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Prostate Oncology Specialists--Membership now required

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Posted 12/29/2020 6:36 PM (GMT -5)
I had an interesting e-mail from Prostate Oncology Specialists today. Beginning in 2021, they are implementing an annual membership fee for all patients. The reason for the change, according to the e-mail, is the fact that much of their patient visits are now virtual and that they are reimbursed by insurance at a much lower rate for virtual appointments. "Membership" will be $250/year for existing clients and $400/year for new clients.

For my part, I've probably progressed enough at this point that I no longer need the medical horsepower of POS and could just establish a relationship with a local uro. At the same time, my care from POS (particularly Dr Lam) has been so top notch that I'm inclined to sign up.
Posted 12/29/2020 6:55 PM (GMT -5)
I could write something nasty about this development, but I won't...
Posted 12/29/2020 7:25 PM (GMT -5)
I too have a negative gut reaction to these types of things. "Membership" - makes ya feel kind of special. 😉 But, for some patients, it may be worth the extra money.
Posted 12/29/2020 7:42 PM (GMT -5)
Virtual visits, in all likelihood, will be a temporary phenomenon, IMO. I know there is a lot of talk about permanent changes in all walks of life including medicine, but i think that when you are dealing with potentially life or death situations, face to face, when possible, is an important dynamic in an important relationship.
So if thats correct, i wonder if they will drop the "membership" once they start seeing patients face to face.
Posted 12/29/2020 8:44 PM (GMT -5)
I was wondering the same thing about whether or not this change would be permanent. Usually when a business begins adding on a fee, those rarely seem to go away. But how much a medical practice fits a typical business model I'm less sure of.

I also know several people here that have done phone consults with POS (pre-pandemic) and it essentially makes those occasional consultations less practical if you have to sign up for a membership first.

What is the rationale for insurance reimbursing a smaller amount of virtual visits? I suppose there's less impact on internal resources, such as checking in, taking vitals, cleaning exam rooms, etc. But for the same reasons, it would also be less costly for the provider when it comes to virtual patient visits, so it seems like it could be a push.
Posted 12/29/2020 8:53 PM (GMT -5)
Before COVID, Medicare would not reimburse for a tele-visit, thus commercial insurance and union plans would not either. Trump administration ordered reimbursements, but not at the same rate as office visits. What the oncology group is doing should not surprise anyone. They have fixed costs to cover.

On one hand, you would think that tele-visits would be good for the provider as they could schedule many more in a day. But two of my specialists tell me that more than 30% of the scheduled tele-visits don’t take place as the patient is busy doing something else or is talking on the the phone to someone else as they are not taking the scheduled call seriously.
Posted 12/29/2020 9:24 PM (GMT -5)
Must be something other than Medicare as I have seen no significant difference in reimbursement between office and video visits on the EOB’s based on three video visits and a handful more office visits that I have had in 2020. Medicare seems to only approve around $100 or less for a visit and it does not seem to matter much what type of visit or what doctor it is.

I am taking a wild guess that it might not even be legal to bill a patient extra if one accepts Medicare reimbursements, It does not seem that you could accept Medicare then indirectly charge more for the service that Medicare reimburses. Medicare is a lot different than private insurance with its rules and regulations. Just guessing based on what I have observed after a couple of years of being on Medicare.
Posted 12/29/2020 10:07 PM (GMT -5)
Their practice they can charge what they want.
Posted 12/30/2020 5:26 AM (GMT -5)
Duck2, not true. One of the bizarre realities of the US medical system is that doctors do not set their fees, at least not really. Doctors who accept Medicare (which, I would suspect would pretty much include all Urologists because of the age of their patients), have to accept the Medicare reimbursements or lose their Medicare status altogether. No matter what the "billed amount" on regular insurance, the provider is not allowed to bill patients for the discount/allowed amount. So if your billed amount, for example, is $250, but the "allowed amount" is $100, and insurance pays 90% or $90, you owe $10, and the practice has to write off $150.

