Concierge Medicine - Any experiences?

[TFA303]

I'm looking into joining one of these practices to get a better quality of care. I'm specifically looking to have more time and attention from the doctor for some complex problems my wife has. I can afford it, and I'd really like to have her get the care she needs.

Would like to hear if other WT folks have used one of these services and get pros/cons.

Thanks,
Tom

[bae]

I have sort of an arrangement worked out with a doctor with a practice here. We help support his non-profit clinic, in exchange we get great service. Like, he or his NPs will see us on a moment's notice, I can just walk in if I have a question, and they'll do house calls/after hours calls if needed. They are also willing to really take the time to talk to you and track down issues to root causes, and include you as partner in the process instead of just a walking set of symptoms.

I think it saves him a lot of trouble too, they don't bother to bill us for most things, so no paperwork or fuss.

I love the deal, but once I need services his practice doesn't provide, I have to rely on referrals, which so far has worked out well.

[baker]

My wife is a family practice doc. She is changing jobs to get away from Obamacare and the changing landscape of her profession. She will be working for a group that provides health care to large companies, on site. There, she will be able to practice better medicine, taking more time with each patient.

A concierge practice operates on a customer service basis, generally with a good provider/physician who takes excellent care of his patient clients. I would definitely look in this direction if it is in your budget.

Some questions I would have:

Do you admit to area hospital(s) where you have privileges?

If not, where do you have privileges? ( no privileges is a red flag for me)

How are referrals to specialists handled? Which specialties are represented within the group?

Since your wife has specific needs, of course you would want to ensure any applicable specialties were covered.

Will prescriptions be covered by insurance, even if the physician charges are up to you?

What ancillary services are avaliable? Lab, xray, other imaging?

Are ancillary services also out of pocket, or may insurance be used for, say, an MRI?

[bdoc]

Do you admit to area hospital(s) where you have privileges?

If not, where do you have privileges? ( no privileges is a red flag for me)



IMO, these two questions are most important. Unfortunately many of our colleagues do not inform their patients that they will not take care of them if admitted to the hospital. If I was to entertain this sort of arrangement, that would be a deal breaker for me.

[TFA303]

Thanks, y'all. This is very helpful.

[CaptBeach]

Since my 50th birthday I've added 8 doctors to my speed dial...it just sucks like that...age catches up on you...

The XO and I have been clients of a higher end practice for several years now...each doctors patient load is capped at 150 instead of the 1500 to 1800 most see in a practice...there are 9 docs in the practice...we pay $1500 per year for her and I get on for an additional $1000...thats $2500 per year for the two of us...each doc is not only a GP but also a specialist too...almost no referrals outside of the practice...they have everything in house, X-Ray, labs...you only get sent out for MRI and really big stuff...I am guaranteed an appointment on the day I call EVEN if I call at 1655 and they close at 1700...the Doc will stay to see me...I am guaranteed to have no longer than a 5 minute wait once I check in and its never more than a minute to a minute and a half literally before they take me back and start working me up...out of town/out of the country and get sick...he's called in a prescription for me when I was in New Zealand, diagnosed me via SKYPE VIDEO and called a doc over there to get a script called in for me legally...did the same for the wife when shes been in Canada and the UK, our dedicate Doc is a UK transplant, thick Brit accent and stutters like no one but we love him to death, studied at Johns Hopkins and Mayo (all of them have huge credentials) and in ABSOLUTE BEST MEDICAL CARE I'VE EVER EXPERIENCED IN MY LIFE...only the Mayo Clinic rivaled the customer service I get from my family doc...ITS WORTH EVERY PENNY WE PAY FOR IT...if I go in for a visit HE CALLS the next day to check up on me...not his nurse of secretary...HIM...I go in for labs...HE calls me when the results are in and goes over them with me in detail...

SPEND THE $$$$ if you have it and enjoy awesome care...

Capt Beach

[bdoc]

What about their service in the hospital ? Does your doc see you or a Hospitalist?

[TennDECA]

What do the docs here think of mid-levels? Do you foresee a large increase in the use of mid-levels in a cash clinic setting as Obamacare starts to go in effect?

What do YOU think the future of Primary Care medicine will look like?

[karl johnson]

What do the docs here think of mid-levels? Do you foresee a large increase in the use of mid-levels in a cash clinic setting as Obamacare starts to go in effect?

What do YOU think the future of Primary Care medicine will look like?

I'm an ICU and ER RN FWIW. I'm starting school in Jan to become a midlevel after long talks with 25+yr docs because I think the future will be very heavy with those.

