How do you pick a Dr.?

[Like2Plan]

I picked a Dr. that was conveniently located and easy to make an appointment.
Before last year, I rarely visited the Dr, but last year I had to make several visits. I'm finding that after filing with my primary and secodary Ins, not everything is covered. My last bill was $180.00, the 2 insurances together covered $55.00. I usually see a PA, anyway, so I am thinking of switching to another Drs. office--possibly in network to my ins.

I am coming across "concierge" networks there is a monthly fee--not covered by ins, but can be filed with a FSA. I've seen Privia. Another one is MDVIP--subscription fees up to $1500 per year. Some of the Drs. in these networks are also in my health ins network.

What do you think about these concierge networks? Is the subscription fee worth it? The Drs office that my DH visits is just converting over to one of these concierge networks, but DH always sees a PA every visit anyway. (I might have gone over to his Drs. office, but the office is not conveniently located IMHO--and now this network thing...)

[disneysteve]

There is a lot of controversy in the medical field about concierge practices. The problem is that reimbursements to the doctors keep shrinking while the costs of running a practice keep growing and doctors are getting squeezed out from making a profit. Some doctors are responding to this by going the concierge route and just charging patients directly and bypassing the insurance hassles. It seems to be working for some but there has to be a large enough population of well-off patients willing and able to pay the fee to make it doable for the doctor. Personally, I practice in one of the poorest cities in America so there is no way we could convert our practice to a concierge model. We wouldn't have any patients.

I think if you have good insurance coverage, find yourself a doctor who accepts that coverage. What's the point of having the insurance if you are then going to have to pay a big fee out of pocket for access to the doctor?

[irmanator]

What is a concierge service?

[disneysteve]

Originally Posted by irmanator

What is a concierge service?

The details vary from practice to practice but basically a doctor decides to limit the number of patients in his practice. Each patient pays a fee to be part of that group. That typically covers an annual physical and guarantees easy access to the doctor. The doctor will usually give the patients his personal cell phone number so they can reach him anytime. The wait time for an appointment is minimal. Office visits are longer and more thorough, not the 10-minute in and out type that most of us family doctors are forced to have due to financial constraints.

It is all about access and attention.

[KTP]

I keep forgetting you are a family practitioner DS.

Have you ever watched the British series Doc Martin? The first two seasons are available instantly on netflix (or via DVD). Highly recommend.

[disneysteve]

Originally Posted by KTP

I keep forgetting you are a family practitioner DS.

There are days I'd like to forget it too.

I'm not familiar with the series. I'll have to check it out.

[Scanner]

Yeah, it's interesting to watch from my perspective as a chiropractic physician what medicine does as usually, what they do kind of "wags" my profession.

Chiropractic actually did this years ago; it was called UCCAAFF (unlimited chiropractic care at a fixed fee), almost like a gym membership. . .you could go as much as you want - you just paid a yearly or monthly fee. Figure if you got 200 patients at $800/year - your gross collections was around $160,000 just from that.

What happened was a few DC's were indicted on charges from insurance companies for basically acting like an insurance company and I think successfully prosecuted.

It was a case of turf encroachment and insurance didn't like being cut out. The fact the patient's got a lot of chiropractic care (figure if they are a roofer, truck driver) for $67/month or whatever was moot. It's not about the patient per se. . .it's about trade.

The idea appears to be resurrected and holding legal muster in medicine.

WHere I think the showdown may be is with Medicare. Imagine if you are a family doctor and enough of them just opt out of Medicare (something chirorpactors actually can't do). . .you'd hav a whole segment of the population who wouldn't have access to basic medical services.

Anyway, all this politics aside, I think the best way to choose a doctor is on referral, but it's pretty much par for the course these days to just check your provider directory.

[disneysteve]

Originally Posted by Scanner

WHere I think the showdown may be is with Medicare. Imagine if you are a family doctor and enough of them just opt out of Medicare (something chirorpactors actually can't do). . .you'd hav a whole segment of the population who wouldn't have access to basic medical services.

It isn't just politics because it isn't just Medicare. It is almost all insurance companies. The premiums the patients pay are going up by double digit percentages every year but the reimbursement to the doctors is staying flat or going down. That money isn't being passed through to the people actually providing the care. As a result, doctors are being forced to find creative ways to stay in business. That might mean starting a concierge practice. That might mean getting additional training to do cosmetic procedures like Botox for which patients pay cash. That might mean getting involved in clinical trial research. That might mean starting to sell nutritional supplements in their office.

Personally, we do drug and alcohol testing for a growing list of local companies. We do physical exams for a foster care provider. We do DOT/CDL physicals for truck and bus drivers. And we are just starting to dip our toes into the clinical trial business. The sad fact is that being a plain old family doctor no longer generates enough revenue to stay in business.

[marvholly]

I KNOW what DS is saying. I have hade HMO type coverage via employer for >10 years and there have been issues w/my local accepted docs refusing to renew their contracts w/my provider. However, that has been a way for my company to change providers.

Also, I will be on Medicare in June. Checked for HMO type plans since that is what I am accustomed to. My Dr/Hosp ONLY accepts 1 iof the 3 vailable in north metro IL. I am trying it as it is only for 7 months. I can change to another plan for the year starting 1/1/12.

[Like2Plan]

Originally Posted by disneysteve

I think if you have good insurance coverage, find yourself a doctor who accepts that coverage. What's the point of having the insurance if you are then going to have to pay a big fee out of pocket for access to the doctor?

