A combination of rising costs and low insurance reimbursements is forcing some primary care physicians to opt-out of the insurance game completely — accepting a flat fee instead of private insurance or Medicare. For a $4,500 annual fee, patients who formerly used their insurance to pay for doctor’s visits can get 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals. Or they can find another doctor.
From the Baltimore Sun:
Diana Moore learned the news through the neighborhood grapevine. Her family’s primary-care physician of seven years would no longer accept Moore, her husband and daughter as patients – unless the family paid a $4,500 annual fee.
The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearlyfee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals.
Known as “boutique” medicine or “concierge” care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it.
“Primary-care doctors are seeing 30 to 40 patients a day – that’s too many,” said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. “It’s not about the money. It’s about having the time to spend with your patients to keep them healthy.”
There’s already a shortage of primary care doctors, and they’re not as well compensated as specialists.
“Doctors have nowhere to turn but to try to find a different business model,” said Dr. Ronald Sroka, president of the medical society, known as MedChi. “Some people want more than their insurance company will provide, and some people are willing to pay for this additional service.”
Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he’s not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.
For those of you thinking of finding a “boutique” doctor, keep in mind that you’ll still need insurance. Hospital stays, blood work and ambulance rides are not included.
For a little more, the doctor will see you now [Baltimore Sun](Thanks, Robert!)
(Photo: Getty)
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A high deductible standard health insurance policy (say $10K deductible) to cover the big stuff and then a private Doc for the minor stuff. Yep, good plan.
“Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he’s not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.”
If he makes $20/hr, and worked 40 hours a week, with a couple weeks off for vacation, he’s making roughly $40,000 a year. Not amazing by any stretch, but very easy to live on it within means. Double that to $80,000 a year and I’m not quite sure what his bills must be.
@FHJay:
Potentially crushing med school debt.
@FHJay: I’ll believe it when I see it. Anyone who owns their own business can tell you to the flipping dime how much they made in the previous year. Sroka is either an idiot or a liar.
@Elvisisdead:
Malpractice insurance?
Scumbag. “It’s about giving quality care.” No, it’s about money. The doctor could alternately–as others have–accept cash only, reduce the administrative staff to a bare minimum, and return the balance to something that offers both the patient and physician something.
I don’t begrudge him making a profit, but let’s call it what it is: gouging your customers.
Well, this is a step in the right direction, although a bit pricey. Health “insurance” should be for emergencies only, unexpected problems … not for routine visits. If I could get insurance to only cover emergency use (at an appropriate rate), and then pay the local doctor completely out of pocket slightly more than what Aetna (my provider) pays them (not what the Dr. bills Aetna, it is already inflated to try to compensate for a broken system), I’d save money and my doctor would make more money. (Anyone who has looked at the EOB’s from office visit claims knows what I am talking about, the doctors are getting screwed by the insurance companies as much as we are.) And even though the plan listed in the article is pricey, it’s still cheaper than I pay for family coverage through Aetna with employer paying the other half.
The problem with our current health insurance model is like if you paid even more for car insurance, but paid a copay to get your oil changed. Then the insurance company covers another small portion of that oil change to the business that did the work, but less than the oil change should cost normally, thus squeezing both the customer and the oil change business. Oh, and you can only go to approved oil change locations, and if there is anything else wrong with your car you need a referral to go to the muffler shop. And if you want a second quote, well, good luck with that one. That sort of plan makes no sense, but it is exactly what he have with health care today. We should be paying a smaller amount to cover emergency care, then cover the rest out of pocket.
I’m sure people with generous employers won’t like this as much, however anyone that has been in the workforce for 10 years or more has seen that the costs of insurance go up every year, benefits get worse, etc (even in cases where the employer steps up and covers a higher percent the benefits get worse drop year after year, and most small businesses get screwed during negotiations setting up employee coverage as well) … so even if your current job pays for everything right now, odds are that will change for the worse down the road.
