A Medical Insurance CFO said she understood where I was coming from when I discussed my practice and the fact that I don't enroll in and insurance plans. Being out of network/opting out of medicare has the benefits of not being required to purchase expensive electronic medical recording systems (and the tech necessary to maintain-I spent 2-3 hours negotiating a 30 minute compliance training slide show on Sherman Hospitals website just to maintain hospital admitting privileges...that was a chunk of an office day where I could have been paying bills!!!)
She then went on to stab me in the heart by saying, she goes to a doctor like me, her concierge doctor. Then I thought....if she negotiates price points between large corporations and medical practices, sets policy for the doctors on what they get reimbursed, "wheels and deals" strategic plans to be the middle man but show a profit to her board of directors......then she herself goes outside the usual medical insurance limitations to maintain her health-what kind of message is that for the masses of people trying to decide which plan is good for their family during open enrollment while at the same time not taking too much out of the bimonthly paycheck. (see my blog on the Duality of Healing and Healthcare)
I am not a concierge doctor. I do not charge a retainer fee to "cherry pick" my most loyal patient and create and exclusive membership club. I destroyed my 401 K to study advanced techniques of mind body medicine, nutrition, acupuncture, yoga instruction so I could heal myself and my patients. I gave up a 10 year practice to break away from a Hospital in the Center of Dupage so I wouldn't be giving up more unpaid weekend time to go back and finish charts/answer phone calls and help my patients heal their suffering. (I was told at one point that since my acupuncture wasn't reimbursed by insurance....I had to do it on my own time.....you cant charge patients over and above the negotiated prices for evaluation and treatment if an insurance contract was signed by the hospital between provider and patient.....which makes me think a concierge retainer fee is illegal) I was working 50 hours a week, plus giving away community lecture time, I missed my daughter growing up....in fact I don't remember much from those 10 years except eating bad food in the morning, drinking alot of coffee in the afternoon, downing beer to force sleep to come....then getting shocked in the ICU to bring down my heart rate from all the crap I was doing.
No question, the guys who do concierge medicine must have a knack for making patients want to come back and pay an annual fee over and above the co pays of insurance. But I have yet to see any of these docs do any further training in medicine above the usual requirements for maintaining board certification every 7-10 years. In fact most of them still refer out to the specialists, still follow standard prescription protocols, may or may not hand out nutrition information, don't use alternative medicine. To get off my soap box, there is a benefit of going concierge. You have one doc that knows your name, goes to the hospital to admit you, in the past they were supposed to offer going to the specialist consult alongside you (I believe that practice stopped), their back log of a waiting list to get in is supposedly short so you can get in same day. So $1000.00 a year to insure a spot on his/her list may be worth it. That is about the equivalent of a 12 week healthy lifestyle program with 3-4 coaches at your side. (I medically cleared a lady for a
Largest Loser program who was able to get off medicine for high cholesterol, depression, high blood pressure and is now down to a body weight she hasn't experienced since college....now that would be a good way to spend "a doctor retainer fee")
You just have to ask yourself, do you want to be in an exclusive club and see your doctor or do you want to change your life, get healthy and not have to see your doctor?