Guest guest Posted November 12, 2006 Report Share Posted November 12, 2006 , There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so. Besides, if they are each making that much money, they can easily pay for a good lawyer. Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2006 Report Share Posted November 12, 2006 : I must just not be greedy. I would do it for $1/day. I am interested at what everyone collects per patient per year on average or the total RVU's generated by list members. Perhaps a survey? I learned recently that the average full time internist works 60 per week, generates 500,000 in revenue and 193,000 in both perks and salary. There needs to be a happy medium, but I have not found it yet. " Brady, MD" wrote: , There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so. Besides, if they are each making that much money, they can easily pay for a good lawyer. -----Original Message-----From: [mailto: ] On Behalf Of EglySent: Saturday, November 11, 2006 8:17 PMTo: Subject: RE: Re: curve ball & Annie: I too am considering an annual fee. Patients would have a choice of my care or others. The critical qwuestion is what is legal and what value would the fee purchase? Wilterding <james.wilterdinggmail> wrote: Annie, I suspect that you may be underestimating the value your patients place on the care that you provide, or else quality primary care must be much more accessible there than here. I’ve been thinking seriously about a “modest annual fee” myself, and I don’t think that I would lose more than 20% of my practice due to it and the ones who would stay would be the ones who truly value the access and care that I provide, and understand that it is very rare in this environment. I would be able to quickly fill the slots left open. Regards, M. Wilterding, M.D.711 Encino Pl. NE; Suite D Albuquerque, NM 87102 Fax: From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, November 08, 2006 6:17 PMTo: Subject: RE: Re: curve ball Who pays your “modest annual fee”? I have 815 active charts and I’m pretty sure 100% of them would leave in a huff if I asked for even $20. Do you take Medicare? Can you charge them any such fees? Annie -----Original Message-----From: [mailto: ] On Behalf Of Ira WarshawSent: Tuesday, November 07, 2006 10:59 PMTo: Subject: Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal "Snow Birds" in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing "boutique" practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FLadam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if "you" could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000 --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 --No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2006 Report Share Posted November 12, 2006 : I must just not be greedy. I would do it for $1/day. I am interested at what everyone collects per patient per year on average or the total RVU's generated by list members. Perhaps a survey? I learned recently that the average full time internist works 60 per week, generates 500,000 in revenue and 193,000 in both perks and salary. There needs to be a happy medium, but I have not found it yet. " Brady, MD" wrote: , There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so. Besides, if they are each making that much money, they can easily pay for a good lawyer. -----Original Message-----From: [mailto: ] On Behalf Of EglySent: Saturday, November 11, 2006 8:17 PMTo: Subject: RE: Re: curve ball & Annie: I too am considering an annual fee. Patients would have a choice of my care or others. The critical qwuestion is what is legal and what value would the fee purchase? Wilterding <james.wilterdinggmail> wrote: Annie, I suspect that you may be underestimating the value your patients place on the care that you provide, or else quality primary care must be much more accessible there than here. I’ve been thinking seriously about a “modest annual fee” myself, and I don’t think that I would lose more than 20% of my practice due to it and the ones who would stay would be the ones who truly value the access and care that I provide, and understand that it is very rare in this environment. I would be able to quickly fill the slots left open. Regards, M. Wilterding, M.D.711 Encino Pl. NE; Suite D Albuquerque, NM 87102 Fax: From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, November 08, 2006 6:17 PMTo: Subject: RE: Re: curve ball Who pays your “modest annual fee”? I have 815 active charts and I’m pretty sure 100% of them would leave in a huff if I asked for even $20. Do you take Medicare? Can you charge them any such fees? Annie -----Original Message-----From: [mailto: ] On Behalf Of Ira WarshawSent: Tuesday, November 07, 2006 10:59 PMTo: Subject: Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal "Snow