"concierge" type practice in the villages?

[serenityseeker]

I am a 44 y/o internist that will be relocating to the villages within a few years if not sooner. My parents live there and my wife loves it. We are looking to go ahead and purhcase soon.

My question is not simple so let me explain. A "concierge" (I really dislike the term but it seems to have stuck) practice is one that usually requires a yearly fee(not sure what yet but typically from 1000 - a few thousand dollars a year) from the patients to be a part of the practice. The fee allows the physician to limit his patient load to perhaps 200-300 patients instead of the normal 2000-4000 it typically takes to sustain a practice. This in turn allows the physician the ability to gaurantee same day appointments, phone access, longer appointment times(45 mins to 1 hr), house calls, and truly treat the patient without running them in and out like the cattle shutes many practices have turned into by necessity. In my case I would not deal with insurance companies or medicaire, leaving the patient the responsibility to file that paperwork, again leaving more time and resources for the patients, not office overhead.

While this may sound a little unconventional or elitist(I assure you it's really not) I think there is sound reasoning for it. I left a private practice because the pressure to see more and more patients while losing more and more money each year was overwhelming. This is the same boat all of my collegues are in. I am now a hospitalist and pretty happy with it, but still feel I could do much more in a controlled outpatient setting.

All of that being said, I wonder what level of interest there would be in this type of practice at or near TV. I will have finished an anti-aging fellowship, and special certification in geriatrics by then.

Just thought I would throw this out for some feedback.

Thanks for taking the time to read and reply.

[Muncle]

It's an interesting concept. I've seen that if has been received with very mixed results throughout the country. There may be a market for it in TV, but I have doubts.

One service that you specifically exclude is handling insurance/medicare paperwork. I realize there are legal implications in this area, specifically since laws prohibit charging to file medicare forms and it could be interpreted in this way. However, one of the most onerous tasks that people face in health care, especially people such as those of us in TV, is filing and tracking medical insurance claims. I would gladly wait an hour in a doctor's waiting room for an appointment knowing the office was handling the insurance that get seen immediately and have to handle the hassle myself. Maybe just my opinion.

Regardless, best of luck to you and I'll be interested in how this turns out.

[bestmickey]

[color=blue]I agree with Muncle. I would NOT want to be responsible for filing my own paperwork. I would expect that having the individual(s) process their own paperwork will result in a large number of errors and resultant delays in reimbursements to the patients. You'll not make them happy that way!

As far as paying extra for the privilege of having more time with you, home visits, etc., it is a possibility. It would depend on two things: 1) the amount of the charge you expect, and 2) whether or not I like you, can communicate easily with you, your bedside manner, and whether or not I'm confident in you/your services.

I also wish you luck in your endeavors. I sure don't envy doctors today. I recognize the insurance industry and the business managers of your practices make life intolerable. My own Internist has the same issues.

By the way, I'm what's called a Villages "wanabee" and won't be living there until 2009, so I guess you can disregard my opinion if you'd like.

[l2ridehd]

The concept is really good and worth paying for. Consider setting a cap on the number of patients, say 300. Also set a fixed annual fee say $1000 to $1500. I would also try to set up a service (another business) that for another $250 annual fee the person in the office next door would do all the insurance paper work. I am sure that is a business that someone in TV has a background in. In fact if not, I will start it. So that for something less than $2000 a year I have excellent access to medical services, insurance help, and only have to get lab work and hospital support. How would you handle hospital affiliation? It is a service I would pay for if I felt you were very qualified in your field.

There are still lots of questions to be answered, but you have probably already worked through them. How do specialist referrals work? Hospital in patient care? Emergency services? Vacation coverage?

I grew up in a small town with a local doctor that did all of these same things. Had his office and pharmacy in his home and made house calls. Seemed to work well then and it could certainly work in TV.

[SteveZ]

Your concept is fine, and I agree with the others regarding the preparation/filing of insurance paperwork. No doubt that if you have a clientele-capped business, there will be others/companies/retirees(?) willing to provide you the paperwork handling service for a fixed fee as well.

The interesting thing about the villages is the number of experts in a myriad of fields who live there, and just sometimes want something to do for a few hours a week for a little extra money and/or the intellectual stimulus. You should have no problem finding an "independent contractor" capable of this service, also for a capped fee.

[Herb]

I would join up in a second if you were my current doctor. However I would not join with a doctor I did not know and had not even a little history with. Good luck though. Herb

[serenityseeker]

Thanx so much for all that took the time to reply. The idea of a separate/independent entity contracting the billinf is a seemingly great idea, will have to seriously look into that.

