Direct Primary Care

[KayLR]

This story was in our paper today. I thought it was intriguing so of course, wondered what you all thought:

http://www.columbian.com/news/2017/feb/20/battle-ground-doctor-direct-primary-care-health-care-via-monthly-membership/

Summary: a local doctor has a practice with 800 "memberships," clients who have paid an annual fee for access to his primary services. Some of them even have health insurance, but prefer to go to him out of convenience or it's cheaper than their co-pays.

"The membership fee is $75 per month for individuals, $140 per couple and $200 for a family of up to four people. Membership is month-to-month; there’s no required commitment length."

[iris lilies]

Concierge service physicians interest me very much. My friend's doctor changed to that kind of practice and at the time, probably 5 years ago, the fee was $1000 annually. The practice I just looked into last week charges $1800 annually. I dont think $900 anually from the article is very much at all.

Joweber, I really do not undersgand what you get for that money. Blood tests would have to be sent put, right? So they wouldnt be covered. Doctors do what kids nds of tests in their own offices now? Are there many, or few?

[ApatheticNoMore]

Seems like it would get pretty expensive if it's $75 a month in addition to whatever one is paying for insurance as well (total spent for healthcare can be getting pretty high there as the insurance part is not necessarily cheap either). $75 a month cheaper than copays? I think only if you are getting a lot of extra stuff done, lots of lab test or something. I've never heard of a $75 copay.

[iris lilies]

Seems like it would get pretty expensive if it's $75 a month in addition to whatever one is paying for insurance as well (total spent for healthcare can be getting pretty high there as the insurance part is not necessarily cheap either). $75 a month cheaper than copays? I think only if you are getting a lot of extra stuff done, lots of lab test or something. I've never heard of a $75 copay.
see the deal is that maybe you dont want to fuss with copays, and deductibles, and etc etc.and neither does the doc.

[bae]

My community recently had a blow-up in our medical services, resulting in some doctors leaving the main clinic in disgust, the smaller clinic being closed, and some reorganization of services/providers.

I decided to buy into one of the doctor's new "membership" practice. I've known this doctor for years, and I've spent many hours with them as a student. My cost is ~$220/month, with a discount for being a first responder.

So far I've been very happy with the (very infrequent) services provided. 1.5 hours spent on my initial intake, some solid baseline testing, some plans and monitoring for some minor conditions.

Saturday I woke up with a dislocated shoulder. I thought I'd just slept on it funny, and it'd get better. It did not. Monday morning I called up in pain, having not slept in two days, and seeing no progress. Doc saw me within 15 mins of my call, and she and her assistance spent > 1 hour putting my shoulder back into position, which was a heroic effort - the muscles and tendons really clamp down after two days, and normally this would have required at least some sedation and pain relief.

Then, she called our clinic, and within 10 mins of the call, I waltzed in the front door, had my x-rays taken and read, and was sent on my way. Shoulder successfully back in socket. The waiting room was full of people when I arrived, and the line hadn't moved when I left.

Range of motion still very poor, pain levels very high afterwards - I definitely needed an ultrasound and a PT Doc to take a look at them and see if there's some other tears or whatnot in the area. This would be a total pain to do, take days, involving losing an entire day (at least) to get to the mainland, dealing with scheduling at the lame facility nearby, and so on. What a pain!

However, Concierge Doc made a few phone calls, and a really good guy is flying over in his own little plane for fun and with the promise of a free lunch, will scan and examine me, and make recommendations. For just the cost of a normal office visit.

This must be how The Fancy People live.

[iris lilies]

Bae, that’s an interesting experience, and I sure hope some specific results are yielded from the exam by the guy who’s flying over.

My direct care physician costs $900 a year. I do not know any special powers she has, though, to get me in to see specialist Although she did once get me a mammogram within 10 minutes. I’ve been going to this doctor for… maybe three years? I Only go once or twice a year, so it’s not exactly cost-effective for me, but I don’t care, I just like the ease of knowing I can go to a doctor with a small practice.