Birds" in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing "boutique" practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FLadam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if "you" could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000 --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 --No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 And ‘takes home’ $193K? A survey would be cool..I am curious too. I know I get $91 per encounter on average, but have never looked at the frequent fliers versus the rarely seen..I bet it would be an interesting comparison. Which group will I want to ditch? (Not that I actually would ditch them…just dream) I may not be greedy, but I have concluded that I must be allergic to money,,,I certainly avoid it as if I am allergic. Annie Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 And ‘takes home’ $193K? A survey would be cool..I am curious too. I know I get $91 per encounter on average, but have never looked at the frequent fliers versus the rarely seen..I bet it would be an interesting comparison. Which group will I want to ditch? (Not that I actually would ditch them…just dream) I may not be greedy, but I have concluded that I must be allergic to money,,,I certainly avoid it as if I am allergic. Annie Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 That's not take home - it's gross salary and perks, usually calculated at 30% above gross salary, if I remember it right. It includes the insurance, malpractice, etc, plus the employer's portion of all employment taxes, such as their portion of social security.And ‘takes home’ $193K? A survey would be cool..I am curious too. I know I get $91 per encounter on average, but have never looked at the frequent fliers versus the rarely seen..I bet it would be an interesting comparison. Which group will I want to ditch? (Not that I actually would ditch them…just dream) I may not be greedy, but I have concluded that I must be allergic to money,,,I certainly avoid it as if I am allergic.Annie -----Original Message-----From: [mailto: ] On Behalf Of EglySent: Sunday, November 12, 2006 6:20 PMTo: Subject: RE: Re: alt financing : I must just not be greedy. I would do it for $1/day. I am interested at what everyone collects per patient per year on average or the total RVU's generated by list members. Perhaps a survey? I learned recently that the average full time internist works 60 per week, generates 500,000 in revenue and 193,000 in both perks and salary. There needs to be a happy medium, but I have not found it yet. " Brady, MD" <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote:,There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so.Besides, if they are each making that much money, they can easily pay for a good lawyer.-----Original Message-----From: [mailto: ] On Behalf Of EglySent: Saturday, November 11, 2006 8:17 PMTo: Subject: RE: Re: curve ball & Annie:I too am considering an annual fee. Patients would have a choice of my care or others. The critical qwuestion is what is legal and what value would the fee purchase? Wilterding <james.wilterdinggmail> wrote:Annie,I suspect that you may be underestimating the value your patients place on the care that you provide, or else quality primary care must be much more accessible there than here. I’ve been thinking seriously about a “modest annual fee” myself, and I don’t think that I would lose more than 20% of my practice due to it and the ones who would stay would be the ones who truly value the access and care that I provide, and understand that it is very rare in this environment. I would be able to quickly fill the slots left open.Regards, M. Wilterding, M.D.711 Encino Pl. NE; Suite D Albuquerque, NM 87102 Fax: From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, November 08, 2006 6:17 PMTo: Subject: RE: Re: curve ballWho pays your “modest annual fee”? I have 815 active charts and I’m pretty sure 100% of them would leave in a huff if I asked for even $20. Do you take Medicare? Can you charge them any such fees?Annie-----Original Message-----From: [mailto: ] On Behalf Of Ira WarshawSent: Tuesday, November 07, 2006 10:59 PMTo: Subject: Re: Re: curve ballAgain, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal "Snow Birds" inNorth Palm Beach).I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices.I have friends doing "boutique" practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year.Ira WarshawNorth Palm Beach, FLadam schwarz <adamschwrz> wrote:Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if "you" could say :a. ave number of calls a week 'after hours'b. do you have some routine call coverage? yes/no - if yes detailsI open 5/2/07 - thanks to your wisdom I'm drying off my wings!Adam Schwarz MDHanoverContinuityClinicHanover NHIra