Telemedicine and Concierge Medicine?

[+ tassojunior]

Since the pandemic my Kaiser office has been mostly empty of patients and doctors and medical care has moved online for non-essential things. I'm not a medical pro so if it makes medical care work better then fine. Today I read that concierge medicine is also soaring, which I would have though was the opposite of telemedicine. I had thought about taking a concierge plan on top of my Medicare Advantage Kaiser but not sure if that's even possible. I've come to terms with the new telemedicine and I do have a regular doctor still (who I rarely see in person anymore). And Kaiser has good urgent care facilities. But it seems concierge medicine adds an extra layer of more personal attention. Is it really that good?

https://www.medpagetoday.com/opinion/second-opinions/103352?xid=nl_secondopinion_2023-03-05&eun=g1786879d0r

 

Will Electronic Messaging Push Us Toward Concierge Medicine?

— Let's examine a possible connection between these trends

by Logan Cho March 2, 2023

[Rudynate]

For the concierge service, you won't be able to get coverage through Medicare Adavantage. You would have to discontinue your Medicare Advantage with Kaiser. 

I tried One Medical briefly - it wasn't bad - there were some impressive bells and whistles and they do things FAST.  The labs are ready in a few minutes and you sit there and discuss them with your doctor as they come up on a great big touch screen and they move the data all around like the guys on TV do with election returns.   I asked her for a letter to be excused from jury duty and they got it done the same day.   Except for the bells and whistles, I didn't think the quality of care was any better than Kaiser.   

The thing that caused me to discontinue with them was a minor thing.  I had gotten a drug prescribed by a doctor outside of Kaiser because my PC doc at Kaiser wouldn't prescribe it becasue it wasn't "medically necessary,"  and I was getting the 'scipt filled by a Canadian pharmacy for less than half of what it cost in the US. I asked the doc at One Medical to write a refill and she said she couldn't do it because she couldn't prescribe drugs in Canada, which is true.  I kept telling them that the 'script just needed to be co-signed by a Canadian doc and that the Canadian pharmacy would take care of that, but they insisted that they couldn't do it.   That would have doubled my out-of-pocket cost for that drug and I had found that I could go around my PC doc at Kaiser to get another doc at Kaiser to prescribe the drug I wanted. So that was the end of the One Medical experiment.   It was fun though - I felt like I was George Jetson going to the doctor.

I  think telemedicine is a useful adjunct to conventional practice, but it isn't a replacement.  I think a doctor has to look at you in the flesh and examine you for some things.  Last summer, my PC doc at Kaiser dx'd my autoimmune condition from a phone call and labs.  She thought that was fine.  I wan't happy with it so I asked for an in-person appointment with a rheumatologist. 

 

Edited March 5, 2023 by Rudynate
correction

[+ Charlie]

When we moved to CA almost twenty years ago, my partner and I got different primary care physicians because we had different health insurance providers. After about ten years, my partner's doctor changed to a concierge plan, because he said it was the only way he could limit his patients to a small group and still make out financially, so my partner joined the group. I was becoming more dissatisfied with my doctor, because he was often unavailable, so his staff would tell me to go to urgent care for treatment; I often went with my partner to his medical appointments anyway as he began to suffer from Alzheimer's dementia, so I also switched to his concierge doctor. The first major change I noticed was that a lot more routine treatment was included in concierge membership--automatically scheduled physicals and tests, for which I did not pay extra--and the doctor was almost always available for all sorts of minor medical problems and advice.  Given how hard it is to find personal physicians in Palm Springs these days, it seems worth it to me to be a part of his concierge practice, even though the price of membership is steep. (My partner and I both have MediCare and supplemental insurance as well.) However, as with any professional relationship, it is only worth the money if you have good personal interaction with your physician and feel you can depend upon him/her when it matters.

[+ tassojunior]

22 hours ago, Rudynate said:

For the concierge service, you won't be able to get coverage through Medicare Adavantage. You would have to discontinue your Medicare Advantage with Kaiser. 

I tried One Medical briefly - it wasn't bad - there were some impressive bells and whistles and they do things FAST.  The labs are ready in a few minutes and you sit there and discuss them with your doctor as they come up on a great big touch screen and they move the data all around like the guys on TV do with election returns.   I asked her for a letter to be excused from jury duty and they got it done the same day.   Except for the bells and whistles, I didn't think the quality of care was any better than Kaiser.   