I sat next to a young woman at dinner recently who said her family uses this doctor for back up service for her kids because it’s no more expensive than the deductible on their insurance.

[JaneV2.0]

see the deal is that maybe you dont want to fuss with copays, and deductibles, and etc etc.and neither does the doc.

If I ever see a doctor again, I want the least possible hassle, so concierge medicine appeals to me.

[Teacher Terry]

Bae, curious how you woke up with a dislocated shoulder. I assumed you had to have a accident for that to happen. Anyway, hoping you get it resolved as it sounds so painful.

[KayLR]

Bae, curious how you woke up with a dislocated shoulder. I assumed you had to have a accident for that to happen. Anyway, hoping you get it resolved as it sounds so painful.

I was wondering the same thing!

[Rogar]

My primary care doctor changed from a private practice to a membership type practice that sounds similar to Bae's, but a little less expensive. His claim was that he went from 1500 clients to 600 so he can spend more time with people. My annual routine physical takes about 3 hours and includes some basic balance, strength, EKG, hearing and vision screening and some extra routine blood work. I've had some issues of smaller concern and have been able to get in to see him the same or next day.

I might reconsider had I not developed some trust with the doctor already or if I were a young person with no health problems. I'm two years into the membership and have considered it value added over a standard medical practice. There's absolutely no benefit I can see that applies to seeing specialists. It seems pretty expensive for what it is and I may reevaluate some day.

[iris lilies]

I’ve been poking around media coverage and discussion boards on concierge/direct care physicians, and I learned that my own physician is expanding yet again to her third town. I’m not sure I am on board with that. She wants her practice to be 1000 patients, and what I’m reading says direct care practices are 600 to 800 patients.

The last time I went into the office I saw her nurse practitioner, a new employee. If this becomes a process where I can’t access the real doctor, that is a dilemma. However, the main reason I go to that practice is because it’s just too easy, is in downtown Hermann in a little Victorian building that’s so easy to access.

[dado potato]

I wonder if the concierge MD accepts Medicare.

Medicare reimbursement for say, seeing a patient 10 minutes (Billing Code 99212-CG) has a "Medicare-Approved Amount" = $145.30. Does Medicare take a dim view of MDs assessing a monthly/annual membership fee aside from Medicare's approved amount for a quota of a physician's time with a Medicare patient?

[iris lilies]

I wonder if the concierge MD accepts Medicare.

Medicare reimbursement for say, seeing a patient 10 minutes (Billing Code 99212-CG) has a "Medicare-Approved Amount" = $145.30. Does Medicare take a dim view of MDs assessing a monthly/annual membership fee aside from Medicare's approved amount for a quota of a physician's time with a Medicare patient?

I’m on Medicare. I have a direct patient care membership (If you want to call it that. )

Very simply, the doctor doesn’t bill Medicare for her time or for any in-office procedures and tests. Her time is not a factor in the insurance game.

[Simplemind]

I've been interested in this since the last time we discussed it long ago..........

[iris lilies]

I've been interested in this since the last time we discussed it long ago..........
So to elaborate and give an examples: my doctor or her tech draws blood for a complete blood count test. There’s no charge for that or anything her office incurs in that procedure.

She sends it off to a lab. The lab bills my Medicare for reading the blood and reporting back to my doctor.

my doctor does an ?Ultrasound? In her office with her own equipment. It was a procedure on my chest a few years ago when I had a rash and an obvious cyst. I knew it was a cyst, she knew it was a cyst, but ya gotta check that out if it’s anywhere near breast tissue. That was not charged. She sent me to the local hospital have a mammogram 10 minutes later and that of course was charged to my insurance.

If I had a dog bite of minor proportions I would go into her office and she would sew it up. There would be no charge for that.

I have not had inoculations in her office, so I’m not sure if she charges for the drug itself or what exactly.

She also does dispense medication from her office if I choose to buy it there. That means I pay her directly for the medication and yes there is a charge for that. It might be cheaper than running it through my insurance, I really haven’t compared because my drug costs are not very much.