Concierge Health Options

Wednesday, February 28, 2018

Trying to understand the United States’ current managed health care system can be a bit like deciphering alphabet soup: DRG, EOB, HMO, PPO, HDHP, HSA.* How did it get so complicated?

Athena du Pre explains in her text “Communicating About Health” that in the early 1980s, the U.S. government and insurance companies began establishing flat-rate reimbursement amounts for inpatient hospital procedures. Over time, this shifted the model away from conventional fee-for-service insurance to managed-care organizations, which coordinate the cost and delivery of health services. Ninety-nine percent of U.S. residents with employer-sponsored health plans now have plans classified as managed care. While the goal of managed care was originally to make health care more standardized, efficient and affordable, many patients today find it to be anything but those things.

Physicians typically are not happy with the structure, either.

A 2014 Time magazine article described how some primary care physicians, fed up with seeing patients every 11 minutes and having their performance assessed by how many MRIs they order, decided to start practices that didn’t take insurance. Instead, they attracted wealthy clients who would pay a five-figure annual fee to have immediate access to doctors, be able to schedule appointments on short notice and never have to flip through a wilted magazine in a waiting room.

These upscale practices became known as concierge medicine. However, other health care providers have realized the benefits of this model can be reaped by people other than the rich.

One local practice, EBO MD, is providing concierge medicine for the common man, or as EBO MD states on its website, “putting common sense back into healthcare.”

“EBO MD’s aim is to offer primary care affordable to everyone, as well as reduce out-of-pocket costs,” says Tony Thompson, CEO of EBO MD in Cape Girardeau. “Our membership offers amazing service and the personal attention you don’t get from many other places.”

For a monthly fee of $79/adult, $10/child and $125/nursing home resident, members have full access to primary care with no limits on visits. They also have 24/7 access to a provider, via telemedicine. The practice includes the most common in-office labs and diagnostic testing as part of the monthly fee and has discounted rates on other labs, as well as prescriptions.

EBO MD has its own physicians and nurse practitioners at its offices in Cape Girardeau and Jackson. Medicare and other private insurances do not cover the practice’s monthly membership fees, and they are up front about the necessity of maintaining insurance to cover the cost of some labs, radiology studies, specialty care and hospitalizations. However, EBO MD points out that, with unlimited access to primary care covered by your monthly membership, combined with a high deductible plan and low monthly premiums, you should save money, provided you do not have a hospitalization or catastrophic event.

“If you look at where we’re at now with the average cost of healthcare, you may have to travel up to one hundred miles or more to find more affordable options for both employers and families,” says Thompson. “The current system is not sustainable for either. We know this is absolutely making a difference in our community and in our region.”

EBO MD has gone a step further to solidify relationships with many local independent specialists for their patients when and if a need arises. Most recently, they have partnered with Planet Fitness in Cape Girardeau, and Simply Fitness in Jackson to round out a wellness package.

With concierge medicine for the common man and employers with 2-2000 employees, the Cape Girardeau region now has options for consumers and employers who are exhausted and overwhelmed from swimming in the alphabet soup of managed care.

What do all of these acronyms mean?

DRG: Diagnosis-Related Groups

EOB: Explanation of Benefits

HMO: Health Maintenance Organization

PPO: Preferred Provider Organization

HDHP: High Deductible Health Plans

HSA: Health Savings Account