The thing that caused me to discontinue with them was a minor thing.  I had gotten a drug prescribed by a doctor outside of Kaiser because my PC doc at Kaiser wouldn't prescribe it becasue it wasn't "medically necessary,"  and I was getting the 'scipt filled by a Canadian pharmacy for less than half of what it cost in the US. I asked the doc at One Medical to write a refill and she said she couldn't do it because she couldn't prescribe drugs in Canada, which is true.  I kept telling them that the 'script just needed to be co-signed by a Canadian doc and that the Canadian pharmacy would take care of that, but they insisted that they couldn't do it.   That would have doubled my out-of-pocket cost for that drug and I had found that I could go around my PC doc at Kaiser to get another doc at Kaiser to prescribe the drug I wanted. So that was the end of the One Medical experiment.   It was fun though - I felt like I was George Jetson going to the doctor.

I  think telemedicine is a useful adjunct to conventional practice, but it isn't a replacement.  I think a doctor has to look at you in the flesh and examine you for some things.  Last summer, my PC doc at Kaiser dx'd my autoimmune condition from a phone call and labs.  She thought that was fine.  I wan't happy with it so I asked for an in-person appointment with a rheumatologist. 

 

I've heard switching out of Advantage has some major downsides in penalty co-pays. I will say my MD has always given me paper prescriptions to fill elsewhere when I ask. Thanks. 

[+ tassojunior]

14 minutes ago, Charlie said:

When we moved to CA almost twenty years ago, my partner and I got different primary care physicians because we had different health insurance providers. After about ten years, my partner's doctor changed to a concierge plan, because he said it was the only way he could limit his patients to a small group and still make out financially, so my partner joined the group. I was becoming more dissatisfied with my doctor, because he was often unavailable, so his staff would tell me to go to urgent care for treatment; I often went with my partner to his medical appointments anyway as he began to suffer from Alzheimer's dementia, so I also switched to his concierge doctor. The first major change I noticed was that a lot more routine treatment was included in concierge membership--automatically scheduled physicals and tests, for which I did not pay extra--and the doctor was almost always available for all sorts of minor medical problems and advice.  Given how hard it is to find personal physicians in Palm Springs these days, it seems worth it to me to be a part of his concierge practice, even though the price of membership is steep. (My partner and I both have MediCare and supplemental insurance as well.) However, as with any professional relationship, it is only worth the money if you have good personal interaction with your physician and feel you can depend upon him/her when it matters.

I knew my MD before she became electronic so at least I have a face. I was getting nervous about telemed until I recently got covid and she had my meds ready in 10 minutes and sent my chart to a hematologist who recommended a new anti-clot covid regime no one else had heard of yet. I was impressed. I still have doubts about telemed for dermatology. Photos aren't the same. But an appointment takes 2 months minimum. 

 

[Rudynate]

I have a story about that.  When I first came down with this autoimmune condition,  on either side of my butt, I developed a rash that looked like a circular patch of raised red bumps. I also developed similar patches on my shoulders.  This was an obvious symptom of the autoimmune disorder.  I sent pictures to my PCP and she forwarded the pictures to a dematologist.  The dermatologist diagnosed them as folliculitis and prescribed an oral AND a topcial antibiotic.   I  thought, "So much for telemedicine" and never filled the prescriptions.  

[Rudynate]

43 minutes ago, tassojunior said:

I've heard switching out of Advantage has some major downsides in penalty co-pays. I will say my MD has always given me paper prescriptions to fill elsewhere when I ask. Thanks. 

Medicare Advantage is a fabulous deal.  I was made at Kaiser for awhile and signed up for  AARP F plan through United Healthcare.  My monthly premium was abount $100 higher and the prescription coverage didn't work at all for me - it only covered generic, didn't cover asthma inhalers, etc.  I take several branded drugs and I use 3 asthma inhalers so prescription drugs were going to cost a fortune.  

Sure, my cheap Kaiser doctor would probably have written a script that I could filled elsewhere, but I thought that Kaiser should be covering that drug.  His declining to prescribe becuase it wasnt medically necessary is like a denial of benefits.  That's the big drawback of the staff model HMO  - physicians are making decicions about coverage that are ordinarily made by an underwriter for an insurance carrier. 

[+ augustus]

On 3/5/2023 at 1:08 PM, tassojunior said:

But it seems concierge medicine adds an extra layer of more personal attention. Is it really that good?

