Dr. Knope responds!

The topic of Concierge Medicine always seems to spark a significant flood of comments and questions here at The Entrepreneurial MD Blog. The latest questions came in a couple of days ago in response to my podcast interview with Dr. Steven Knope.

"Dr. Knope,

• If you "Opt out" of Medicare and do not use a Medicare number, can you still hold privileges in a hospital?
• Is the concierge physician disenfranchised from the system in any way?
• What kind of care would I need to give up if I "Opt Out?"
• How do you help your patients see a specialist who is on an insurance plan?
• Can your fee apply toward deductibles that insurance plans charge patients?"

Steve was kind enough to respond and I thought these helpful enough to share with all of you who are interested:

1)  Yes, I hold hospital privileges and I've opted out of Medicare. I still can order any test on a Medicare-aged patient.  The only thing I cannot do is bill Medicare for any of my services.

2)  There are attempts to disenfranchise concierge docs by the third parties (as you will see in a big, upcoming story that will break this week.)  However, since we run independent practices, they cannot harm us. 

3)  You don't have to give up any care if you opt out.  The only thing you are changing is your billing practices.  You bill you patient directly for your services.  Nothing else changes.

4)  If you see someone on a third-party plan, you are simply an "out-of-network" physician.  The patient again pays you for your services directly.  You can still refer your patient to a specialist.  If that specialist is on their plan, the plan pays for the specialist's visit.  If not, the patient can pay an out-of-network rate for that specialist, just as they would do in a traditional insurance plan.

5)  The fees of the concierge doctor do not apply to an insurance plan's deductible, because again, you are out-of-network.

Everything I've said above applies to the kind of practice that I operate, which is a retainer practice.  I don't bill Medicare or insurance companies for concierge patients because I'm off the grid. There are some concierge doctors who accept third-parties as partial payment of their services, typically with a lower retainer.  In this case, you can bill third-parties and/or Medicare.  For further discussion on the different forms of Concierge Medicine, see my book.

And here is one more resource that I scan daily  -- it's a listserv discussion board for physicians with Ideal Medical Practices (IMPs) who are asking and answering exactly those questions: http://health.groups.yahoo.com/group/Practiceimprovement1/
They are very active, helpful and generous with their resources!