G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000--No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006--No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 That's not take home - it's gross salary and perks, usually calculated at 30% above gross salary, if I remember it right. It includes the insurance, malpractice, etc, plus the employer's portion of all employment taxes, such as their portion of social security.And ‘takes home’ $193K? A survey would be cool..I am curious too. I know I get $91 per encounter on average, but have never looked at the frequent fliers versus the rarely seen..I bet it would be an interesting comparison. Which group will I want to ditch? (Not that I actually would ditch them…just dream) I may not be greedy, but I have concluded that I must be allergic to money,,,I certainly avoid it as if I am allergic.Annie -----Original Message-----From: [mailto: ] On Behalf Of EglySent: Sunday, November 12, 2006 6:20 PMTo: Subject: RE: Re: alt financing : I must just not be greedy. I would do it for $1/day. I am interested at what everyone collects per patient per year on average or the total RVU's generated by list members. Perhaps a survey? I learned recently that the average full time internist works 60 per week, generates 500,000 in revenue and 193,000 in both perks and salary. There needs to be a happy medium, but I have not found it yet. " Brady, MD" <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote:,There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so.Besides, if they are each making that much money, they can easily pay for a good lawyer.-----Original Message-----From: [mailto: ] On Behalf Of EglySent: Saturday, November 11, 2006 8:17 PMTo: Subject: RE: Re: curve ball & Annie:I too am considering an annual fee. Patients would have a choice of my care or others. The critical qwuestion is what is legal and what value would the fee purchase? Wilterding <james.wilterdinggmail> wrote:Annie,I suspect that you may be underestimating the value your patients place on the care that you provide, or else quality primary care must be much more accessible there than here. I’ve been thinking seriously about a “modest annual fee” myself, and I don’t think that I would lose more than 20% of my practice due to it and the ones who would stay would be the ones who truly value the access and care that I provide, and understand that it is very rare in this environment. I would be able to quickly fill the slots left open.Regards, M. Wilterding, M.D.711 Encino Pl. NE; Suite D Albuquerque, NM 87102 Fax: From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, November 08, 2006 6:17 PMTo: Subject: RE: Re: curve ballWho pays your “modest annual fee”? I have 815 active charts and I’m pretty sure 100% of them would leave in a huff if I asked for even $20. Do you take Medicare? Can you charge them any such fees?Annie-----Original Message-----From: [mailto: ] On Behalf Of Ira WarshawSent: Tuesday, November 07, 2006 10:59 PMTo: Subject: Re: Re: curve ballAgain, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal "Snow Birds" inNorth Palm Beach).I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices.I have friends doing "boutique" practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year.Ira WarshawNorth Palm Beach, FLadam schwarz <adamschwrz> wrote:Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if "you" could say :a. ave number of calls a week 'after hours'b. do you have some routine call coverage? yes/no - if yes detailsI open 5/2/07 - thanks to your wisdom I'm drying off my wings!Adam Schwarz MDHanoverContinuityClinicHanover NHIra G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000--No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006--No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 My understanding of the legality of the an annual (or monthly or daily) fee is that you need to decide if it is for medical or non-medical services. If it is for medical services, you would need to opt out of Medicare and carefully check other insurance contracts (particularly HMO's). (You cannot charge your Medicare patients a required additional fee. Now, if it was optional, I guess this may work.) If it is for non-medical services, it is allowed under Medicare. Often these non medical services includes same day appointments for non-urgent as well as urgent problems, 24 hour cell phone access to your own doctor, phone & e-mail consultations, more patient friendly office, etc. However, if your fee is for non-medical services, patients cannot use money from Health Care Reimbursement Accounts or Health Savings Accounts to save taxes on that money. These types of tax saving accounts are growing rapidly. Medical services can be paid for from these accounts, which may make the fee more palatable. Some of us are trying to use these fees for certain patients in order