Why is there a practice membership fee?
Without this I’d need to have many more patients (and therefore not be able to provide the same level of responsive and personal service) or charge much more for each service provided.
This fee includes services that are not typically covered by health plans and for which some medical practices charge itemized fees. This includes telephone and email consultations, medication refills, and completion of medical forms.
Having a practice membership fee allows me to know exactly how many patients I have at any time so that I can keep my practice to no more than 500 patients
Why are some concierge medical practices charging much higher annual fees?
Many of these practices include all visits with the physician, so they have to include the potential costs of multiple visits per year for each patient even if they might not be needed.
Some include an “executive physical” and possibly also multiple tests in the annual fee (see related questions below).
Some of these concierge physicians will accompany their patients to specialist visits or go to a patient’s workplace to provide care, and this requires having a much more limited number of patients so that a higher annual fee is required to make it financially viable. I will not do either of these things but will be very involved in discussing a patient’s care with any specialist that may be involved.
Why is your medical practice cash only?
This allows me to get out from all insurance contracts, which have steadily forced lower and lower reimbursements on physicians resulting in a need to increase patient volume in order to maintain a certain income.
This allows me to get reimbursed the same by each patient so there is no need to charge a higher per-service fee that allows for cash-paying patients to subsidize those patients whose insurance plans pay much less than what is charged.
In summary, it means that I work for my patients instead of the insurance companies.
Does “cash only” mean you don’t accept checks or credit cards?
Certainly not! Checks and credit cards are welcome. In fact, the practice membership fee is typically paid in quarterly installments by either an automatic charge to a patient’s credit card account.
Many Health Savings Accounts (HSAs) provide a debit card for payment of medical expenses directly from a patient’s account.
Is my practice membership fee refundable?
Yes. A patient can resign from my medical practice at anytime and the fee for any unused months will be refunded.
Is my practice membership fee reimbursable by my health insurance?
No.
Are my service fees (office expenses) reimbursable by health insurance or HSA?
These fees are reimbursable by HSAs.
These fees are reimbursable at the non-preferred provider rate by fee-for-service insurance.
These fees are not reimbursable by capitated managed care health plans (HMOs).
These fees are not reimbursable by Medicare.
Why are none of the office fees reimbursed by Medicare?
I have chosen to opt out of Medicare. Opting in to Medicare would require that I accept the low Medicare rates and require that I bill Medicare for my services, which in turn would raise my overhead and result in higher fees for my other patients. Unfortunately, opting out of Medicare means that my patients are not allowed to submit a bill to Medicare for reimbursement of expenses paid to me (this is a federal government regulation).
Why doesn’t the practice membership fee cover an “annual physical exam” like some concierge medicine practices?
Not everyone needs a physical exam or large panel of tests each year, so why have my patient pay for something that might not be needed? I will follow published guidelines to recommend what examination and tests, if any, are indicated each year, and together my patients and I will determine what tests are ordered
Carving out the physical exam allows for a patient’s payment for this to be reimbursed by the patient’s health insurance company (HMOs and Medicare are the exception) as practice membership fees (a.k.a. retainer fees) are typically not reimbursed by health insurance companies.
Some concierge practices also include multiple tests such as screening blood tests, electrocardiograms, stress tests, chest x-rays, and breathing tests as part of the annual fee. Why won’t you do that?
Some of these tests are not on the list of recommended screening tests put out by various organizations, and others that are indicated certainly don’t need to be done annually. As noted above I choose to instead follow published guidelines for preventive medicine care and therefore only recommend screening tests that are medically-indicated according to these guidelines.
Also, in most cases you can get your tests done by a contracted lab, radiologist, or specialist and have the charges for these services paid directly by your insurance company or HSA.
Why doesn’t the practice membership fee cover office visits?
For the same basic reasons as noted above for annual physical exam:
Why have a patient pay for more care than might be needed?
Office visit fees are reimbursable by the right type of health insurance, whereas the practice membership fee is not, so these need to be separate items.
If I call or email for an appointment, do I have to describe all my symptoms in order to schedule an appointment? In other words, do I have to prove that I’m sick in order to get a same day or next day appointment?
Absolutely not! Just let me know that you want to come in and I’ll get you scheduled (and I’ll see you on time!).
This policy includes routine follow-up appointments in addition to acute illness appointments.
Do I still need health insurance if I’m paying you directly for your services?
I am happy to see patients who have no insurance (unfortunately there are too many in our society in this situation), but if at all possible you should have insurance, even if it’s just high-deductible insurance for potential medical catastrophe.
Your insurance may reimburse you at least a portion of what you pay me (see below).
Insurance is needed to help with the cost of tests, specialist care, hospital care, etc.
If you have medical insurance and join my practice you may decide to switch from an HMO plan or a low-deductible PPO plan to a high-deductible PPO plan and use the savings in insurance premium to help pay for the practice membership fee. A high-deductible insurance plan is truly for catastrophic healthcare, as insurance was originally meant to be. Compare this to automobile insurance, which you similarly hope to never need for the car for which you pay separately as needed for routine servicing (equivalent to a preventive care visit) and for mechanical problems (equivalent to an office visit for an acute illness). By not paying an HMO to manage your healthcare dollars you instead get to decide how you want to spend (or NOT spend) your healthcare dollars.
