A Bitter Pill or a Better Choice? Is a Concierge Practice Right for You?

There has been a lot of news about a new type of primary care practice, sometimes called a "concierge" practice. In this type of practice, a patient pays somewhere in the neighborhood of $1000 a year for access to a primary care provider. The patient in turn, is guaranteed coverage of all primary care routine visits, with no co-pay. I have to disagree with the link's headline that it has to be a "bitter" choice. For a relatively healthy person, paying $1200 a year for personalized basic healthcare dictated by that patient and his/her doctor vs paying thousands of dollars to an insurance company that really, only cares about the bottom line, might make sense. For $1200 a year, I can go to my primary care doctor for routine blood pressure checks, occassional colds or allergy shots, and not have to face an office co-pay. Nor will there be any unpleasant surprises in the mail if my insurance company decides it shouldn't have to pay for something like a a flu vaccine.

The physician, with the assurance of a steady income rather than being bogged down by the fits the insurance claim process can cause, can take the time that a primary care provider should devote to every visit. Most patients don't understand how long it actually takes to bill for that $88 office visit. To them, they may be with the doctor for 20 minutes. But behind the scenes, the work starts even before the patient arrives in the office. Does the patient still have insurance eligibility? Once the patient gets into the office, the provider then has to spend time trying to decide how to "code" the visit so the claim gets paid. Should that wart removal be a surgery, or something else? Will we get paid for the EKG by this insurance company, or should we just bill for a more comprehensive visit? If the claim is rejected, someone has to figure out what went wrong. This often means countless time on the phone with a claim representative. The claim is resubmitted, hopefully, to get paid this time. Patients often don't realize that it's not just their insurance company the provider is dealing with; it's often 20 or 30, many of them with different rules and nuances.

Time and other resources should be spent on the treating the patient, not worrying about how to get paid. Time spent with a patient is especially important in the Family Practice, where the emphasis is on treating the whole patient rather than specific body systems as in a specialized practice.

So, would a concierge practice, perhaps backed by a lower-cost catastrophic insurance policy, be right for you? One of our friends, Dr. Shawn Moyer, offers his Pinchot Plan to his patients. It's also a great idea for small businesses. What do you think? Would this be right for you and  your family? In this age of rising premiums, and minimal healthcare reform in the future, maybe it's time to think of alternatives.