Our New York City adventure is going very well. My daughter was blase about the Egyptian wing of the Met excluding the awesome temple where she wanted to go swimming in the reflecting pool, but she absolutely loved the Greek section and tolerated my poking around in the Byzantine area. She hailed her first taxi-cab and danced on the BIG piano at FAO Schwartz before we all headed back to Brooklyn to eat at a great little taqueria finished off with artisan made ice cream. Also, four out of the six subways we’ve ridden featured both my daughter swinging wildly on the center aisle pole and ads for a flat fee/direct PCP service/concierge medicine provider advertising healthcare for $49 per month.
How does that work? And is it a good idea?
The provider is AMG Medical Group and their pricing/plan descriptions are here. The basic plan design is that a direct PCP service provider charges a flat monthly fee to people who want to join a practice and then the practice provides unlimited basic care. The practice will take care of the daycare crud complaints, they’ll take care of basic disease management, they take care of sprains, they take of all the little things. They can’t take care of any of the big problems. This means they don’t reset bones, they don’t handle pregnancies, they don’t remove gallbladders, they don’t take care of you or your costs after you get hit by a bus. It is very limited care.
The direct part of the model is that it is a cash basis transaction. The practice does not take any insurance.
What this is not is a qualified health plan under PPACA regulation. Someone who belongs to a direct care practice will still need health insurance or pay the mandate penalty.
Now is this a good idea?
Well, it depends.
If a direct practice PCP service is wrapped into a qualified health plan, it is not a bad idea, especially if it is used to divert people from emergency rooms to either urgent care centers or primary care provider office visits. That will reduce net individual and net social costs.
There are a couple of other scenarios where these types of services can make a lot of sense. The first scenario is for someone who does not qualify for cost-sharing assistance Silver plans and has a chronic condition that requires fairly frequent office visits and low level lab testing. Buying a direct service contract to cover unlimited PCP visits for $600 to $1,200 a year could lead to much lower net spending on deductibles than having to allocate all PCP maintenance visits to the deductible. The other scenario where such a service makes a lot of sense to me is for people who are not qualified for subsidies on the Exchanges (perhaps due to immigration status) and want some type of routine coverage and care.
That last scenario is an unwrapped scenario where the direct service provider is the only paid provider. That is the only scenario where it is a decent idea. Any other situation where a person can get access to a qualified health plan or Medicaid but elects to choose a direct service primary care provider as a standalone instead of as an addition, is not a wise idea. The fees for these services are so low because primary care services are very cheap to provide compared to anything else in this country. Most primary care can be provided by non-MD/non-DO level trained people, and it does not require a large capital investment in equipment.
The model for primary care is to take care of the basics and then ship people to specialist for anything odd, weird or expensive. The advertised benefit structure embraces that PCP model where anything expensive is not covered. If I was to blow out my knee while walking to the really tasty doughnut shop three blocks from my brother’s apartment, I would be uncovered. If my sister in law announced that she was pregnant this afternoon, she would be uncovered for pre-natal care as well as labor and delivery. If anything that requires an emergency room visit or an inpatient admission happens, we would be uncovered.
It is very limited coverage that as a standalone it is grossly inadequate as it does not cover the vast majority of the medical expense curve. It is better than nothing, but it is not good health coverage.
gene108
Glad you are having a good time in NYC. Glad you and your daughter made it through the Met. I find trying to go through the whole thing in a day can be exhausting.
richard mayhew
@gene108: We did not even try to do the entire Met — just the first floor Egyptian and Greek rooms with the Byzantine room as an incidental gain due to how we were walking between the wings. Doing the Met is like doing the Louvre, to do it right, you need a week and no kids.
Mike E
tl;dr except for the first part about riding the subways with the daughter…I have pics of Miss E doing same in the big city, nothing but smiles :-)
The Ancient Randonneur
Bernie Sanders will in ABC’s Sunday morning show. Should be interesting, with an apologetic liberal on.
Baud
@The Ancient Randonneur:
Unapologetic?