[Manwell]

I truly think this will be the way good medical service will be provided in the future. Professionals as well as consumers have always developed ways to work around the pathetic roadblocks the government continually puts in front of us. My experience today is mostly not good when it comes to service in the medical world and it's bound to get worse as the tentacles of big government worm their way deeper with Obamacare. My employer provides me with reasonably priced coverage and I purchase the best plan they offer. Perhaps some type of catastrophic medical insurance coupled with concierge care is something worth considering.

Manwell

[Housertl]

The midlevel question is pertinent to me...I am trying to figure out what I want to do when I grow up and retire from the Navy. I currently AM a midlevel practitioner, but only in the military setting. It would probably cost me a pretty penny, both in time and money, to move up to an NP or PA certification. I am looking at developing HARD skills, as I simply don't trust that my retirement pay will be there for long(I think it will be one of the things that gets cut quick as we move ahead with our Federal economic plan....), and wonder if the prospective market is good enough to justify the time/money/effort, or if I should just spin off in another direction.

[RickyRifle]

Since my 50th birthday I've added 8 doctors to my speed dial...it just sucks like that...age catches up on you...

The XO and I have been clients of a higher end practice for several years now...each doctors patient load is capped at 150 instead of the 1500 to 1800 most see in a practice...there are 9 docs in the practice...we pay $1500 per year for her and I get on for an additional $1000...thats $2500 per year for the two of us...each doc is not only a GP but also a specialist too...almost no referrals outside of the practice...they have everything in house, X-Ray, labs...you only get sent out for MRI and really big stuff...I am guaranteed an appointment on the day I call EVEN if I call at 1655 and they close at 1700...the Doc will stay to see me...I am guaranteed to have no longer than a 5 minute wait once I check in and its never more than a minute to a minute and a half literally before they take me back and start working me up...out of town/out of the country and get sick...he's called in a prescription for me when I was in New Zealand, diagnosed me via SKYPE VIDEO and called a doc over there to get a script called in for me legally...did the same for the wife when shes been in Canada and the UK, our dedicate Doc is a UK transplant, thick Brit accent and stutters like no one but we love him to death, studied at Johns Hopkins and Mayo (all of them have huge credentials) and in ABSOLUTE BEST MEDICAL CARE I'VE EVER EXPERIENCED IN MY LIFE...only the Mayo Clinic rivaled the customer service I get from my family doc...ITS WORTH EVERY PENNY WE PAY FOR IT...if I go in for a visit HE CALLS the next day to check up on me...not his nurse of secretary...HIM...I go in for labs...HE calls me when the results are in and goes over them with me in detail...

SPEND THE $$$$ if you have it and enjoy awesome care...

Capt Beach

Capt, I'm assuming the docs still file with your insurance and that you're still responsible for your copays and deductibles? In other words, the yearly fee is "in addition to," correct?

[TennDECA]

The midlevel question is pertinent to me...I am trying to figure out what I want to do when I grow up and retire from the Navy. I currently AM a midlevel practitioner, but only in the military setting. It would probably cost me a pretty penny, both in time and money, to move up to an NP or PA certification. I am looking at developing HARD skills, as I simply don't trust that my retirement pay will be there for long(I think it will be one of the things that gets cut quick as we move ahead with our Federal economic plan....), and wonder if the prospective market is good enough to justify the time/money/effort, or if I should just spin off in another direction.

House,

I thought there were bridge programs for SOCM graduates to civilian mid-levels? As far as cost, wouldn't GI Bill cover most of it?

[TFA303]

Capt, I'm assuming the docs still file with your insurance and that you're still responsible for your copays and deductibles? In other words, the yearly fee is "in addition to," correct?
Ricky,

The way most of them work is that the annual fee pays for all your office visits, and you file insurance for your labs, Rx, etc. The Dr. saves a ton of money (and headaches) by not having to have a staff that futzes with all the insurance paperwork.

[CaptBeach]

Capt, I'm assuming the docs still file with your insurance and that you're still responsible for your copays and deductibles? In other words, the yearly fee is "in addition to," correct?


Yes...they file my insurance and I still pay my fees...the $2500 ensures me no waits, immediate care and the best damned medical care I have ever experienced...

[Housertl]

House,

I thought there were bridge programs for SOCM graduates to civilian mid-levels? As far as cost, wouldn't GI Bill cover most of it?

I believe there are bridge programs for SOCM guys, largely due to their requirement to maintain NREMT-P status, so they have civilian recognition of their skill set. I, however, am not a SOCM guy, I am a Navy Surface Force Independent Duty Corpsman. Within the sphere of the military, both schools are recognized to be equivalent, if different in focus, much like John is an ER Doc, and Dan is an Anesthesiologist; different specialties, but both are physicians. SOCM focuses much more on trauma and remote medicine in REALLY austere environments, IDCs are much more heavily oriented toward primary care and industrial hygiene/occ health. Functionally, the care I give my patients is no different in scope than the care given by the PA I work with, but he can legally do the same thing on the outside, where I cannot.