to be able to provide better care for them (by being able to maintain a lower patient panel) and for those that cannot afford it (by waiving the fee for lower income patients). What an interesting patchwork we are creating to make this health care system function. Sharon (At 03:20 PM 11/12/2006, you wrote: : I must just not be greedy. I would do it for $1/day. I am interested at what everyone collects per patient per year on average or the total RVU's generated by list members. Perhaps a survey? I learned recently that the average full time internist works 60 per week, generates 500,000 in revenue and 193,000 in both perks and salary. There needs to be a happy medium, but I have not found it yet. " Brady, MD " wrote: , There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so. Besides, if they are each making that much money, they can easily pay for a good lawyer. Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Everyone is raving about the all-new Yahoo! Mail beta. No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.0.409 / Virus Database: 268.14.3/530 - Release Date: 11/11/2006 Sharon McCoy , M.D. Renaissance Family Medicine The Rebirth of Personal Healthcare www.SharonMD.com Phone Fax (949) 281-2197 No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.0.409 / Virus Database: 268.14.3/530 - Release Date: 11/11/2006 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 No way, can not be legal. I guarantee you those docs are in violation of their contracts with insurance companies. These contracts all explicity state that you will accept their fee schedule as payment in full for any & all professional services provided. These docs may interpret it as “going above & beyond” but the insurances will just say all of that nice stuff they do is bundled into the contracted fees they are paid. I’m no attorney but I would be very surprised if that is not a violation of their contracts. Now, that may or may not open them up to legal charges but certainly could get them dropped from all insurance plans. Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " in North Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Apparently they don't think this is illegal. This is from MDVIP's FAQ, a company that offers "franchises" for concierge practices to physicians, and charges patients $1800/year on top of insurance: http://www.mdvip.com/NewCorpWebSite/Patients/PatientFrequentlyAskedQuestions.aspxHow does my insurance work in an MDVIP affiliated practice? Most PPO, POS and HMO health insurance plans are fully compatible with your membership in an MDVIP affiliated practice. We will be happy to discuss your specific health plan with you. Your annual fee is for preventive care services that are not covered by insurance. You will still need health insurance to cover all other healthcare visits unrelated to your comprehensive annual preventive care examination, including office visits hospital stays and visits to specialists. Is Medicare accepted? Yes. MDVIP affiliated practices are entirely compatible with Medicare. SetoSouth Pasadena, CANo way, can not be legal. I guarantee you those docs are in violation of their contracts with insurance companies. These contracts all explicity state that you will accept their fee schedule as payment in full for any & all professional services provided. These docs may interpret it as “going above & beyond” but the insurances will just say all of that nice stuff they do is bundled into the contracted fees they are paid. I’m no attorney but I would be very surprised if that is not a violation of their contracts. Now, that may or may not open them up to legal charges but certainly could get them dropped from all insurance plans. -----Original Message-----From: [mailto: ] On Behalf Of Brady, MDSent: Sunday, November 12, 2006 1:38 PMTo: Subject: RE: Re: alt financing ,There were 3 docs in burg who opened up a boutique practice charging a fee of $1800/year/person or $3000/year/couple. As far as I know they have done well, but what is interesting is that they still bill insurances!! Their argument is that it is legal as they are offering much more than what they are required to do by insurances. For instance, they offer a yearly physical with CXR, EKG, and a complete panel of blood work (of course most of this is generally not recommended testing) along with a consultation with their nutritionist to discuss nutrition and even an appointment with a trainer to talk about an exercise program. Their patients also get 24 hour access to the doctor and same day appointments in the office. Given the “executive” physical and the high quality access is not technically required by the insurance companies, it is fair game to bill for extra. So, the doc gets rich (think over a million a year) to cover 600 patients, and the rich patients feel like