Although Canada’s health care system isn’t without problems such as appointment waiting-times and priority lists unless you don’t mind paying more in taxes to adopting a Canadian-style system, where the government funds and provides Healthcare this problem will continue in the USA. In the end, the government will spend less and “better” quality service health care will be available to all.
Personally… I think it is time to socialize colleges. Paying through the nose for medical school is too major of a disincentive to be a doctor. There have been a few posts that point out that it isn’t that we need socialized health care, we simply need more doctors!
Also allowing for a degree that sits in the middle between nurse and doctor to see patients that do not actually need much beyond basic care would take a lot of stress of doctors. Popping a joint back in place, and splinting it does not require 12+ years of medical training.
I really hope that the Feds make state and community colleges free, much the way they are in Cali, or Egypt for that matter. One should never have to pay for education, because the results are beneficial to everyone. The more educated society is, the higher the GDP will go.
Now, I am not so much of a socialist that I think ALL education should be socialized. If you want a degree from a better than average institution, like Harvard, then you should be able to pay for it. Sorta like private high schools, not necessary, but there if you have the money.
@LeoSolaris: There are programs out there that will defray the cost of medical school in exchange for years of service in a high-needs area but they are under-utilized because spending six years in the sticks trying to convince country people that they need to exercise and treat their “diabeetus” after already spending an eternity in school becoming a doctor is not appealing to enough medical students.
This is $375 a month for health maintenance. It’d be worthwhile for people with a very high deductibles on their main plan, particularly if it offers a la carte options like only paying for hospitalization and emergency care. This might work for families or people who are chronically ill, but it doesn’t really make a lot of sense for people who don’t have a reason to run off to the doctor all the time (that is, people who are no elderly or who do not have children).
The health care system isn’t really “broken.” Far from perfect? Yes. For what it’s worth, I’m one of the 90% of the 90% (that is to say, one of the 90% of insured Americans, and one of the 90% of that 90% who is very happy with his insurance, and I think I pay a fair price through my employer) [numbers according to Dateline NBC].
y’all want your cake and eat it too. waaaah! waaaaaaaah! I want to be able to get the most professional caring medical service available but god forbid I have to pay anything for it! waaaaaaaaah!!!!!
geebus fR$#@ing xmas already.
1. most doctors get into this business to help others. by the time they’ve been sued 15 times by greedy asshole patients and screwed over by the hospitals and the insurance companies they tend to get a bit jaded. YOU WOULD TOO FOR F$#@’S SAKE
2. a single payer system would be the best answer, but to have the government running it is just plain stupid. the government hasn’t run anything well, ever. you WILL get screwed if you let them run the show. wait and see in nObama’s new socialist experiment (as if the USSR hadn’t already shown the world that particular philosophy just doesn’t work!)
3. law suits against doctors are probably 90% plus frivolous. that’s an accurate number and probably actually conservative. until we find a way to stop this abuse of our right to sue anyone we please, health care will continue to cost an arm and a leg, and your MD will continue to fear and therefore ultimately hate you. do you like to know that your MD actually fears and hates you? if he/she has been sued by their patients, trust me, they fear and hate you. all of you. how would you feel, suffering for years to learn how to take care of sick and suffering patients, devoting your LIFE to attempting to alleviate suffering, then BAM!! getting sued by some asshole who just wants to take away your Mercedes Benz ‘cuz they think you haven’t earned it. Or they just don’t care and want what you have because the law and some f$#@ing stupid jury composed of housewives and jackasses are more swayed by the plaintiff’s lawyer.
there are answers to this complex problem, but it should be the MDs, first and foremost, who help to shape the new system we design, NOT the lawyers, politicians, government. it’s the MDs who have historically actually been the ‘advocate’ of their patients, NOT the f$#@ing lawyers, politicians, government.
people, for FUCK’S SAKE, wake up and smell the coffee. this country, once great, can still be fixed if only we will begin to adopt new systems that WORK, that are constantly reviewed and tweaked to excel. NO reason for this mess we find ourselves in, except common human (CHOSEN) ignorance, greed, selfishness, and laziness.