GHayduke (formerly lojasmo)
I think probably so for a person with multiple medical problems and a high deductible plan. These PPC will be able to write prescriptions and primarily manage problems like hypertension, diabetes, hyperlipidemia and the like.
gogol's wife
@richard mayhew:
I’ve been to the Met probably a hundred times, but I don’t think I’ve ever seen anything other than the European floor.
heckblazer
It says something that when I first read “direct PCP service”, my thought was angel dust delivered straight to your door.
Gypsy Howell
@heckblazer:
Well, he IS in Brooklyn, so….
Michael Bersin
The republican controlled Missouri General Assembly is all hot and bothered about approving voter ID legislation because, you know, “vote fraud”. Meanwhile, the irony at an annual republican party gathering completely escapes them.
HinTN
@richard mayhew: Do you still have time to do the Hayden Planetarium? The size relationship exhibit is extraordinary and can be fun for little ones.
Richard mayhew
@heckblazer: you guys think my life is way more exciting than it is
Richard mayhew
@HinTN: probably not this time
debbie
@gene108:
When I was unemployed and looking for work in NYC, I took a day each week to go through a single section of the Met, including the back-room storage areas. This was one of the smartest things I did in all the years I lived there.
Wag
Let’s look at this from the provider’s side
A typical Internist has a panel of 1200 patients. At $50 pmpm that equal $720000 gross. Out of that would come all overhead as well as all lab charges, so testing include a lot of point of care testing (Hemoglobin A1c testing, perhaps cholesterol testing) as well as pretty limited lab performed testing at a single contracted lab
Add to that practice overhead that can run 40%, and provider probably comes out ahead as well.
Interesting model.
jo6pac
If you live in Calif. or AZ here’s a supplemental plan you can join. My Dr. pushes the hell out of this even if it is a hmo.
https://legacy.scanhealthplan.com/
Sound like a good time was had by all in NYC
lonesomerobot
I learned about PCP on an episode of BJ and the Bear. They call it Angel Dust on the streets.
SarahT
@Richard mayhew: Since you’re in Brooklyn, try the NYC Transit Museum – great for kids & grown-ups alike.
PurpleGirl
Glad to hear that so far the trip to NYC has been good. I was concerned about the weather would be like and if it would cause you and your daughter problems.
While I mostly like the current Egyptian rooms, I remember the old exhibit and miss the sarcophagus room — it was dark, had statutes around the walls and the sarcophagus was in the center with a mummy inside it. It was covered in glass and you could go right up to it and look inside at the mummy. It was sort of scary and as a kid I loved it.
Richard mayhew
@Wag: throw in a high proportion of CRNPs or PAs to MD/DO the business case is persuasive
jo6pac
@jo6pac:
Forgot to add this plan is for Medi-Care only
Nicole
@SarahT:
I second that. It’s a fun museum. Only took me 20 years of living in the city to get around to it.
Next time you’re in the city and have the time you should head out to Queens for the Museum of the Moving Image, which is eighteen kinds of awesome.
SarahT
@Nicole: Yes ! It sure is.
Jim
I continue to be enthusiastic about the emergi-care clinics that are opening all around. The ones in the drugstores and big box stores take care of a host of minor illnesses and injuries. The free-standing ones offer more in the way of diagnostic equipment like x-rays, and an on-site physician. That makes for shorter lines at the hospital emergency rooms for the life-threatening stuff. The main problem is that the new facilities have difficulty getting enough staff. Until the nursing schools and universities start pumping out more NPs and PAs, there will be growing pains. But I’m optimistic for the long term.
Frankensteinbeck
@Michael Bersin:
Why do you think it’s so easy for them to believe liberals do it?
rikyrah
thanks for the information
Damned at Random
I live in a town of 3000-4000 which lost its only MD 2 years ago. We recently got a flat fee service like the one mentioned – it charges $59 for month and has a doctor (he may be an osteopath) and a couple of nurse practioners. We are 40 miles from the nearest hospital and have a mostly Medical and Medicare population. This has been a godsend for our area, though the services provided are limited – no X-ray, all labs sent out. Did I mention that the only pharmacy in town is closed on weekends?
I really hope this model works out for underserved populations like ours.
MaxMary
The other question here is how easy is it to get an appointment, be able to drop in for something like a cold/fever? I know people who would get that in addition to their regular insurance if it meant scheduling convenience.