Back on the SOAPM list, I saw an interesting discussion about concierge practices. There was the usual commentary ('Only crazy people in super special circumstances could do that!'), so I thought I'd take a moment to dispel some of the myths. I suspect that if some of the naysayers stopped to do some simple math, they'd be surprised by the results.
Let's pretend that you are a busy practice in northern NJ making good money. What would it take to drop all of your insurance and spend more time with your patients? How much would you have to charge people?
We'll make some grand assumptions:
Let's say that you end up doing 30,000 visits a year and bring in $100 a visit. You have 7500 active patients who make up these visits.
Do you know how little money you would need to collect from your families instead of the insurance companies to maintain your standard of living and care?
7500 active patients, divided by $3,000,000?
$400 per patient per year. Not even $40 a month.
Think about that. If you simply skipped the middleman, you'd have to only collect $400 per patient to meet the same level of income you have presently. That's providing all the immunizations, taking in everyone who calls (which you do now), having the same staff, etc.
I realize, of course, that it's not that simple. All your patients won't do it, for example.
But think about it a little more. If only 1/3 of your patients chose this route...you would only have to charge them an average of $1,200 apiece. That's it. $100 a month. And you could spend an hour with them every time they came. Imagine...1/3 the visit volume, only $100 a month. You could probably cut your staff by 2/3s, increase the pay of the ones who are left so they'd never leave, and give each new mom a massage with every visit.
Believe me, this is the math the insurance companies don't want you to see. For once, it isn't the money that's the problem.
[In my mind, there are two great variables here: the age distribution of the practice and the health care you don't provide. Those are both quite manageable.]
Over on one of the MGMA mailing lists (whose content and quality seem to diminish over time), the ED of an interesting organization - True North: Maine's Center for Functional Medicine and the Healing Arts - posted a message about their cash-only business. I poked around and found this segment in their pediatric section:
Best First Year of Life
This package approach to Kathryn’s services allows a family to purchase a year of care in one lump sum or in quarterly payments. The package includes: a prenatal consultation, up to 2 hospital visits for normal newborn care, well-child visits at 1 week, and at 1, 2, 4, 6, 9, and 12 months, one hour of phone consultation time, one, 30-minute behavioral or parenting consultation, two acute visits and a one hour pediatric class.
...that's exactly what I've described offices should do in the face of the HSA programs (only Lynn Cramer @ Eden Park Pediatrics seems to have investigated the possibilities). I'm excited to see someone actually do it!
First, I just got back from a great weekend at Skytop Lodge, where I spoke for the Goryeb Children's Hospital. Had an excellent time, hung out with some old friends, learned a lot. This may be the best pediatric conference to which to bring a family anywhere in the country. Well, that and our AAP endorsed Orlando event in July.
Meanwhile, I asked the other day if anyone were interested in putting together a pediatric-focused "concierge medicine" community. I've had a few positive reponses and no negative, so I'm going to work on it here at PCC. Stay tuned.
An interesting set of survey results entitled "Key Findings from the 2008 Health Tracking Study Physician Survey" by the Center for Studying Health System Change (HSC).
Lots of interesting tidbits in here as they break down physician attitudes towards compensation, career satisfaction, etc., by race, compensation level, working hours, and speciality.
I find it interesting to see by how much the specialties differ on certain issues. Sure, pediatricians are much more like to be "very satisfied" with their careers (over half of you). I also find it interesting that you are twice as likely to accept Medicaid patients (three times more likely than the surgeons - shocker!), though less likely to provide "free" care as a result.
Table 5 - Physicians With No Managed Care Contracts - is also quite fascinating...look at how far pediatrics lags in this regard. Other specialties are 2-3x more likely to not take insurance than pediatricians.