As for some of the other comments, I realize that the convenience of not worrying about billing is more important to some than the benefits of this proposed type of practice. As with any practice it would have to have time to grow on it's own merits and reputation. I have no problems with that, as my prior practice was soon full beyond capacity when it was open. I pride myself not only on my medcine, but even more so on my "bedside manner", which is nothing more than providing the same level of care, compassion, and interest that I would to my own family. I have consistently used this as my guidepost for practice and have been content with my practice and my patients response to it at the end of the day.

After reading this forum for some time I expected intelligent and well thought out replies and was pleased to receive them. Thanks again all and any other thoughts are welcome.

Ya'll take care.

[MiraMesa101]

I don't know if you will read this, but here are some thoughts not mentioned by others.
Currently when I visit the different doctors responsible for my care it does not cost me anything over what Medicare and my supplement pay. The Doctors I visit have all seen me within an hour. We are all retired here and still people are always in "a hurry". If you are a good Internist with Geriatric specialty you would do well in The Villages under that profession. All of my specialists have been excellent and if not, I have looked for another.

Therefore, the privilege to pay a sum of money to be guaranteed to see the Doctor may be for the more affluent of TV, but not for those who are on a limited income, naturally there are both here in the Villages. Good luck in whatever you decide to do. :) :)

[serenityseeker]

As always, thanks for the feedback.
Actually I am aware that this type of thing isn't for everyone. What I am actually doing is exploring a way to open a practice that is not a "patient mill", which is almost required in this day and age to be viable. I guess I am looking for a way to practice outpatient medicine in a way that does justice to the patient and to my skills and education. I, like many interists, became disillusioned with the pressure to see more patients in less time, and the knowledge that for me, I was no longer able to provide what I knew was the best I had to offer.
This may all be sort of "pie in the sky" thinking but I am just exploring options. All of your replies are helpful and appreciated.

[Number 6]

What I think that many people do not understand is that there has been an erosion of physician income over the last few years. The highest reimbursement rate from Medicare was in 2001. Costs have risen every year which has, In turn, lowered physician compensation. Should Congress stop the 10+% cut scheduled for July, then the payments will almost reach 2001 levels.
How is a single primary care physician going to react to these facts? In order to keep compensation the same he is going to have to see more and more patients, to the determent of his current patients.

The problem that you may have in developing a concierge practice in a heavily Medicare population is CMS regulations. I believe you can only charge Medicare rates unless the service is “non covered”. By that, you could charge for an annual physical but not for a sick visit. That is really problematic in the Villages. Here is a decent article –
http://www.physiciansnews.com/business/204.kalogredis.html

I have, for a number of years, been a medical practice administrator. If I can be of any further help, please do not hesitate to contact me. Best of luck.

[Janey]

I am a 44 y/o internist that will be relocating to the villages within a few years if not sooner. My parents live there and my wife loves it. We are looking to go ahead and purhcase soon.

My question is not simple so let me explain. A "concierge" (I really dislike the term but it seems to have stuck) practice is one that usually requires a yearly fee(not sure what yet but typically from 1000 - a few thousand dollars a year) from the patients to be a part of the practice. The fee allows the physician to limit his patient load to perhaps 200-300 patients instead of the normal 2000-4000 it typically takes to sustain a practice. This in turn allows the physician the ability to gaurantee same day appointments, phone access, longer appointment times(45 mins to 1 hr), house calls, and truly treat the patient without running them in and out like the cattle shutes many practices have turned into by necessity. In my case I would not deal with insurance companies or medicaire, leaving the patient the responsibility to file that paperwork, again leaving more time and resources for the patients, not office overhead.

While this may sound a little unconventional or elitist(I assure you it's really not) I think there is sound reasoning for it. I left a private practice because the pressure to see more and more patients while losing more and more money each year was overwhelming. This is the same boat all of my collegues are in. I am now a hospitalist and pretty happy with it, but still feel I could do much more in a controlled outpatient setting.

All of that being said, I wonder what level of interest there would be in this type of practice at or near TV. I will have finished an anti-aging fellowship, and special certification in geriatrics by then.

Just thought I would throw this out for some feedback.

Thanks for taking the time to read and reply.
Are there now any concierge medical services in The Villages? My parents are new residents, and are not happy with the quality of medical services, and would be very interested in a concierge plan. Thanks.