The bizarre part, according to doctors I've talked to, is that the insurers, when signing up a practice, ask for a copy of their standard fee schedule, then respond with telling them what their 'new' fee schedule is and their reimbursement schedule. Low and behold, their reimbursement schedule isn't that different from their old fees, and the new fees are what the insurer uses to trumpet their "discounts we negotiate for you" and the medical statisticians use to calculate the "cost" of US medical care....when in reality, no one really pays that amount.
Posted 12/30/2020 7:32 AM (GMT -5)
Actually Hal, many of these specialists do not enroll completely in Medicare participation and are not limited to the fee schedules. Snuffy Myers, PCA oncologist, did not and charged $1,700 for the initial examination and assessment, which was a very robust and complete examination. The patient could get Medicare/Insurance reimbursement for some of the costs, but Myers did not follow their schedules or file for reimbursement. The highest volume PCa robotic surgeon in Georgia does the same. If you want him to operate you pay his price upfront, then get partial reimbursement from the third party payors.

There are basically three levels of Medicare provider participation and the intermediate one requires that the provider do all the reporting and can get direct reimbursement but does not agree to limit their charges to the Medicare reimbursement. But then can not participate in the Medicare/insurance bonus plans. This is fairly common among the boutique specialty practices and concierge practices. The first level most providers participate in, the provider’s bill to the patient is limited to the reimbursement schedule and allows the provider to get Medicare bonuses for proper statistical reporting, practice management requirements and meeting prescribed medical outcomes. So the good ones at managing the requirements and process can get far more money from Medicare and insurance companies than your EOB indicates.

The firm mentioned states it will submit bills for reimbursement to Medicare and insurance companies, but also states that there will probably be unreimbursed fees to be paid upfront. That sounds like they take the intermediate level described above, and to Duck’s point, they can charge what they want and need to support their practice model.
Posted 12/30/2020 8:10 AM (GMT -5)
Jack, OK, I stand corrected. This "membership fee" does sound pretty bizarre to me.....it's not unlike (to me) the baggage fees that airlines now charge....

There has to be a better system. I have no idea what it would be, or how it would work. No one would consciously design the system we have.
Posted 12/30/2020 10:50 AM (GMT -5)
In the last decade many concierge medical practices have been established in the Atlanta area. Generally they charge anywhere from $150-$1,000 per month depending on the types of services provided and speciality. Think of it in the same way many businesses and some families have retainer agreements with lawyers, accountants, financial advisors, landscape and lawn services, etc. You pay a regular fee that covers a lot of services tailored to your specific situation and keeps you at the front of the line as a regular and valued customer.

Since most Medicare/commercial insurance/union plans reimburse based on a visit/consultation and procedure basis, much of the monthly costs get reimbursed when you see the provider or have a procedure like a physical exam. One that I know of has negotiated special prices with labs, pharmacies, specialists like surgeons and a hospital to keep their patient’s costs lower for these items.

These arrangements are very popular in many countries (rich and poor) that have government run medical services so that residents have healthcare choices more tailored to individual needs and means.
Posted 12/30/2020 12:34 PM (GMT -5)
Prato:
I disagree with your comment. PC is PRECISELY an ailment that will be fine with video/telephone visits.
I have been doing that since 2015 with Dr. Lam. The visit is pretty straightforward. PSA behaves, we have a continuance. PSA activates, I go back on HT and/or do a PSMA scan at Umich and probably SBRT at Umich.
Regardless, my "meeting" with Dr. Lam involves discussions and, like many of his patients, I do HT/radiation/scans at a closer location with other practitioners.
POS also charge me $150 every 6 months for deigning to look at my test results, sending me 'scripts, etc. It seems their consultations (typically $300 +/- $150) should cover that. I look at that as paying for their expertise. They are very knowledgeable in all aspects of PC.

Nevertheless, when I got their email, the word "greedy" came to mind. Their propensity to find "end-around" ways to exact more money is clever...and DISTURBING.

Me
Posted 12/30/2020 1:28 PM (GMT -5)
I mentioned upthread that I was inclined to sign up for "Membership" since I've had such a good relationship with POS over the years. But now that I've had a day to think about it, I'm not so sure. At this stage, I meet with them every nine months--we chat about SEs (I don't really have any) and they take blood for my PSA, which has been low and steady for several years now. So essentially, I'd have to pay the $250 annual membership fee (as an existing patient) just for a PSA test.

I realize that's not a lot of money, but really, why would I want to do that?
Posted 12/30/2020 4:51 PM (GMT -5)

Michael_T said...
I mentioned upthread that I was inclined to sign up for "Membership" since I've had such a good relationship with POS over the years. But now that I've had a day to think about it, I'm not so sure. At this stage, I meet with them every nine months--we chat about SEs (I don't really have any) and they take blood for my PSA, which has been low and steady for several years now. So essentially, I'd have to pay the $250 annual membership fee (as an existing patient) just for a PSA test.

