Tuesday, February 1, 2011

Rethinking Concierge Medicine

Strangely enough, I find myself again this week pondering a New York Times health article, this time on concierge medicine.

I remember when I first heard about the concept awhile back, and thought the idea of paying a surcharge on top of the price my insurance company contracts with my doctors was ridiculous. I don't need to pay extra for a spa-like ambiance, nicer receptionists and more up-to-date magazines. And the costs for concierge practices were way out of my budget, tens of thousands of dollars of annual fees just to feel like I was getting to see some exclusive doctor. Yeah, definitely not for me. 

But now I've spent a couple years watching USA Network's Royal Pains series, with a cute doctor who appeals way more to me than House, M.D. And suddenly, concierge doctors who can figure out complicated health issues and treat them on the spot are much more appealing than they used to be, even if the price tag is higher than "regular" doctors.

Of course, now my situation is different than it was back then, too. And I'm a little curious if the concierge practice here in Portland that's almost affordable (Greenfield Health) would even accept someone like me without charging an extra premium. After all, I already routinely get 40 minute appointments with my internist, and it's not unusual for them to stretch to an hour. And my insurance company does pay more for the longer appointments than it does for a normal 20-minute appointment, albeit not as much as seeing two different patients in that time period would.

I know my friend, the Queen of Optimism, has said many times in her blog that she'd happily pay an hourly fee or anything else out of pocket if her PCP was willing and able to spend some extra time talking to specialists and coordinating her care. She has even flown to Baltimore to consult several doctors at John Hopkins at her own expense.  

I'm curious -- have you ever tried a concierge doctor? Checked one out but decided not to do it? What do you think about the concept? Will they keep an "expensive" patient, or would they dump her? (I.e. An expensive patient is one who uses a lot of a doctor's resources, whether it's office appointments, email, or the time it takes to coordinate care among specialists.) 

Meanwhile, it's the time of year again that I most miss being able to sit at a desk for more than extremel short periods. Yep, I'm working on bookkeeping to close out our 2010 finances in preparation for doing both our taxes and our financial aid application, which is due next week. Getting a laptop and being able to use it both in bed and in my recliner saved my sanity, but they don't make it any easier for handling paperwork while on the computer. I'd love suggestions for things like document holders that clip onto a laptop and/or other ways to organize paperwork for use while using a laptop on, well, a lap. Let me know what you've used, and whether it's been successful or not. Thanks!


Pissed Off Patient said...

Concierge medicine is something I'm considering. I don't just need someone to coordinate care, I need someone who keeps the specialists accountable and on track.

In my area the fee is somewhat reasonable, about $1000. I don't have that money but could maybe fund it with a tax refund or perhaps our HSA account would consider that a medical expense.


Aviva said...

Hi M!

I guess there's a handful of concierge medicine practices here in PDX, ranging from the low end of $450 to somewhere around $15,000 a year. On the upside, the folks who charge only $450 a year also accept most insurance plans.

My worry is that it wouldn't end up being any more helpful than I'm already getting. I understand how charging $450/year for a typical patient allows the practice to have longer appointments and more availability via phone and email while remaining profitable. But I wonder what they do if they have a patient who's complicated and requires infinitely more of a doctor's time (whether in person or simply keeping tabs on the specialists and communicating with them and with me).

The place here does have a monthly open house, which I just missed this week. I'm contemplating checking it out next month, and making a call to see what they think about my situation.

I think if I were decidedly unhappy with my PCP, I would be jumping on something like this. But I'm actually pretty happy with her, despite her limitations on how much time/energy she can spend following up with my specialists.

More to think. Hey, will you do me a favor and let me know what you decide to do re switching to a concierge doc? I'm sure you'll blog about it, but I'm very curious to hear about the experience complicated patients like us have with it. Thanks!

Pissed Off Patient said...

Will do. I'm in a holding pattern right now waiting to see what my body does as I taper.


Penelope said...

Hi Sick Momma,
I just followed a link on Pissed Off Patient's blog to your site and my jaw is on the floor. Your journey is so much like my own. I'm even on to the gluten-free trial! (ok, I'm about a year behind you).
I live in Canada and using concierge medicine is more unusual here, I think. But without it, I'm sure my health wouldn't be as good as it is today (not that its great, but I am living life). It is expensive, but at some point I asked myself, what is my health worth. I would gladly pay many times more to have a few more good days.
I am adding you to my links, as I hope to follow you and your journey.
All the best,

Anonymous said...

Concierge is a thing of the future. To have a Doc, you can call 24 hours a day, 7 days a week is what people will pay for.