"Concierge" medical practices?

So we had a phone message from our primary care doc, saying that we’d receive a call from a company doing a customer-satisfaction survey to see how their practice could improve their service. Oookay. fine, no problem.

Got home the other day and there was a call on caller ID, no message, but we looked it up on reverse-lookup - it was the same area code as my in-laws (welcome call but of concern if they’d phoned and not left a message) and my brother (NOT welcome call).

Nope - it was some output called MDVIP or some such. So we realized that was the “improve customer service” call, and furthermore realized our doc’s office is apparently considering going to a concierge-style approach. The deal there is: You pay a fee each year - 1500+ dollars - to remain a patient. Then they bill normal office visits to insurance as usual (but that 1500 is out-of-pocket). The advantages: more individual attention, longer appointment, more focus on preventive care, fewer patients per doctor so you get in NOW when you need to be seen…

So when we got another call, last night, I knew who it was and what their target was, so at the end of the call when the last question was “Would you spend 1500? 1800? 2400? for such service” My answer was “d) none of the above” (which, ha, was NOT one of the choices).

We don’t happen to have that kinda money to spare and obviously I’m really hoping they get enough “are you frickin’ NUTS” responses that they don’t go down that path because I happen to really like this internist and don’t wanna have to change.

But the IMHO part: Anyone ever been a patient of such a practice? Love it? Hate it? Thought it a ripoff? worthwhile?

No, I wouldn’t. Barring emergencies, I don’t spend that much on health care out of pocket each year, so it wouldn’t be cost effective for me.

Does the “concierge” fee count towards your deductible? Do you still have to pay what your insurance doesn’t cover for those visits?

I like my doctor, but I don’t like her that much. That level of extortion would lead me to find another doctor. Maybe I’d feel differently if one of us had a chronic medical condition we needed regular care for. As it is, anyone can give childhood immunizations and fill out school medical forms. My visits are just as long as I need them to be, because I keep asking questions until I’m done. If she were to leave the room before I’m ready for her to, she wouldn’t be my doctor.

Pisses me off when doctors think we should bow and scrape. Fuck that. You’re my doctor, you work for me. I’ll tell you when we’re done here.

I wonder if the doctor’s office even knows about this. I’m wondering if the folks who called you cold-called them to do “customer satisfaction surveys” and they’re really intending to sell this concierge style service TO the doctors. Since there’s no “none of the above” option, it seems like they have an interest in “proving” there’s customer interest in the service, and they’re stacking the questionaire to get the responses they want to show to the doctor.

I’d call your doctor and tell him what they’re doing. Make sure he knows your answer was “D” and that they can’t record that answer. Tell him your concerns. A lot of the time the doctors are so overwhelmed with just their clients that they don’t know a lot about the front desk or the business end of things. (Just this week my 9 month pregnant friend, who has been seeing her old OB for prenatal care, went to a new OB who’s going to do the delivery. His assistant out front insisted that she had to pay the whole $3000 package price for prenatal care and delivery. When she pointed out she wasn’t using 8 months worth of prenatal visits, the assistant wouldn’t budge. One phone call to the doc himself got a reasonable pro-rated rate and a slap on the wrist of the assistant.)

I wouldn’t pay it, but my doctors’ offices are already pretty good about getting us in when we really need it and I don’t care about having to schedule routine exams way ahead of time.

A Houston AIDS doctor recently instituted a $1500 per year “concierge” charge. And said he would limit his practice to the first 600 patients who could pay that amount.

From the Houston Press.

No, I wouldn’t pay that. I expect that level of service from my doctor without having to pay an extra fee. If they can’t keep up with that quality of care, they have too many customers and I’ll take my business elsewhere. That’s ridiculous.

No, I wouldn’t pay it. Things work just fine the way they are, with my doctor. Sure, occasionally I have to wait for an appointment, but if I’m actually sick, they’re pretty good about getting me in. For routine crap, I should have enough sense to book ahead of when I really need to be seen.

Most insurance carriers do not allow providers that are in their networks to charge anything other than for visits. They are contracted for a certain rate per code and can be kicked out of the network for charging more.

No, I wouldn’t.

No. I choose our smallish town doctor because he joined an established medical practice because he had all the resources but isn’t that far out of medical school. He explained me in the interview that he is growing his practice over time and only takes the number of patients that he can handle at any given time. He always has slots for same day patients and often within 2 - 4 hours so I don’t need to pay for it.

Actually, your physician, oops, Primary Health Care Provider, does not work for you. Your PMHCP works for your medical plan provider. They get their revenue from billing your insurance company, unless you are paying out of pocket. And the system is now set up to force providers to maintain high patient volume.

If people are willing to pay premium prices for cars, clubs, televisions, cable, ISPs, why not medicine? If the retainer relieves the need for ridiculous patient volume, why not?

Just a random question: if you have a health savings account, would you be able to pay the $1500 fee from that account?

And to answer the question: I probably wouldn’t sign up for that now because I’m a poor graduate student who can’t spare $1500. However, maybe in the future when I have extra funds and kids (is that possible?).

I work in IT for a benefits consulting mega-corp although I am not a benefits expert but you probably could use your health savings account for this. They are generally pretty liberal. That would save 20 - 30% or so.

