In my area, there are several internists who run cash-pay practices. Only one of them refers to me, and that’s just when he can’t get them to see the Mayo Clinic folks fast enough.
I’m not a cash-only concierge neurologist for a number of reasons I’ve previously mentioned. I don’t really try to cultivate these referrals, and the concierge physicians don’t really want me to see their patients.
Why would I not be bending over backward to get more patients? I take Medicare (and other insurances), so whether you want to pay cash or not, if you’re on Medicare, I can’t accept it. It’s a crime. I can only take what Washington says I can. Maybe that law will change someday, but I doubt it.
So the patient who’s paying $3,000 per year to see Dr. Concierge down the street and cash for every visit after that isn’t financially any more special to me than the guy who’s living on a fixed income and only has Medicare. I get paid the same for both.
About a year ago, a representative from a cash-only practice came by, asking me to be the "designated neurologist" for them. In return, I’d have to agree to the following conditions:
• All patients from them would be seen within 24 hours of calling my office.
• I’d have to give my cell and home phone numbers to all of their patients, so I’d be available. ("Our patients want a lot of hand-holding" is what he said.)
• If needed, I’d meet them on weekends, either at my office or by making house calls, at the patient’s request.
There were a few other requests. I politely said, "No, thank you" and handed his "designated specialist" paperwork back to him.
My practice right now is pretty egalitarian. Uncle Sam pays me the same for your visit regardless of how much money you have or what your social standing is. I also value my privacy and home life. My patients know how to reach the doc on call in an emergency, and know it may not be me.
So, if you’re a concierge physician and don’t feel I’m going the extra mile to get your patients in at the drop of a hat, or to make sure a double-soy latte is ready for them on arrival, I’m sorry. They may be paying you a lot for these perks, but not me. The only thing I have to offer at my practice is the best patient care I can – to all equally.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.