Faced With A Broken Health Care System, Some Doctors Are Opting-Out
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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Comments:
I would gladly pay the fee. My husband's health coverage is free to us (he's military) so the $4500 fee for a family doc would mean we'd have access to a doc 24/7 and still be covered for office visits. For us, it would be awesome.
4500? I couldn't afford that, and I doubt most others could as well. It's tough enough saving for a home, a car, college - an added yearly expense, a considerable one at that, is over the line for me. I sympathize with the doctor's getting jerked around by insurance companies, but there has to be some middle ground for affordable health care.
Sounds tempting for those who have the cash. 375/mo for one person or 1500/mo for a family of four, assuming they do no incentives to get families in the door. This added to existing insurance fees.
I'm sure it will work for some affluent areas, but part of me cringes at how our current system seems to have created another sub-system that further screws over the people who can't afford health care in the first place.
Also, it's kind of funny how a health care business model is addressing the symptoms, not the cause.
Wonder what happens if you wind up using too much of the doctor's time?
You have to pay for the entire year up front? GAH!
Why can't there be some middle ground? Unhurried appointments are nice but I don't need 24hr access to a doctor and I don't really need one to come to my house. It's awesome that some are going back to house calls if some people need that but $4,500 is too much money to pay for a lot of care I don't need and won't use.
@El_Guapo: All you said less the sympathy for the doctors. Last I checked I still drive an aging Mitsubishi and my doctor has a new Mercedes.
$4500? For health care? I could swear I heard a bunch of people a few weeks ago saying you could not get health care for under $5000. I think someone was proposing a $5000 tax credit to pay for health care and people said it was impossible.
@El_Guapo: If you look around (ie, not your employer-based coverage) you can get catastrophic health insurance for a decent rate. Its hard to find, but its out there. Its typically about 40-60% of what you pay for full health insurance, so that savings goes to this care.
Even better, if you can find a high-deductible plan that offers HSA's, go that way. The monthly premiums are usually pretty cheap, some employers do matching for contribution to your HSA's, which could then be used to pay for medicine and incidentals.
But, sad to say, this is going to become more and more common if we keep this movement to governmental/socialized medicine. Those with means will always have a better access than those without.
Oh, and $4500 is $375 a month. Considering a family of 3, that's not all that bad...
Yeah but it says the family would have to pay that. How much would it be for each individual?
Holy shit that's a lot of money.
I get decent healthy insurance. I get about $23 or so taken out of my check every week (I get paid weekly). That's under $1200 a year for insurance.
$4500?!?!?!?! Holy shit no.
@Rectilinear Propagation: Yeah I'm young and fairly healthy. I have health insurance but don't use it often. If I weren't female and doing yearly exams and on BC, I might not even really need it (though I know I should have it).
$4500? Jesus CHRIST NO.
@VA_White: I'm glad you're rich, then, because I sure can't afford that and I don't know anyone who can.
@Erwos: Yep. So basically you still need insurance to cover all that ... plus $4500 up front for a doctor.
Hells to the no.
Is that $4500 for a family of 4?
That comes up to 1125 per person. I'd consider paying that for 24/7 access, but no more than that. And it would still be something I'd have to think about seriously.
Yay! It's what privatized health care should actually look like! Doctors in charge of their own profit margins?? Accountability?? OMG!
Keep in mind that while you're paying a bit out of each paycheck, your employer is spending thousands more for your healthcare each year. Normally.
@Git Em SteveDave loves this guy-->: @dtmoulton: You misread. The $4500 was for a family of three. Or at least that's what the article implied. That would be $375 for all three, or $125 a person. Its probably $1500 a person for a year.
But, as I mentioned elsewhere, you wouldn't need your traditional "full" insurance but something more akin to what your auto insurance is: "catastrophic" coverage. Or switch to a high deductible coverage with an HSA.
The health system as we have it now will not survive. Job-based coverage is one of the problems (if its such a great idea, lets tie ALL coverage to our jobs!). There are so many problems that need solving, but people aren't willing to pony up to it (needless tests, overbilling, etc).
@Git Em SteveDave loves this guy-->: This still isn't the same as comprehensive health care. This is only the fee for the primary/family doctor.
I'd imagine a referral to specialist, getting stuff like MRIs or Xrays, medications or surgery would all cost extra on top of this fee.
@Git Em SteveDave loves this guy-->: Yep, it still is. This $4500 only gets you access to a PCP, which is the cheapest part of some people's medical expenses. Doesn't include drugs, specialist visits, tests, or hospital stays.
$ 4500.00? Fantastic. I wondered what I was going to do with all my extra money floating around.
@negitoro: Yep. So it's $4500 a year which isn't bad for a family of 3 or 4 ... until you realize that it isn't full coverage. So let's double that price.
So basically it's rich-people insurance, YAY!
@davere: And it does not include hospital care, etc. It's not full insurance. And what about prescriptions? Something tells me that's not included, unless I missed something.
I can't help but think that 24/7 translates into every other Tuesday from 9:00 - 4:30pm.
In California that would be a steal. I doubt any Dr's in CA would adopt that model. Not at that price anyway.
It sounds doable with an HSA and high deductible plan. However, it is probably out of the reach of those with more comprehensive insurance.
I had a professor in college argue that if you removed third party payers from the system, health care costs would decrease. It makes sense since many doctors, hospitals, etc incur higher costs to deal with the insurance companies and pass that on in terms of fees.
I first read about this several years ago.
This is not insurance for under $5K. This is simply a fee to be a patient. You still pay for each visit, treatment, etc. It is possible, depending on the practice, that some charges may be lower, since they don't have to cover the additional overhead insurance compliance requires.
