Concierge Medicine

HOW DOES IT WORK?

Here’s how the system works for John Q. Public, a Medicare beneficiary who is 70 years old.  John signs up for the concierge medical program. Extra or discounted services John gets are as follows: 1) Preferential scheduling, often including seeing John the same day if he is acutely ill.  2) Access to my personal cell phone number to text me and have me call back, day or night, for problems.  3) Extra time and attention with extended office visits, something we have offered for years.  Dr. Van Reken will typically spend about 30 minutes on return visits for patients and an hour or more on new patients.  4) Your assurance that I will do extra reading about your problems if they are difficult or unusual to diagnose or treat.  5) Discounts if other family members join the concierge program.  5) A 6% discount on insurance noncovered services, examples might include PRP injections of his knee for arthritis and some laser therapy to get rid of spider veins on his nose.  6) Fees that were previously charged are no included in the concierge system, so these will not be charged.  These include FMLA forms, driver’s license fees, DMV forms and controlled substance fees.  7) Occasional Saturday office services (currently offered about one Saturday monthly).

So let’s walk through an example.  John comes in and gets a physical and finds out his cholesterol and blood pressure are up, and he has had a heart attack a few years back.  His physical is billed to Medicare as it is a covered service and he pays his copay.  His last doctor had him on some blood pressure pills, but his blood pressure is still not well controlled, so I add a second pill for this.  He is on a cholesterol pill as well, but it is not strong enough to lower his cholesterol as much as I would like for someone with a prior heart attack.  I increase his cholesterol medication.   2 days later, at 8 pm, he has developed a cough and thinks he needs antibiotics.  He texts me.  I call him back and after talking with him, realize it is likely his blood pressure pill change that is causing his cough as he has no fever or phlegm.  I stop his new drug, call in a replacement to his pharmacy and agree to see him in a week, when his new blood pressure pill is on board and he’s had time for the cough to slip away.  He’ll get a hold of me sooner if not improving at our phone number: 775.358.1717 or text my cell phone.

A week later John comes in and is now getting along fine with his medications.  His pressure is now controlled, and we set up labs to check his cholesterol since we recently changed his cholesterol medication.  He then asks about his wife Julie, also on Medicare.  Will we accept his wife Julie as a concierge patient?  We will.  He finds out she’ll get a 10% discount, if she also becomes a concierge patient.  She signs up and does not seem complex, but 6 months later she develops scleroderma, a rare condition.  I do some extra reading to make sure I am up on the latest for this unusual problem and order the appropriate testing and medication to get her on track.  Her problems stabilize.  She occasionally gets worsening of her breathing problems and is happy that we can provide same day appointments, saving her the extra deductible fees and the long wait of going into the ER.  It turns out she needs expensive medication and she scores some free samples when she comes in.  She has a bad knee and it turns out she can get a discounted PRP treatment for her knee arthritis, which insurance does not cover.  We do the PRP on her and she gets a long term 70% reduction in knee pain.

John and Julie pay a monthly fee for the extra access and care.  This fee does not cover copays or deductibles, but is for extra care and access.  Concierge practice allows me to routinely spend more time and get compensated for it.  The problem, of course, is money.  Neither government nor private employers wish to pay more than their current insurance rates for extra service.  This means if you wish to participate in the concierge medicine program you will personally have to pay extra.  However, for those with itemized deductions and/or health savings accounts this is typically a deductible expense.

John and Julie like the program.  Can his son Peter join?   He is a 50 year old type 2 diabetic.  The answer is yes.  However, the fees are age based, so older, patients (who are usually more complex) pay a higher subscription rate to be in the  concierge practice.  Peter, being younger, will pay less than his father John.