Regarding GI bill, it would likely pay for much of it, but it will not float myself and my family while going to school, and the military programs to get to PA would require me to spend about 3 years taking classes I already have credit for, just to be eligible to apply. The sad truth is that, despite my training, the best paying job that I could get in the medical field, were I to separate tomorrow, would be a phlebotomist. I have an NPI number, but they won't let me practice.

[Ron Ray]

Use of Terms Such as Mid-Level Provider and Physician Extender
Purpose: The American Academy of Nurse Practitioners opposes the use of terms such as “mid-level provider” and “physician extender” in reference to nurse practitioners (NPs) individually or to an aggregate inclusive of NPs.
ENA Position: ENA endorses the consensus statement issued by AANP on the use of terms suchas mid-level provider and physician extender.
Background: Nurse practitioners are licensed independent practitioners who practice in a variety of settings and provide care to individuals, families, and groups. As licensed practitioners they practice autonomously and in collaboration with other health care professionals. Since nurse practitioners are independently licensed and their scope of practice is not designed to be dependent on or an extension of care rendered by a physician, it is essential that the terms used todescribe individuals in this role be appropriate.
Supportive Material: The AANP position statement is as follows:
The American Academy of Nurse Practitioners (AANP) opposes use of terms such as “mid-levelprovider” and “physician extender” in reference to nurse practitioners (MNPs) individually orto an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANP encouragesemployers, policy-makers, healthcare professionals, and other parties to refer to NPs by their title. When referring to groups that include NPs, examples of appropriate terms include:independently licensed providers, primary care providers, healthcare professionals, andclinicians.
Terms such as “midlevel provider” and “physician extender” are inappropriate references to NPs. These terms originated in bureaucracies and/or medical organizations; they are not interchangeable with use of the NP title. They call into question the legitimacy of NPs to functionas independently licensed practitioners, according to their established scopes of practice. Theseterms further confuse the healthcare consumers and the general public, as they are vague andare inaccurately used to refer to a wide range of professions.
The term “midlevel provider” (mid-level provider, mid-level provider, MLP) implies that thecare rendered by NPs is “less than” some other (unstated) higher standard. In fact, the standardof care for patients treated by an NP is the same as that provided by a physician or otherhealthcare provider, in the same type of setting. NPs are independently licensed practitionerswho provide high quality and cost-effective care equivalent to that of physician.' The role wasnot developed and has not been demonstrated to provide only “mid-level” care.
The term “physician extender” (physician-extender) originated in medicine and implies that theNP role evolved to serve as an extension of physicians’ care. Instead, the NP role evolved in themid-1960s in response to the recognition that nurses with advanced education and training were fully capable of providing primary care and significantly enhancing access to high quality and


Supported Position Statement


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[TennDECA]

Um... not trying to be a jerk, but while NP's may be "individually licensed practitioners", don't they still need to operate under an MD's license? Also, isn't the scope of practice of an NP (and PA for that matter) less than that of an MD, and if so, how can level of care provided be exactly the same, even in the same setting (ie, can an NP or PA working in an ED, do *exactly* the same things that an ERP can?)

Can someone clarify?

[SheepDog68]

Um... not trying to be a jerk, but while NP's may be "individually licensed practitioners", don't they still need to operate under an MD's license? Also, isn't the scope of practice of an NP (and PA for that matter) less than that of an MD, and if so, how can level of care provided be exactly the same, even in the same setting (ie, can an NP or PA working in an ED, do *exactly* the same things that an ERP can?)

Can someone clarify?


As you stated a NP has their own license that they work under and at least in our state can do their own thing. A PA works under a MD and their license is tied to that fact and gets pulled if they quit or are between jobs.

As far as what they can do? It pays to have everyone working toward the top of their license not dinking along doing things that someone 2 or 3 levels under them could be doing. After that it as always depends on individual skills.

In most offices you want whoever does that job everyday to be working on you not someone licensed way above them that has not actually performed what ever in several months. (Example: If a tech draws blood every day all day long with good skill let them do it they will probably be the best one there. The doc could do it of course, but they probably don't do it that often and will likely not be as smooth with it.)

Oh and in primary care the scope of practice is not that much different between the 3 so if you are really sick you are headed for a specialist anyway where they will likely have them separated as described above. Specially if the office is wants to make any money and run with efficiency.

I can't over state individual skill set!! We have a tech who is about to graduate from nursing school (We pushed her to go so we could use more of her skill set since she has the talent and skill already.) who throws stitches better than most docs you are likely to find, so find out who does what and how well they do it.

SD