Comments on: I disagree with @DrVal – retainer medicine is the answer

By: solo dr

solo dr — Sat, 19 Dec 2009 22:43:57 +0000

It is difficult to say what will fix the system. Currently doctors who take insurance and Medicare are expected to do for free drug prior authorizations, MRI/CT prior authorizations, and phone calls during regular and after hours. We get the same pay for working holidays/weekends and are told by the insurance companies to have extended hours on weekdays for the same $55 average office visit.
No other profession would exist under the current conditions with HMOs and the Government whittling away any independence of physicians. Dentists, Accountants, and other professionals charge for their paperwork and phone calls. We are told we cannot charge the CPT codes by the insurance companies and Medicare, yet we are liable for the care.
The current system is about to break. For 2010 premiums, copays, and deductibles are increasing, meaning patients will be paying more for the same or less care. Once copays hit $40-$50, it might make sense to drop insurance completely and let the patient pay for each office visit/phone call etc. Let the patient spend 15 minutes on the phone prior authorizing an MRI or telling the Medco/Caremark company why they need Wellbutrin for depression and not simply for smoking cessation.

By: #1 Dinosaur

#1 Dinosaur — Sat, 19 Dec 2009 13:46:07 +0000

What Val said.

Retainer medicine is better for doctors, but limits access to patients with more limited financial means. "Many patients" may be willing to pay $60-70 monthly (which adds up if you have a couple of kids and are paying that per person) but it still quickly exceeds the reach of others. Where are they supposed to go?

If you're talking about "job desirability", I propose more than lip service to fixing the culture of medicine where primary care is considered intellectually second-rate. Improve compensation, yes; reduce the day to day regulatory and paperwork hassles, sure; but you'd be surprised how much financial altruism there is out there that withers in the face of intense scorn from med school on.

By: Rocky Balboa, Jr, MD

Rocky Balboa, Jr, MD — Fri, 18 Dec 2009 01:44:46 +0000

How do you differentiate "cash only" from "retainer"?
In my opinion both are cash only.
HelloHealth allows an individual to customize the payment model.
Could charge $35/month plus $200/hr. Or $20/month plus $250/hr. Or waive monthly fee plus $300/hour. Or whatever floats one's boat.
Prices will always be transparent.
The payment model will adjust to the local market.

By: Jenny

Jenny — Thu, 17 Dec 2009 21:06:12 +0000

According to Concierge Medicine Today recent 'recession' poll, when we asked currently practicing 'concierge physicians'...'Financially, how is your practice doing compared to one year ago?' 100% of physicians surveyed said Better or No Change 75% responded saying their concierge medicine practice was actually doing better than this time last year less than 25% indicated 'no change'

By: Dr. Val

Dr. Val — Thu, 17 Dec 2009 15:03:10 +0000

The problem with retainer medicine is that it incentivizes smaller patient loads. I understand that this is desirable for doctors, it's not good for the healthcare system as a whole. My point is that direct-pay IS a great option for many people, but I question whether the exclusivity of VIP concierge practices is good for the common person. My model rewards volume while decreasing admin paperwork and decreasing costs. This can be scaled, while concierge practices cannot.