@banmojo: the government hasn’t run anything well, ever.
1) The Post Office consistently runs better than FedEx and UPS, and has home and weekend delivery and pickup, all for the price of a 40-cent stamp. And it turns a profit. You tell me how that’s the government “not running anything well, ever.”
2) The VA hospital system – administered and run by the government – is consistently better-rated than most area for-profit hospitals.
3) Social Security, despite Republican misinformation about its “imminent demise”, is the best-run social insurance program in the world, with less overhead and expenses and better administration than any private firm in the country.
Government-run healthcare is apparently so awful, after all, that every single member of Congress including John McCain has opted for it for their own healthcare needs. You might want to ask your guy, or his supporters, why he thinks that a public healthcare system would be so bad for everyone but him. It was, after all, at a government-run hospital that he was patched up after his POW experience.
An insurance model simply can’t work for healthcare. It works for houses because not everybody’s house burns down. But everybody needs healthcare. Insurance can’t work.
As a family physician practicing for 30 years I have seen and done it all. From delivering babies in the patient’s home unexpectedly to making house calls to a dying elderly patient. The overhead of dealing with insurance companies and our present “Nationalized Healthcare” called Medicare has made the family physician’s profit margin go to less than 15% if you work for just 45 hours per week. Medicare has FIXED the prices for all physician’s services since 1984. Since 1984 physicians have not been allowed to bill anything extra for the time that they spend with the patient. If I give extra time to the patient I must document all sorts of signs and symptoms unnecessarily in order to “possibly” be paid what the government decides what I should pay. This is why we are going to a prepaid formula to avoid being sent to jail for billing more than medicare will allow us to bill you. Presently we are only allowed to charge $3 to draw your blood and fill out all the paperwork so that the lab can bill medicare. This is why most of us do not want to draw blood anymore. If we charge more for the personalized service we can be sent to jail for 6 months for each offence under the medicare program. Therefore we are now drawing the line in the sand. I can make it if my patients pay only $700 per year extra in order to keep me in business. I would rather charge by the time that I spend with them like I did before 1984 and the cost would be less but you government and insurance companies demand that we work for them and not you.
Back in the good ole’ days, doctor’s did house calls, and did not charge an arm and a leg for a regular appointment or hospital stay. As the years have gone by, everyone has gotten in the act! Physicians, the drug companies, the medical insurance companies, the hospitals, etc…. and they have made medical care into a “For Profit” business, with no real regard for the patients. Filling their quota, asking for insurance before any treatment is done; all this is BS! Doctor’s make alot of money off of us pions!!!!! Living in luxury!! They paid alot for school, and they want to make that money back and then some!! I think this is all a conspiracy!!! Enough said!
Health services consist of more than a visit to the primary doctor’s office. In this model, you first pay an annual fee; then when you call the doctor, he or she might charge you a consultation fee for talking on the phone; then you go to the office, there is a flat fee for “seeing” the doctor. How about you need lab, it usually goes to outside private lab. That can easily add up to several hundred dollars (for example, for a cash pay patient a real lipid panel, not the in-house finger stick for cholesterol, is $150 to $200); if you are going to have any outsider procedures (let’s say a CT scan, it is close to thousands); how about you need a specialist, then you are an uninsured patient to that specialist doctor. By the way if you have kids, you had better pray that none of them break any bones or have any accidence.
There are a lot of other charges from outside of your primary doctor’s office when you receive health services. In this model, the patient would be left in the cold for all this “other providers’ charges”. Even if you have other insurances, they might not pay for the orders or referral from out of network providers.
I guess this model might work, if the patient is young and lives in a safety bubble. Also, if there are different disciplines of doctors to form a small group. In that case, we just create another private HMO. Was that how the Blue Cross Blue Shield started many years ago, a group of doctors got together and form a health insurance company. The bottom line is doctors want to make more money like everyone else. Doctors have their family to feed too. Do you honestly think the doctor worry about helping every patient? Think about if you have financial difficulty in the middle of year and cannot pay the flat visit fee, will the doctor continue to see you on a credit. You can forget about it.