Why should I choose Calvin Van Reken, MD, as my provider, since there are other concierge providers in the area? Our system has benefits that very few concierge practices offer.  Dr. Van Reken was accepted into medical school  at age 19.  He went to an excellent med school (Univ. of Michigan) and trained at excellent internship and residency programs.  He is board certified in internal medicine 4 times (currently certified through 2024) and is board certified in geriatric medicine 3 times (currently certified through 2024).  He has run a senior clinic,  run a hospitalist company, been the chief of medicine at Northern Nevada Medical Center in the past and was elected to Best Doctors in America 2 years in a row.  He is bilingual, speaking good medical Spanish.  Few concierge physicians have such qualifications.  Dr. Van Reken also is exceptionally skilled at taking care of complex patients on multiple medications with problems such as diabetes, hypertension and high cholesterol.  He regularly calculates cardiovascular risk using computer models to help assess how to best treat patients at risk for cardiovascular events.  He is skilled at psychiatry, clinical medicine, orthopedic injections and even cosmetic medicine.  So, in addition to increased access to the physician you’ll get a very well trained physician with a broad scope of practice.  Most concierge members are over 50 and many have arthritis and other orthopedic problems.  Dr. Van Reken regularly offers joint, plantar fasciitis and other orthopedic injections including off label treatments such as PRP injections into joints for these problems.  These are often quite effective.

Concierge patients generally have insurance or a product such as Medicare.  What happens is as follows: you see us after enrolling and we perform services such as an office visit and an ECG, a flu shot and a joint injection.  This is billed to Medicare and/or the insurance.  Medicare or the insurance company drops this to a contracted price.  For purposes of argument we’ll assume you have 100% coverage such as Medicare plus a secondary insurance after your copay.  You have a 20.00 copay.  We collect 20.00 from you, and then bill the services performed to Medicare.  After your copay they pay us the balance owed.   We then write off the balance of any amount above the contracted price.  The next day you text Dr. Van Reken at 9 PM on his cell phone as you are failing to improve.  He calls you back immediately, changes a prescription over the phone based on your new symptoms and agrees to see you the next day.  He does some reading about your unusual problem and sees you the following day.

Hospitalized patients: Dr. Van Reken no longer practices in the hospital.  However, he is more than happy to discuss your case with your hospital or ER doctors at admission, discharge or at any other time.  Often, they are hard to get a hold of or do not wish to take the time to “hand off” the patient at discharge to us at discharge.  An office visit within a few days of hospital discharge to clarify the treatment plan is a good option.

Uninsured patients: uninsured patients are accepted into the concierge system as well, but they will pay for office visits and services separately, but at a discounted rate.  These office visits and services are not included in the concierge fee, but a prearranged discount will be available for medical services for such patients of 30% for clinical services paid the day of service.  If the service Is not paid the day performed the discount does not apply.

Additional benefits: Should you wish any cosmetic services or noncovered services such as PRP of the joints these are discounted 6%.  After 6 months of membership you will be credited $80 to use for any cosmetic or off label services or yourself or a friend or relative or you may use this credit to purchase a gift card for any services, medical or cosmetic, for your or a friend.  Examples of what you might use this for include purchase of sun screen, facial vein treatment with laser, removal of moles, or a PRP knee injection for arthritis.

Controlled substance prescriptions and fees, disability insurance fees, FMLA forms and fees, etc.: Dr. Van Reken has traditional charged his patients fees ranging from 20-75 dollars for these forms, due to the extra work required.  These fees are waived for concierge members.

Pricing for Individuals: see the chart below.  If you are a man or woman aged 50, then you fall into the 45 Plus category and your fee is $100 monthly.

Family pricing: Couples of any type, married or not, get a discount for joining together.  The oldest member of the couple pays the full fee for their age, the youngest partner in the couple pays the partner fee based on their age.  Example: Husband is 67 years old, wife is 57.  Husband pays senior rate of 133/month.  Wife pays 55 plus partner rate of 108/month

How services are billed for the first month: 1st month is prorated on the basis of a 30 day month, so in the example above if the couple started their plan on the 21^st of the month they would pay (30-21)/30 or 0.3 x the monthly fee for the first month, then the monthly fee on each 1^st of the month.   In the example above this would be 241/month ongoing and 0.3 x 241 for the first month, or 72.30.

Cancellation: You may cancel for any reason, at any time, in writing via email or letter.  We will stop billing and collecting from you at the next monthly cycle on the first for concierge services.  However, if you still owe us money such as for copays or deductibles we will continue your monthly collections as if these were concierge services until this sum is paid off.  Example: you cancel March 15^th and you owe us 20 dollars for a copay and 200 for deductibles (total of 220) and you are a 55 PLUS member.  Your concierge membership and services end the last day of March.  However, since you still owe use $220 we will continue your 120 monthly collections for 1 month, dropping your balance to 100 and then your final monthly payment for 100 will be billed on May 1.