Articles Cost & Spending Healthcare

A Cash-Based Concierge Medical Practice

A traditional medical practice hires physicians to see a large volume of patients and bills the insurance company for tests and procedures to establish a solid bottom line. A concierge medical malpractice charges the patient directly for their bottom line and can instead have the physicians focus on high-quality care with the patient.

Why the Elitism?

Our current healthcare system can do a great job in the case of an emergency. But the stats show that it underperforms quite a bit when it comes to disease prevention and a good patient experience. Neither patient nor doctor seems terribly satisfied in the current system.

The question isn’t if a concierge medical practice is elitist but whether mainstream medical practices are even adequate to meet the healthcare needs of those passionate about their health.

I need at least 30 minutes per patient as a physician to get a good history. I need another 20 minutes to document the visit and another 20 – 30 minutes to do clinical research on the topic to fill any knowledge gaps. No insurance company will reimburse me for 1-hour long appointments.

Patient-Centric Care

At Digital Nomad Health most of my patients have high health literacy and rather in tune with their bodies. They are looking for a physician willing to do the legwork of clinical research and available to them when they need him.

A traditional urgent care will see the patient for one complaint, treat them, and street them. That’s fine for an urgent care visit, but most patients need education, empowerment, prevention, empathy, and extensive follow-up.

A patient-centric model starts with a system that is sustainable for patient and doctor. The doctor knows their overhead and charges that fee to the patient upfront. Some concierge practices will then bill the insurance for office visit reimbursement while others only deal in cash – no third party payers.

Cash-Based Concierge Practices

When I designed DNH, I started out with how much income I needed from my medical practice to make it worth the time and effort to run it. What were patients after, and what did they value most?

Patients wanted to get to know their doctor and be seen in a timely fashion. An appointment 1.5 weeks out just wasn’t going to cut it. Same day appointments were crucial along with ongoing asynchronous communication.

My concierge medical practice patients want someone who can go beyond the basics. Everyone in my practice already knows the harm of ultra-processed foods and appreciates the importance of exercise and stress management. But they needed advice, support, and help to execute a proper health plan.

In a cash-based concierge practice, I charge my patients a monthly fee to be part of the practice. This ensures that I don’t enroll more patients than I need, which guarantees my patients timely access.

If they have health insurance coverage, they can submit my visit, imaging, or lab tests to their insurance for reimbursement. But I have chosen not to contract with any insurance company, so I can’t bill on their behalf. This ensures that remain fiduciary to the patient and not the insurance companies.

Is a Concierge Medical Practice Better?

Whether concierge medical care is better than mainstream medical care depends on the patient and the doctor. Just because someone is paying their concierge doctor $500 – 10,000 a month doesn’t guarantee a better outcome.

The tenets of good medical care are:

  • individualized care instead of algorithmic care
  • respecting individual patient values
  • exploring the patient’s health preferences
  • demonstrating kindness, empathy, and compassion
  • excellent communication, which includes listening
  • mastery, not just competence in clinical medicine
  • collaboration with specialists and the patient’s family
  • confidentiality
  • cultural sensitivity
  • timely access
  • commitment to prevention
  • empower and not infantilize

Can you reach your doctor whenever you need to?

Do they lecture you or listen and support you?

Are they able to stand up to you and tell you something you need to hear?

Can they help you think through complex medical decisions?

Can they help you look around the clinical corner to prevent common chronic diseases?

Can they meet you where you are instead of talking down to you from the pulpit?

Do you feel they are a good friend and support?

Justifying the Cost of Concierge Care

As we like to say, you either have to pay your money to the farmer and gym or the doctor and hospital. For most reading this article, the choice is simple. But how much is a concierge doctor worth?

What’s your net worth/income?
What is the value of an extra healthy life-year in the next 10, 20, 30, and 50 years?
How much can you earn per healthy life year?
How important is health to you?
How do you define health for yourself?
How averse are you to having a stent in your heart?
How averse are you to chemo/radiation?
How much free time do you have to research health-related topics?
How likely are you to heed your doctor’s advice?

At $500 per month you’d spend less $180K in 30 years, which is the amount you would spend for an ICU stay after a major heart attack or stroke.

At $5,000 a month you’d spend $600K in a decade which could mean an extra 3 decades of healthy living.

If the purpose of health insurance is to safeguard you from a potential financial disaster related to your health, then the payments you make for concierge services should be higher than what you pay for insurance premiums. This is because insurance only covers the minimum level of treatment for a disease, and even then, there is a risk of the insurance company denying coverage.

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