It is actually.  The 2 main issues with concierge medicine is the price of membership fees and how many concierge doctors are in your geographic area.  Also some insurance companies won't pay for this.

[+ tassojunior]

24 minutes ago, augustus said:

It is actually.  The 2 main issues with concierge medicine is the price of membership fees and how many concierge doctors are in your geographic area.  Also some insurance companies won't pay for this.

around DC there's constantly ads for ne personal care MDs for about $100/mo. I wondered how this could piggyback other plans. 

[EZEtoGRU]

I have been generally displeased with the delivery of primary medical care in the last three states I have lived:  Florida, Texas, and now Michigan.  Long waits for appointments, long waits at the doctor's office (multiple hours in some cases), rushed appointments, incompetent support staff at the doctor's offices.  I had first heard about concierge medicine when I was living in Houston.  When I moved back to Michigan in 2016, I explored the possibility of getting a concierge doctor here.  I can afford the annual subscription fee but the problem here is that there are few concierge options.  Certainly there were none available within a 1 hour drive from where I live.  There seemed to be a good option in Ann Arbor linked to The University of Michigan Medical Center (probably the top medical facility in Michigan).  However that was over a two hour drive from where I live so didn't seem very practical.  I think that concierge medicine is an interesting option to take care of your primary care if you can find one and can afford it.

[+ tassojunior]

well, this is the reason telemedicine has taken over:

Almost Half of All Public Health Workers Left Their Jobs Over the Past 5 Years

— If trends continue, more than 100,000 workers could leave in 2025

https://www.medpagetoday.com/publichealthpolicy/publichealth/103457?xid=nl_mpt_DHE_2023-03-08&eun=g1786879d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily Headlines Evening 2023-03-08&utm_term=NL_Daily_DHE_dual-gmail-definition

[+ tassojunior]

What is this new One Medical of Amazon? It says it's primary are and the several advertising in DC at $100/month also say they are primary care. I imagine their medical costs are higher than Medicare pays?

[Guest]

On 3/6/2023 at 10:35 AM, Rudynate said:

I have a story about that.  When I first came down with this autoimmune condition,  on either side of my butt, I developed a rash that looked like a circular patch of raised red bumps. I also developed similar patches on my shoulders.  This was an obvious symptom of the autoimmune disorder.  I sent pictures to my PCP and she forwarded the pictures to a dematologist.  The dermatologist diagnosed them as folliculitis and prescribed an oral AND a topcial antibiotic.   I  thought, "So much for telemedicine" and never filled the prescriptions.  

Well, folliculitis usually resolves on its own with no treatment. If one is going to treat, either oral or topical antibiotics should be used (not both). Obviously, if a patient had folliculitis in an area impractical to reach, such as over the shoulder blades, then one would prescribe oral antibiotics, if anything. I obviously don't know what you actually had, but if you disagree with a diagnosis, it's probably wiser to get a 2nd opinion than to assume you know more about skin problems than a dermatologist. Sometimes you'll be right, others not. Sometimes the consequences aren't important (such as a usually self-limited problem), sometimes they are. 

[Rudynate]

1 hour ago, Unicorn said:

Well, folliculitis usually resolves on its own with no treatment. If one is going to treat, either oral or topical antibiotics should be used (not both). Obviously, if a patient had folliculitis in an area impractical to reach, such as over the shoulder blades, then one would prescribe oral antibiotics, if anything. I obviously don't know what you actually had, but if you disagree with a diagnosis, it's probably wiser to get a 2nd opinion than to assume you know more about skin problems than a dermatologist. Sometimes you'll be right, others not. Sometimes the consequences aren't important (such as a usually self-limited problem), sometimes they are. 

Skin problems almost always resolve on their own.  Dear Unicorn - no one can confuse an issue the way you can.  It is an enviable skill - you should go into politics.

[Guest]

41 minutes ago, Rudynate said:

Skin problems almost always resolve on their own...

I'm not sure where you got that idea, but certainly not if it's due to an autoimmune process (such as psoriasis, for example), which you said your skin condition was. 

[Rudynate]

46 minutes ago, Unicorn said:

I'm not sure where you got that idea, but certainly not if it's due to an autoimmune process (such as psoriasis, for example), which you said your skin condition was. 

I will say that the rash took a long time to go away,  but I made a judgement call and I'm still standing. 

[+ nycman]

3 hours ago, Rudynate said:

I will say that the rash took a long time to go away,  but I made a judgement call and I'm still standing. 

Because this thread needed to be more GAY!