they are getting the best care they can get. Ethical…probably not, Legal…probably so.Besides, if they are each making that much money, they can easily pay for a good lawyer. -----Original Message-----From: [mailto: ] On Behalf Of EglySent: Saturday, November 11, 2006 8:17 PMTo: Subject: RE: Re: curve ball & Annie: I too am considering an annual fee. Patients would have a choice of my care or others. The critical qwuestion is what is legal and what value would the fee purchase? Wilterding <james.wilterdinggmail> wrote:Annie,I suspect that you may be underestimating the value your patients place on the care that you provide, or else quality primary care must be much more accessible there than here. I’ve been thinking seriously about a “modest annual fee” myself, and I don’t think that I would lose more than 20% of my practice due to it and the ones who would stay would be the ones who truly value the access and care that I provide, and understand that it is very rare in this environment. I would be able to quickly fill the slots left open.Regards, M. Wilterding, M.D.711 Encino Pl. NE; Suite D Albuquerque, NM 87102 Fax: From: [mailto: ] On Behalf Of Annie SkaggsSent: Wednesday, November 08, 2006 6:17 PMTo: Subject: RE: Re: curve ballWho pays your “modest annual fee”? I have 815 active charts and I’m pretty sure 100% of them would leave in a huff if I asked for even $20. Do you take Medicare? Can you charge them any such fees?Annie-----Original Message-----From: [mailto: ] On Behalf Of Ira WarshawSent: Tuesday, November 07, 2006 10:59 PMTo: Subject: Re: Re: curve ballAgain, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal "Snow Birds" inNorth Palm Beach).I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices.I have friends doing "boutique" practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year.Ira WarshawNorth Palm Beach, FLadam schwarz <adamschwrz> wrote:Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if "you" could say :a. ave number of calls a week 'after hours'b. do you have some routine call coverage? yes/no - if yes detailsI open 5/2/07 - thanks to your wisdom I'm drying off my wings!Adam Schwarz MDHanoverContinuityClinicHanover NHIra G. Warshaw, M.D.1216 U.S. Highway #1North Palm Beach, FL 33408(561)626-1000 --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 --No virus found in this outgoing message.Checked by AVG Free Edition.Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 If they were truly just charging the annual fee solely for coverage of “preventive care services that are not covered by insurance” then I suppose it would be allowed, but I highly doubt that is how the fee is applied in reality. They are charging the extra fee for the higher level of service (direct access, etc) & those nice things are technically bundled into the fees you receive from insurance companies. You are technically required to be available 24/7, etc if you sign their contracts. Also, what about patients that do have insurance coverage for preventive services (the majority do) that are being charged the extra fee? My guess is the MDVIP style practices are all non-participating with all payors & that is how they can get away with charging the fee (ie, they have not signed any insurance contracts). The FAQ’s listed below do not say that the MDVIP practice ACCEPTS Medicare & other insurances, it just says they are COMPATIBLE with it. I think therein lies “the catch.” Re: Re: curve ball Again, I rise from the shadows, as an admirer of IMP, but living in the 180 degree universe. I have a PA, 2 MA's and 3 from office staff, and probably >3,000 patients (hard to know with so many seasonal " Snow Birds " inNorth Palm Beach). I rotate call by the week with my PA (he's been a PA for >25 yrs), and I back him up on his call week. I get at most 1 call during the week, and maybe 2 on the weekend (a UTI or similar). The call is far less than when I shared coverage with other practices. I have friends doing " boutique " practices, with about the same # of calls as I receive. I charge a modest annual fee of $175/year. Ira Warshaw North Palm Beach, FL adam schwarz <adamschwrz> wrote: Many non imp collieges ask me about dealing with 24x7 call; I'm wondering if " you " could say : a. ave number of calls a week 'after hours' b. do you have some routine call coverage? yes/no - if yes details I open 5/2/07 - thanks to your wisdom I'm drying off my wings! Adam Schwarz MD HanoverContinuityClinic Hanover NH Ira G. Warshaw, M.D. 1216 U.S. Highway #1 North Palm Beach, FL 33408 (561)626-1000 -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.0/524 - Release Date: 11/8/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.2/528 - Release Date: 11/10/2006 Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
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