[dbussone]

Originally Posted by golfing eagles

Well, here's an interesting topic in the new health care reality that I haven't seen much of on TOTV.



My personal opinion is that concierge practices are the unintended consequence of unbridled government and insurance regulation. Currently, it costs each primary care doctor about 55K/year to deal with Medicare, Medicaid, and insurances. We had 7 doctors and 6 NPs, so do the math. Yes, there was some economy of scale, but it still ran many hundreds of thousands of dollars/year to comply with all their garbage---and that's just what it is---GARBAGE. I'm sure someone will post how we need government regulation, and how doctors are ripping off patients and misdiagnosing them and blah, blah, blah----But at the end of the day, if it looks like garbage and smells like garbage, guess what?---it's garbage.



Concierge practices were started by solo practitioners, usually one of the best in the town, who had it up to their eyeballs with the garbage. They opted out of Medicare and Medicaid, stopped submitting bills to insurance, and charged essentially cash for the privilege of staying in his/her practice and then cash for any services rendered. I think the first was in West Palm beach and charged $5,000/year and limited his practice to 200 patients. Do the math again, that's 1 million before lifting a finger, all cash. but there's a catch---it's the type of patient he attracted---rich lonely hypochondriacs who would call just for companionship. I think he committed himself to the asylum after 2 years



You have no idea about the type of call you get at 2 AM when you are "on call". Medicaid patients who want a prescription of brand name Tylenol, not generic. A woman complaining about a 2 week old bee sting because people could see a red mark on her thigh (right about final call hour). People who didn't even know why they called, but tried to talk for hours. And these were the ones who paid nothing, imagine what you get from someone who laid down 5 grand???



Now, we have doctors hiring other doctors for big concierge practices, corporations getting into the game. This is akin to what happened in the UK after socialized medicine----doctors opting out of the system and taking cash only. The problem is that eventually no provider is accepting insurance and access to care becomes limited.



Sorry to be a downer, but this is the future our government has been working to bring us---single payer gov't healthcare once enough people have been forced away from their doctor and cannot pay for the concierge practice.

Thanks for your response, GE. One result I saw personally:

A physician friend of mine (solo internist) went the concierge route. One of the major insurers he was dependent upon cut him off about a year later. They refused to reimburse him for any of the patients they insured.


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