My doctor sees me the same day if I ever have a real need to see her. When I scheduled a physical it was about a month in advance, but that was so they could block out extra time. I never see a PA, although a nurse takes my vitals. I never feel rushed and she usually takes the time to ask about my dogs and horses. I ask about her kids. I appreciate the good care I get, but not enough to pay and extra $125/mo. Especially since I only go a couple time a year.


Concierge medical practices have been around for quite a while for patients wealthy enough to not need a health plan–that is, those who pay cash. I’m not personally aware of anyone who charges a retainer and then bills your insurance, but I wouldn’t be surprised.

This is what they call a market-based solution. Patients complain because they can never get in to see the doctor, and because they’re crammed into a fifteen minute slot when they do get in. Doctors complain because their reimbursement isn’t going up any while their expenses are. Every doctor I know would love to reduce his patient load without taking a pay cut, so this is an obvious way to do it.

I think it’s exactly the wrong direction for medicine in the US to go in, but I think this is going to become more common until we overhaul the system altogether.

Nope. I wouldn’t pay it either. Like the others, sounds like you’d be paying extra for the stuff you should be getting anyway.

more individual attention: I get plenty. I’m not sure what this even means. Sounds like a buzzword-type thing–who can argue against “individual attention?” I’d want to know the particulars of what I’d be getting.
longer appointment: What do I need a longer appointment for? My appoinments are as long (or short) as needed. There are times when my doctor seems a little frazzled, but she always makes sure all my questions are answered and my concerns are addressed. And the yearly physical is thorough.
more focus on preventive care Again, this is one of those things that everybody thinks is a good idea…but exactly how is this “focus” going to manifest itself?
fewer patients per doctor so you get in NOW when you need to be seen… The issue isn’t patients per doctor. The issue is appropriate scheduling and use of resources. My doc’s office can always get me in the same day when needed. They do have an excellent nurse practitioner who handles a lot of the routine stuff. Regardless, I get seen right away when I need to be, and I don’t need to fork over an extra $1500 to do it.

In response to DoctorJ’s comments–

I agree that doctors are often put in a bad position given the current system. I’m wondering what you think of the way my new gynecologist handles it.

Her office doesn’t deal directly with the insurance company. The patient pays out of pocket, and then submits the claim herself, and then is reimbursed directly by the insurance company.

I see it as having several advantages–

  1. She doesn’t have to pay the staff to deal with the claims and the disputed claims and all that.
  2. She gets her full fee regardless of what the insurance company wants to pay.
  3. She doesn’t have to wait for payment. She gets the cash in hand right away.

All of that adds up to more money per patient, which translates into more profit for her and/or a lighter patient load.

She has many more people that want to go to her than she has time for, so I guess that’s what allows her to run things this way. And she does make exceptions on a case by case basis.


When it’s a seller’s market–that is, when there are too few doctors and too many patients–this isn’t a bad way to handle it.

This is exactly the opposite of my medical community. Here, doctors are competing like crazy for patients*. So it’s all about what extra services you can provide for the patients, and a doctor who didn’t file insurance on routine claims wouldn’t last ten minutes. (That’s doubly true since a doctor who did that couldn’t accept Medicaid.)

  • Yeah, I know I’m in a supposedly “medically underserved” area, but it’s definitely a buyer’s market here when it comes to health care. The reason for that is not just another thread, it’s a whole other book, one I’m thinking about writing.

Right, but who doesn’t pay out of pocket, at least something, for almost all visits? I do, ‘cause my deductible is friggin’ $2500 and I almost never use that much health care in a year. Even after I do meet it, I pay 20%. The doctor works for ME not just in the sense that I’m paying her, but in the sense that I control my presence in the office. I have the power to walk out and see any of the other gazillion pediatricians in Chicago. I understand that elsewhere the power balance might tip the other way due to a shortage of providers.

And before you ask why I don’t switch to a plan with a lower deductible, it’s because then my monthly premiums would be even worse than the $500 a month they already are, and I can’t justify going without insurance with two children and a husband who could get hit by a bus any day. My daughter spent 3 and a half months in intensive care as an infant - that was the *only *year we ever met our full deductible and went past the “maximum out of pocket” and THEN the doctors were getting paid 100% by our insurance.

Right now, I’m pleased enough with my doctor’s service that I wouldn’t want a switch to this model. However, the concept doesn’t offend me, and I can imagine circumstances when I might give it more consideration. If I did ever use this model, I’d probably visit the doctor a lot more often and expect/demand a much higher level of customer service, believe me those people would work for their $1500. Did the survey include any questions about visiting the doctor’s office on Saturday and Sunday? I think that could be a big thing for a lot of people who might lose money when taking off of work to visit the doctor.

I was trying to think if there were any other professions that could tempt me with a concierge model, and “auto mechanic” was the first thing that came to mind, like AAA but even more personal and on-demand.


I don’t like the sound of that…

But then, I work for the NHs, so ya know… don’t like that much either.

I might be willing for an auto mechanic, if he’ll do things like email me when I need an oil change and tell me about routine maintenance instead of letting things break. Add in pick-up/drop-off service and a free shop loaner while you’re working on my car, and I’ll be your bitch for the year.