Okay, I’ve paid you for an office visit. Do I need to submit a claim form to my insurance company in order to get reimbursed?
No! We’ll do this for you.
Do you make house calls?
Yes, when medically indicated
Are you affiliated with any hospitals?
I have medical staff privileges with UCSD Healthcare (Thornton Hospital in La Jolla and UCSD Medical Center in Hillcrest).
I have medical staff privileges at Scripps Memorial Hospital in Encinitas.
This does not mean that my patients cannot get care within the Sharp, Tri-City, or Palomar-Pomerado healthcare systems if that is where a patient chooses or is required to obtain specialist or hospital care.
Will you take care of me in the hospital?
My patients will be much better served by having the excellent hospitalists at the above-noted hospitals manage their in-patient care (I guess that makes me an officist!). I will be in frequent contact with these hospitalists so that I can have input as a member of a patient’s healthcare team, and I will visit patients in the hospital as needed.
Are you really available 24/7 to your patients?
Yes, I am on-call for myself daily and will arrange coverage by a colleague only in very limited circumstances such as illness or travel out of cell phone contact.
Aren’t you afraid that you’ll burn out by being on-call every day?
No! There are several reasons for this…
The practice has a limited number of patients.
Patients will know that they can easily reach me the next morning, so that may eliminate the need to call at night.
My medical practice is based on mutual trust and respect. I trust that my patients will know when to call 911 or to call me for a less urgent after-hours problem that can’t wait until the next morning, and if that’s the case I want my patients to feel comfortable calling me after hours. And, for those things that can wait, my patients generally respect my time when I let them know by email that I will be at an event (for example, my weekly softball game or a child’s performance) and hold off on calling me until after the conclusion of the event. In return I plan to respect my patients by providing responsive and on-time service, and I plan to earn my patients’ trust by providing the best possible medical care.
How can I learn more about this new style of medical practice?
www.simpd.org takes you to the home page for the Society for Innovative Medical Practice Design, of which I am a member. I attended the second annual meeting of this organization in Dallas in May of 2005, and my heart was warmed by the universal message from the physicians who spoke at the meeting: not only were they much happier, but their patients were also much more satisfied and happy with the care that they receive. The good vibes continued when I attended the fifth annual meeting in May of 2008. The home page contains the organization’s mission statement and tabs to information specifically aimed at patients. The “find a physician” link takes you to a list of physicians across the country who are using some sort of innovative medical practice design. Many of the physicians listed have links to their websites, which will allow you to see details of various practice models as well as the wide range of fees associated with these practices. Many of these sites note desires similar to mine of wanting to return to the “good old days” of practicing medicine before insurance companies got involved and changed things. Some invoke the name of Marcus Welby, M.D., even though he was a fictitious character.
You can also find my practice and other ideal medical practices (IMPs) listed at www.impmap.com
Where can I read more about your medical practice?
In February, 2007 the local ABC affiliate 10News included me in a story about concierge medical practices. You can view the story and read the transcript at http://www.10news.com/health/11038794/detail.html?taf=sand
In February, 2006 the local CBS affiliate News8 included me in a story about concierge medical practices. You can view the story and read the transcript at http://www.news8online.com/features/healthcast/story.php?id=37995
The October, 2005 issue of San Diego Magazine had an article about concierge medicine that discussed my medical practice. You can read it at http://www.sandiegomag.com/issues/october05/featured51005.asp
Can I meet you before deciding to join your medical practice?
Yes! You are most welcome to come in for a complimentary “meet the doctor” visit before deciding that you want to join my medical practice.
How should I notify you of my interest in your medical practice?
You can call my office at 760-436-7464.
You can send an email to me at mschulman@ucsd.edu . This email is not secure so please do not include anything in the email except name and contact information (do NOT include any medical information, credit card numbers, etc).
What other names did you consider for your medical practice?
These were considered VERY briefly:
“AMATT Family Medicine” with AMATT being an acronym for All Marty All The Time.
“Doc Around The Clock Family Medicine” (sing it Bill Haley: “one, two, three o’clock, four o’clock doc…”).
“All-In-The Family Medicine” (thank you Norman Lear)
“We-Are Family Medicine (with regards to Sister Sledge)
Who should not sign up for my medical practice
Someone who needs a physician who wears a tie…
1. Ties are uncomfortable.
2. You don’t need me to wear one to know that I’m the physician.
Someone who needs a physician who wears a white coat...
1. See above re: ties.
2. I don’t need the extra pockets!
Someone who dislikes puns… sorry, I can’t help it.
Someone who is uncomfortable with paying a practice membership fee.
If this is you please think about what you pay for cable or satellite television service, automobile club membership, shopping membership such as Costco, or health club membership regardless of how much or how little you actually use these things. If you're still concerned about this, please call me and I'll be happy to discuss this with you. I am waive the practice membership fee for the first quarter for new patients so you can try out the practice for just the cost of the office visit.
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