Concierge Medicine Compared to CSFM

Because half of my goal in opening CSFM is to provide AFFORDABLE medical care, I want to take a moment to answer a question I have received several times: What makes CSFM different from concierge medicine?  Isn’t this just another get-rich-quick scheme?  I have a whole other group asking me, how can you even afford to pay rent with this model?  I find it amusing that my finances concern people so much in both directions, but as my goal is to be community supported, I think it only appropriate that I explain to my community how this works.  Today, I’ll start with explaining how we compare to concierge medicine.  Another day, I’ll explain how I’m able to make ends meet.  I also want to discuss how I define QUALITY medical care, since that is the first half of my goal.

Let’s start by talking similarities.  Obviously, there are enough of them that people are asking.  The one similarity that has caused the questions is the membership option for care.  You’ll recall that you can become a CSFM member for $30 a month ($360 a year) for the first two members of the household and $15 a month ($180 a year) for the rest of the members of the household.  Concierge practices also charge a membership fee.

Concierge practices and I are all interested in providing high-quality, personal care.  You’ll notice that I answer my own phone or it goes to my own voicemail: no receptionists, no nurses.  If you need urgent care, you can page me directly.  In my case, it is a cost-cutting measure to allow me to lower my overhead and pass on the savings to those who may not otherwise be able to afford medical care.  For concierge practices, it’s part of the “value added.”  Nonetheless, it is a similarity.  We also both provide longer appointment times.  That’s because we all enjoy taking the time to get to know our clients/patients and make sure we provide the best care possible.

I did an online search for “concierge medicine denver” and here are the first five practices that came up (they are not all in Denver, but all are along the Front Range).  I copied bits from their websites to illustrate the differences.  Concierge practices typically charge much higher membership fees, and all of those that charge lower membership fees also charge a hefty price per appointment, and a different price for different types of appointments.  They typically will not see you unless you are a member…you must belong to the club, so to speak.

1. Advanced Integrative Medicine.  ”This service is provided for a fixed annual fee of $1,500 per patient, $2,500 per couple and $250 per child (18 years and younger).”  That would be the first big difference.  Price of membership.

2. Dr. Kevin Lutz.  ”For $3,000 a year (just $250 monthly), Dr. Lutz and his staff provide comprehensive and proactive care. Your health insurance still covers prescriptions, hospitalizations, lab and radiology tests, and care from other doctors.”  That price thing again.  The assumption is that your insurance foots the bills for everything else.  As you know, one of the huge benefits in my practice is that I assume you are paying out of pocket so run your labs through my account (at a huge discount) and help you find affordable medications and imaging whenever possible.

3. Flatiron Premier Medicine.   ”Yes.  Your insurance company will be billed directly for office visits with Dr. Erik Mondrows.  If your insurance carrier/plan requires a co-pay, Dr. Erik Mondrow is required to collect it. Office visit charges, with the exception of your Annual Comprehensive Medical examination, are not included in your annual fee.”  Many concierge doctors are charging the fee just for you to belong, and they also charge for visits on top of that.  This doctor does not say how much the appointments themselves are.

4. My Family Doctor.  ”For $350 a year, patients receive: A 1-hour comprehensive annual physical exam with age and sex-appropriate screening tests (e.g. pelvic exam, breast exam, prostate exam, etc.).  Cost of pap smear pathology fees and lab fees are not included.  A discounted rate of 30% on office visits which are charged based on time spent by the physician.  E.g.  a member can expect to pay $110 for a 30 minute visit, whereas a nonmember would pay $165 for a 30 minute visit.”  This office actually lists their prices.  $110 or $165 for a 30 minutes visit are typical costs for any doctor’s office and are charged in addition to the annual fee.

5. Pinnacle Family Medicine.  ”Annual Access Fee   $360/adult $240/minor  Office Visits  •15 minutes   $85  •30 minutes $110 •45 minutes   $150  •60 minutes  $200.”  This is her silver level option.  The membership prices go up from there.  Again, there is that additional charge per visit.

I am not criticizing the concierge physicians for their decisions any more than I criticize friends for going into business or retail instead of teaching or social work.  We each have to make decisions according to our own values, and I’m sure these physicians provide excellent care; however, our goals and values are different.

The goal of my “membership” is to allow patients to budget their primary care over the course of the year and then not limit themselves to only coming in if they absolutely have to.  Most uninsured and underinsured people I know won’t see a doctor unless they absolutely must because of the cost of the appointment.  By having appointments without a separate charge for each appointment, I’m hoping everyone will come in when they feel they need to come in, instead of waiting.  I want everyone to get things (concerning skin spots, ongoing cough, blood pressure creeping up, low moods, whatever) taken care of instead of just living with them.  Some studies have shown that even a $10 copay prevents insured people from seeing their doctor.  These are people who are often already paying hundreds of dollars a month for insurance.

I also want the prices to be transparent.  Many of us have had the experience of going into a doctor’s appointment for one concern and coming out with several other issues addressed.  In a typical practice, you would be charged more because the visit was more complicated and took longer.  Me, I expect most people to have more than one concern and I plan accordingly…but don’t penalize you by raising the price for my time.

Ultimately, it comes down the goal of CSFM.  My primary goal is to provide quality, affordable primary care for families and individuals regardless of their ability to acquire insurance. Yeah, I need to pay the bills and feed my family, but I don’t need a big fancy house (I live in a little bungalow a few blocks from the practice), a new car (I’m proud of our one car and its 100K miles), or long vacations (besides, it would be hard to find someone to take care of the chickens for more than a few days).  What I do need is to find meaning in my work.  If I’m going to have to be away from my family during the day, I’d rather spend my time doing this than anything else.

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