It's kind of like when you pay an entrance fee to live in a retirement community, but after the entrance fee, you still pay monthly rent.
One of the giant questions about healthcare reform that neither candidate is adressing is a magic wand is waived and all American's have access to healthcare, exactly who will these 42 million newly insured go see?
@little stripes: $4,500, I wouldn't say rich. The husband is military, they get discounts on some stuff, free health care (though you may be getting exactly what you're paying for) and possibly very inexpensive to free places to live.
the $4500 may be what health insurance would cost them anyway if they had to pay.
mmmmm.... I think that I'll be staying with my company's plan @ $20.00 per month for everything (health, dental, vision, long/short term disability, etc..) So, $240.00 a year sounds like a better deal for full coverage with a very low out of pocket responsibility.
@Git Em SteveDave loves this guy-->: This is NOT insurance. It's just prepaying for a year of doctor's vists.
If the doc finds you have cancer, you sure better hope you have regular insurance ON TOP of this thing.
When the doctors get tired of insurance you know it's time for a change.
I've read several stories like this over the last several years.
Personally I think the doctors want to much for basic office visits and the patient want a free visit for the sniffles-both have abused insurance on visits.
Unless you have to see a doctor every month you could save alot by having a major medical type coverage where you pay the doctors out of pocker per visit.
If the doctors knew they would be payed by the patient:a person and not an insurance company they would almost have to adjust their rates.
My favorite doctor(may he rest in peace) never accepted insurance of any kind but the most I ever paid for a visit was around 40$.He had no appointment office hours,a answering service would call him at home if you had a serious problem and he would refer to specialist if needed.
Now most doctors or practices figure the maximum payment from a particular insurance company and take it from there.
Yeah, but you would need this AND some type of regular insurance.
Because that $4500/year ain't gonna cover chemo if the doc finds cancer. And then you'd be really screwed.
Reading these comments shows how insulated most of you are from the true cost of your health coverage. $4500 for a year for a family of four is a steal even if it excludes major medical.
@erratapage: I was wondering about that too. I wonder if you could pay it from your HSA? If I did that it would meet my deductible for the whole year right off the bat. Then my PCP would be free for the whole year and since my deductible was met anything else would be greatly reduced or free.
Interesting. I wasn't too sure about the whole idea at first but that would almost be worth it.
One of the specialists I used to see didn't accept insurance. He shared a small clinic office with a couple of other doctors. It was clean and in good repair but utterly no frills and small. He also charged a fraction of what the other specialist in the area on the traditional model of accepting insurance and having a huge swanky set of offices.
OH NOES!! OMG11!! Free market healthcare!!! It must be stopped! This is why Lasik (not covered by insurance) surgery is $2000 instead of $20k.
Use that money to see a doctor in Latin America. You'll get primary care, a vacation and perhaps even money to spare.
There is one primary case for this being a good idea, for some. New parents are a good example...
@polyeaster:
according to the full article:
"Rather, the doctors will charge patients $2,000 a year plus $500 for each child ages 14 to 25, a plan the practice calls the "Personalized Health Care Model.""
I've wondered about this system, supposedly some of these groups limit the number of patients they'll accept so that you get the kind of access you're paying for. My question is what happens if one of these patients ends up seriously ill or needing high level of treatment such that they are in to see the doctor once a week or more often? Does that patient get that level of service, is there a contract of some sort, if I pay x per year for full access can my access be trimmed back?
@Erwos: Considering that you could drastically scale back the level of your insurance to cover catastrophic expenses this could financially viable for a lot of patients. My family pays a ton in premiums that we would save if we changed to a catastrophic policy.
@Tux the Penguin: Except that you can't get those sorts of cheap high-deductible plans at all (or if you can, they cost a ridiculous amount or have exclusions) if you have any sort of preexisting condition. And most of the aggregate healthcare dollars are spent on people who have chronic illnesses. So HSA plans are not a solution to our healthcare problems, because the only "insurance abuse" they discourage is frivolous minor use of the healthcare system by healthy people, and that just doesn't account for most of the costs.
This is a really interesting subject. We have an HSA with a huge deductible. If by doing this, I wonder if I could then turn around and submit the claim for the doctor, thereby almost meeting my deductible with one swoop. Then it would be worth it.
Doctors who opt out of the current insurance-based morass of a health care system in the United States and opt in to a "boutique" or "concierge" model of health care practice only serve to exacerbate an already awful situation.
Put another way, they end up "treating the symptom instead of the disease."
My doctor sent out notices a year or two ago offering concierge services for $2,500 per person. I don't think it included any medical care though, the way the OP covers it (but the price differential may be that). I do not recall if it waived the deductible.
What it did offer was 24 hour access and more convenient appointments. Of course, this is exactly like the airlines blocking off wide groupings and classes of seats and then charging you if you want them. Create the disease and sell the cure.
eh, If I had this, I would see the dr a lot more, which would be good.
$4500 is a lot, but if you put it up there with rent and food, its do-able.
Aside from that though, seems stupid. Insurance just needs a little bit of reform.
@VA_White: 4500 is $375/mo. if you have kids or an elderly parent, having home visits can be a godsend.
We're 27 & 30 y/o (no kids, non smokers) and we pay $500 for insurance (NJ), and that's not including the portion paid for by my husbands work. we're young and healthy - but we still have a $2500/deductible, and our health insurance is still crappy.
Admittedly, $4500/yr isnt for everyone. but you can likely pay it out of a HSA which is pretax $$, so you wouldve only seen $3,000 in your pocket if you spent it elsewhere.
i dont think i could get a Dr to my house for $250 ONE time, let alone 'on call anytime'.
Yeah, and if you need surgery or a hospital procedure, you're totally screwed.