The doctor will see you . . . for a price

Created date

February 27th, 2009
Doctor counting money

More physicians are charging annual retainer fees: Are you the recipient of a new wave of physician practice that actually charges you to have the privilege of seeing your doctor for more then 5 minutes? In MD, Va, and across the US, there is a new trend affecting the practice of medicine. Impacted by insurance reimbursement, including Medicare, or lack thereof, doctors are forced to see many patients to earn enough income to pay expenses. Many practices have become fast visits, no time to explore all the issues one person could have. While I understand the cause, the effect has been to force those people who can t afford this fee for service ($1500 to $15000 in addition to having health insurance) to stay in their primary care doctor s office. ' Call it concierge, boutique, retainer medicine, or personalized wellness it generally means paying an added fee to guarantee your doctor sees you quickly, keeps you waiting less, and provides more time on individualized care.In the March issue of theErickson Tribune, in theYour Healthpages, there is a featured article on this topic. Excerpts of the article are printed here to spark dialogue and commentary from those of you who are affected. The caveat is that at Erickson, where I work, we practice with seeing patients not only for their regularly scheduled appointments, but if the need arises, we see them the same day. The average length of time spent with each person is 25-30 minutes. It is the way medicine was meant to be practiced. And there are no upfront fees to be a patient of one of our doctors. How do we do it? Our staff is salaried. We have an operations team that handles insurance reimbursement. We have physicians and onsite medical centers in each of our communities so our practice is very large. All of our physicians focus on the care and well being of those in the 65 or better age group. And, we improve outcomes and reduce costs. But we are able to do that because, in the words of our founder, John Erickson, we want to provide unmatched health care to allow people to live their lives to the fullest . ' No question, we are very fortunate we can provide that health care. We understand the issues affecting doctors. But we also understand the effect of this new trend can have particularly on those 65 or better. So, here s the story. Please take the time to give us your thoughts. Your email will not appear with your comment. Concierge and boutique medicine are the better-recognized terms for a type of medical practice that started moving across the country at the beginning of the 21st century. ' Some doctors and professional organizations, perhaps mentally agreeing with the luxury image those designations imply, now prefer the term retainer medicine. The concierge concept: The premise is simple: ' you pay your doctor to be retained among a select group of patients. Though there are some practices that charge up to $20,000 annually, the average is about $1,500 per person, which is separate from your health insurance costs. Doctors who develop a concierge office claim it isn t money that drives them, it s their desire to provide quality time with the people they re serving. Shaveta Kotwal, M.D., is lucky: being part of Erickson Health, she doesn t have to add an annual fee to provide quality care. She schedules only two people an hour (the goal of many concierge practices), with some time built in for last-minute appointments. That means she can generally average 25-30 minutes of exam and discussion time with people. ' I can say to people, Bring me all the medicines you take, including over-the-counter and natural supplements. Then I have the time to review what they re taking, she says. By seeing everything, Kotwal can suggest items that can be replaced or even eliminated, thus saving someone money and even preventing dangerous interactions. By contrast, the average doctor in an outside, ' non-concierge practice is currently seeing anywhere from four to eight people hourly. It takes time to truly know the patient, especially older ones who often have several conditions interacting. Otherwise doctors end up treating the problem that brought someone in and then letting them go, Kotwal says. Typical concierge medicine services: ' Attention like the kind Kotwal provides is becoming more unusual in private practices. Instead the concierge fee guarantees you what they call back to basics of good medicine. Among the services it often includes: ' * Appointments scheduled immediately * Shorter waiting room times * 24/7 access to a doctor * Greater emphasis on preventive care * Looking for, and addressing, mental health issues * Nutritional counseling * Electronic medical records (EMR) to quickly check medical histories and look for potentially dangerous drug interactions before prescribing. The price of attention: ' Ultimately the difference between a service like Kotwal s and the concierge or retainer practice is money: many people find the extra attention doesn t come cheaply. They ask: What happens to people whose fixed income means suddenly losing their doctor?1 That s not an unusual scenario for seniors as this concierge practice continues to rise. ' Bernard Kaminetsky, M.D., the medical director of MDVIP (a national concierge practice group) prefers the term personalized wellness to describe the service they provide. ' Any doctor who wants to join MDVIP has to make sure the people who opt out have another doctor taking them on. A doctor can also retain scholarship patients people he/she carries without the annual fee, usually someone who truly can t afford to pay it, he says. The annual fee comes to about $125/month. Now think of your cable bill, or the money you spend on gourmet coffee. It s a matter of just not purchasing a few discretionary items, but most people don t make these choices when it comes to health care, he says. What do you think about concierge medicine? Share your thoughts here!