I realize that's not a lot of money, but really, why would I want to do that?

I haven't been back since I finished radiation - I did visit the RO one time 9 months after I finished ART.

I do call my RALP surgeon's office a couple of weeks prior to when I want to get the uPSA script, leave a message and they send it to me. After the test results, the NP or RN in the office calls me with the results (they've been nondetectable). Then I go to Labcorp portal for my copy.

Not sure if I'd pay for membership unless you feel the visit helps you.

As an aside, my RALP surgeon runs into my wife at the hospital (she's a Nurse Case Manager there) and last time, around TG, he said I could stop by if I wanted to, no rush...
Posted 12/30/2020 6:53 PM (GMT -5)
@Compiler/Mel, you make good points. At the same time, I believe you’ve seen Dr Lam in person early on (maybe I’m wrong) so you’ve established a relationship with him.
I just think at least at the beginning, for many, establishing a relationship is important, and that is more easily done face to face. I could be totally off base, just my humble opinion.
Posted 12/30/2020 6:53 PM (GMT -5)
@Compiler/Mel, you make good points. At the same time, I believe you’ve seen Dr Lam in person early on (maybe I’m wrong) so you’ve established a relationship with him.
I just think at least at the beginning, for many, establishing a relationship is important, and that is more easily done face to face. I could be totally off base, just my humble opinion.
Posted 12/30/2020 7:36 PM (GMT -5)
Michael and CG:

Yeah, it's a tough call. On general principles, I would not re-up. But I'm willing to pay for top tier service.
It's the little things: having me take metformin and avodart based on recent research (more recent research may
nix metformin) when on HT vacation. Even being on HT vacation. My local urologist would not have a clue on ANY of these little things. Ditto for the next steps (G-68 PSMA scans).
I was dx. in 2009 with an intermediate unfavorable G 4+3. I failed surgery and SRT. Studies showed my life expectancy at that time to be 6-7 years. I am currently doing well thanks to scans and SBRTs. I owe Dr. Lam AND HW some gratitude for that. My high PSA was 17.55 before I saw Dr. Lam. My last HT vacation started on 8/1/17. Pretty dam good. My PSA has ranged from 0.21 to 0.75 since my last SBRT completed (2/5/19--PSA 7.9 just before starting SBRT).

BUT HERE'S THE TIEBREAKER:

I am not naive. My PC can change at any time. Or there could be some breakthrough with research. I want POS to let me know.

(But these price things suck)

Mel
































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Posted 12/31/2020 9:08 AM (GMT -5)
Seems like $250 a year (or even $400) isn’t a high price to pay for that kind of expertise.
And it does seem like a legitimate charge, as opposed to a money grab opportunity.
Posted 12/31/2020 9:55 AM (GMT -5)
Just another sign of the apocalypse...Jeez...the signs are there...and ya know what...we deserve every bit of it...and sadly wimp ering is one of the first signs...having said that...human beings will survive...elementary...whot ??...'So other than that...did you enjoy the play?'
Posted 12/31/2020 11:13 AM (GMT -5)
Prat:

It's not just the $250/$400. That's okay. But, as I posted earlier in this thread:

..>>>>>>>>>>>>>
POS also charge me $150 every 6 months for deigning to look at my test results, sending me 'scripts, etc. It seems their consultations (typically $300 +/- $150) should cover that. I look at that as paying for their expertise.
>>>>>>>>>>>>>>>>>>>>>>
But again, I am willing to pay for their expertise!! In fact, one other example from some years ago. I don't recall the details, but I was getting blowback from my insurance company about something. POS took care of the appeal, sending them research articles, etc. I won (maybe it was for a C11-Choline scan, the best at that time).

Mel
Posted 12/31/2020 12:13 PM (GMT -5)
I didn’t get the email or letter yet of the new fee and I was just at POS to see Dr Lam a couple of weeks ago and signed all the paperwork. I guess I have to re-read what I signed. I still see Dr Lam every 4 months so I guess I will pay the fee. Not looking to change when I have various side effect issues. Maybe they can have levels like travel cards and I can work my way up to diamond status! smile. -JR
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