The core issue is all we Americans need to push some health insurance reform to cap or regulate health insurance industry. The problem is the health insurance company, not the patients or the doctors. Between patients, doctors, and insurance companies, insurance company is the only one making tons of money. US Health Insurance Company is the most profitable industry in the world. Based on some statistics, one of the health insurance companies even makes 200% profits in one year. We all know that beside insurance premium from employee and employer, there are co-insurance, deductible, and co-pay. Did you ever wonder where all the premiums have gone, how about CEO’s bonus! Don’t you think there is something wrong?
375/month is less than what I paid for insurance when I worked for Haliburton.
go capitalism driven healthcare!
I know docs that do this model. They really are available 24/7. Usually its 2 docs covering the practice, so they can have days off. There is also FAR less patients…thats what lets them have more time. It allows them to give the attention each patient needs, the time and availability the doctor wants to give, but cant at just the insurance rates. IMO you get what you pay for (but not specialist coverage). Downside: it kinda screws regular/poor people. Usually they donate about 1 out of 25-50 spots to people with no health insurance (at least the ones I know).
I know of FPs that had to quit their job and wokr for pharma cause their practices were losing money…or they were working 60 hr weeks for 60 grand…might as well work a less stressful job.
And its true, this only covers your family practice visit. The upside is, you will be referred out less since the doc has more time to manage your problems. But you have to find a good one. And it still wont cover X-rays, consults etc…but a lot of the docs have deals for “routine” stuff with the labs..ie your membership might cover part of chest X-rays and lab…but definintly not chemo, MRIs, ED visits…
Gee, the system in France delivers this level of care for all its citizens for about $3500/year, including house calls, office visits, prescriptions, etc.
[www.cbsnews.com]
We have a lot to learn.
And the greedy doctors (as opposed to those who actually went into medicine to help people) need to be dragged down a cobblestone street by their balls/tits.
I’m an American currently living overseas. I have health insurance from an European company and my annual premium is approximately $4000. For this amount I get worldwide coverage, medical evacuation, prompt payments with no hassles and a yearly coverage of $1.5 million. Overall, I think I get a better deal than I had when I was living in the States and had coverage from an American insurance company.
Ok so I pay a fairly steep rate of over $3700 a year for insurance and these asshats want me to pay another $4500 on top of that? So$8,200 a year, f- that.
I can’t afford an extra $5000 each year for the medical care I need. I don’t know ANYONE who can.
As a doctor who works in an underserved urban community, I find the whole “boutique” concept to be utter greed.
Many of my classmates and peers have shunned insurance/Medicare/Medicaid altogether, choosing instead to practice in wealthy areas where they can charge high fees for their services. As a result, they end up serving <1% of the population, and an even smaller proportion of the population who actually NEED their care (sometimes desperately). Sorry, that doesn’t sit well with me, as it runs directly opposite to why I chose this profession.
True, practicing medicine with third-party payment is frustrating, but it CAN be done (and even done efficiently, with some creativity), and it even pays a living wage. I may not be earning the salary of a Beverly Hills dermatologist, but I’m able to support myself. Moreover, I’m providing good care to people who need it and I thrive on the therapeutic interaction with my patients– that’s why I’m a doctor.
Socialized medicine. That is all.
Real universal health care works in other countries…not flawlessly, but with a HELL of a lot less problems than we have here.
Now even doctors are bailing on the sinking ship that is our national health system. Is it time to fix it (ACTUALLY fix it, like, for everybody, not just the young/healthy/wealthy) yet??
@Mary Marsala with Fries: Agreed…healthcare is a right NOT a privilege.
A tip for everyone. Whenever anyone says, “It’s not about the money”, it’s about the money.
Ah, private doctors, private hospitals… America is becoming a Third World country again.
A doctor who only nets $20 per hour?