Disneysteve,
I can see both sides of the issue. Sometimes the reimbursements seem so low on the explanation of benefits-especially on labs that I don't see how anyone could have agreed to the negotiated rate.

On the other side of things--these concierge services seem expensive. And, some of the services they are advertising are services that I don't care about or I would think the Dr. should be doing anyway. One of them being reviewing the chart and patient history before an exam. If they don't do that now, what is the point of going to the same physician?

Then there is the practice DH goes to. The office is nothing fancy (and in my opinion the office staff is kind of mean) and it is not conveniently located. The letter said DH didn't have to join the concierge system to continue to go there, but he might have to see a PA instead of a physician (which is what DH does now anyway). Even so I think if they got behind on their schedule they would see the folks who are paying the extra fee first.

[disneysteve]

Originally Posted by Like2Plan

One of them being reviewing the chart and patient history before an exam. If they don't do that now, what is the point of going to the same physician?

How could a doctor not review the chart before seeing the patient. Even with patient who I see regularly, I review the chart before I enter the room to refresh my memory of what happened last time and if there was anything in the process of being done, any recent labs or test results, etc. That one makes no sense to me.

The letter said DH didn't have to join the concierge system to continue to go there, but he might have to see a PA instead of a physician (which is what DH does now anyway). Even so I think if they got behind on their schedule they would see the folks who are paying the extra fee first.

That's no big deal. In many practices, a PA or APN is involved now anyway. We have been looking for an APN but haven't found one yet. As soon as we do, we'll be making that shift also.

And yes, I would expect them to see the concierge patients first since those patients paid to be assured a certain level of access.

[frugalgirl]

Originally Posted by disneysteve

How could a doctor not review the chart before seeing the patient. Even with patient who I see regularly, I review the chart before I enter the room to refresh my memory of what happened last time and if there was anything in the process of being done, any recent labs or test results, etc. That one makes no sense to me.

I don't want to derail this thread but this has been a huge pet peeve of mine especially since having my father go through the extensive treatments, tests, and follow-up appointments for acute myeloid leukemia. His hematology oncologist NEVER read his chart before his appointments. I felt like I was helping the doctor cram for a final the first ten minutes of every appointment when I filled him in on Dad's treatment plan, tests, results, etc. He'd ask us if we'd received the results from the bone marrow biopsy, for example. I just wanted to scream: That's why we're here to see you. The pathologist doesn't send results to the patient! It was incredibly irritating to be treated that way.

[Like2Plan]

Originally Posted by frugalgirl

I felt like I was helping the doctor cram for a final the first ten minutes of every appointment when I filled him in on Dad's treatment plan, tests, results, etc. He'd ask us if we'd received the results from the bone marrow biopsy, for example. I just wanted to scream: That's why we're here to see you. The pathologist doesn't send results to the patient! It was incredibly irritating to be treated that way.

+1. I'm so sorry you are having to go through this with your Dad. It is of no help to you in your current situation, but I wonder if the electronic records (if done right) will improve this sort of thing in the future?

[disneysteve]

Originally Posted by Like2Plan

I wonder if the electronic records (if done right) will improve this sort of thing in the future?

Electronic medical records do absolutely nothing to improve medical care. If anything, one could argue that they make it worse. The huge push from the government for doctors to go electronic has nothing at all to do with concern over patient care. As usual, it is all about money and ability to track everything the doctors are doing.

[Like2Plan]

Originally Posted by disneysteve

Electronic medical records do absolutely nothing to improve medical care. If anything, one could argue that they make it worse. The huge push from the government for doctors to go electronic has nothing at all to do with concern over patient care. As usual, it is all about money and ability to track everything the doctors are doing.

Disneysteve,
I was thinking rather than having to dig through pages and pages and pages of medical records, a physician could search labs and results display in a graph.
This could be done for just about any aspect from meds that have been prescribed to immunizations that are due.
I have gone to an office that recently went electronic. The initial check in involved a lot of data entry (by the patient). I was dismayed to find when I went back one week later for a follow up, the check in process was not much less streamlined. I was thinking--check in--there ought to be an AP for for that!
I have also visited an office that wasn't electronic. The initial consult involved a patient history--very reasonable although a lot of stuff was left to my memory. I had another visit a year later---I had to fill out the same history going back to day one. I went up to the receptionist and said--there must be a mistake I'm not a new patient. No mistake, she said. I had to fill it all in again. I asked--could I just put "no change" for the history. She said that was fine, but they don't go back and look at the old form....

[disneysteve]

Originally Posted by Like2Plan

Disneysteve,
I was thinking rather than having to dig through pages and pages and pages of medical records

Sure they would except instead of paper pages they are "electronic" pages.

My experience with EMR systems thus far has not been positive. When I refer a patient to a specialist, I used to get a simple report, less than one page most of the time, summarizing the findings and recommendations in a paragraph or two. Now, those offices are using EMR and I get a 4-page report that is 98% form letter and 2% useful information buried in their somewhere. It takes me forever to find the parts that are actually important. Sometimes, I read the whole report and still don't really know what the doctor thought or what he is recommending.

Since there are dozens of different EMR systems out there, and none are compatible with each other, any data and reports imported from one to another is just done by scanning in the report to view on the computer. All of the papers are still there - just in digitized form.