never fully reimburse).
I'm not defending concierge medicine. I'm just presenting the other side because it is VERY hard to be a primary care doctor in the current healthcare climate.
The end result is fewer and fewer med school grads choosing careers in primary care. I'm a prime example of that, as I was a family medicine poster child all through medical school but find myself now changing specialties after taking things like debt, lifestyle, and the potential for burnout into consideration. The end result is a tremendous shortage of primary care doctors and a healthcare crisis in the making...all because as a society we undervalue the role of preventative medicine, comprehensive healthcare, and primary care as a whole. By "society", I mean the gov't (reimbursement rates are usually set by medicaid/medicare), private insurance companies, patients who self-refer to specialists, medical schools that do not encourage students to pursue primary care, states that don't have loan repayment programs to help primary care docs get out of debt, etc. Such a huge problem, so many contributing factors, and the end result is this...doctors who see no other way out than to close their doors to all patients who can't pay large membership fees, which then worsens the problem for the remaining primary care docs who are not concierge-based. The fallout, including all medicaid patients (medicaid has the lowest reimbursement rates), the uninsured, etc. are then pushed onto a new doctor whose burden to serve the community is now even larger.
I'm sorry your family is at the other end of all of this mess! I hope you find a new doctor and one who can meet your family's needs.

[Green Me Alison]

First, when it comes to records, in my experience you are always charged and I always have been when I ask for them. A few times its been for traveling internationally and other times because I was changing doctors due to a change in insurance. Sometimes they don't charge if you have them transferred directly from one doctor to another, but sometimes they do...I wouldn't find fault with your doc though for this particular act.

Secondly, I think if I received such a letter in the mail I would have the same reaction. The odd thing is that his premium is high for the adults, but not for the kids. The doctor that I would have to consider keeping in this situation is my pediatrician. I only see my doc once per year for a well visit, so why would I want to pay $1450 on top? On the other hand, I swear we see the pediatrician every other month -- and frankly his office is rushed/delayed/overbooked and I honestly just might pay something out of pocket to guaranty better service.

The thing that is odd about this is the way your doc went about it all -- it seems that he should have given a grace period or a 6 month warning or something. I think he marketed his switch to you all wrong and he may discover this himself if more than 50% of his patients leave and they just might do so...