How Private is Your Medical History?

Most patients believe that their medical records are private—after all, there are laws in place that require healthcare providers to keep these records under wraps, right? Well, yes, but the truth is that your medical records are a lot more accessible and at risk of exposure than you might believe.medical-records

The Definition of “Medical Records”

The term “medical records” covers a wide range of information for you and your family, including:

  • Medical history
  • Lifestyle habits, such as smoking and drinking
  • Hospital and medical bills
  • Insurance claims
  • Prescription history
  • Laboratory test results
  • Prior medical procedures
  • Medical appointment history
  • Genetic test results
  • Medical providers’ opinions and notes
  • Information from health insurance applications, including Social Security numbers

Today this information is often available in several different places through large healthcare providers or systems and electronic record storage. This is beneficial to the patient because it helps a variety of legitimate care providers gain access to information quickly, but it can also be dangerous because it opens the records up to exposure, theft, and unauthorized access.

Privacy Protections Currently in Place

Whether you see a concierge physician or you have a more traditional care provider, there is a national standard for handling medical records called the Health Insurance Portability and Accountability Act (HIPAA, pronounced “hip-uh”). This regulates how everyone from concierge doctors and healthcare providers to health insurance plans and health clearinghouses store and share information.

HIPAA requires that healthcare providers describe to individuals their privacy policies and how records are handled. The person must sign a notice that they have seen and understand the information. Most consent forms include a statement that says once your sign the document your medical records can be shared for “routine” reasons without requiring your consent or notification, a very broad statement that makes it easier for providers to share information.

There are benefits to being able to quickly share information, particularly when you are admitted in an emergency situation or require care when you are traveling and are a significant distance from home, and HIPAA was intended to help facilitate this sharing while still maintaining some privacy.

The Dangers Your Medical Records Face

There are many ways that medical records can be breached today. Some of the most common include:

  • Unauthorized access by employees of hospital systems or healthcare providers
  • Stolen or lost computerized patient records from unsecured online systems, on laptops, smartphones, or tablets
  • Data breaches from computer hackers
  • Mishandling or illegal use of data by employees who have legitimate access
  • Authorized access by employees of the Federal Bureau of Investigation for any investigation intended to protect against terrorism (under the Patriot Act)

Since HIPAA was implemented in 2003 the Department of Health and Human Services has reported about 35,000 cases of privacy breaches. About 200 criminal cases have also been filed by the Department of Justice under the statute that includes HIPAA, but it is not immediately clear how many of these actually involve HIPAA violations.

Protecting Your Medical Records

There are some things that you can do as an individual to ensure better protection of your personal records. Privacy Rights Clearinghouse offers these recommendations:

  • Adjust HIPAA releases by removing the “boilerplate” language that allows broad access and writing in more specific language about how it can be shared.
  • Talk to your concierge doctor or other providers about how and what medical records will be shared.
  • Request that only necessary photocopies of your records be made.
  • Be aware of all the places where you fill out health information (online and in person) or get free health screenings, and minimize what you share that could be distributed.

Finally, to protect yourself it’s always a good idea to be aware of what is out there for your medical records and keep an eye on how it is shared, stored, and used by all your providers. Carefully read through agreements that you sign at your doctor’s office, understand the privacy and sharing policies for health websites and online forums, and know your rights as a healthcare consumer. You can also talk to your concierge doctor about any additional concerns you might have to ensure your privacy.

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Tips for Converting to a Private Medical Practice

dv2062025The decision to start your own concierge medical practice is often the result of a lot of thought and preparation, but many doctors still have difficulty knowing where to begin. When you are ready to make the switch to a smaller and more manageable practice that will allow you to connect with patients and offer a higher level of care to the people you see, these tips can help you make a smooth transition.

Don’t Do It Alone

The transition from a traditional medical practice to a concierge practice is a process that requires a whole team of people to do it right. For many doctors this is a foray into the great unknown, so having personal and professional support can be critical to help you get through the highs and lows of the process.

If you have an existing medical office, it’s also very important to let your staff know about the changes you will be making because it will affect everyone in the practice, but don’t make any announcements until you have done your homework and have a solid plan and timeline in place.

Know Your Stuff

If you thought you were done with homework when you graduated from medical school, think again. To transition successfully from a traditional practice to a concierge medical practice, you are going to need to do a lot of research, planning, and preparation.

Successful preparation will cover several different components:

  • A business plan that outlines realistic goals and objectives for revenue, patient recruitment, facilities, and staffing
  • A marketing plan that identifies your brand message, target audience, and outreach methods
  • A legal plan to ensure compliance with all local, state, and federal regulations

Moving forward before you have any of these plans in place will make it difficult, if not impossible, to succeed in your new practice.

Hire a Top-Notch Team

In order to run a successful concierge practice that offers the highest quality patient care, you need a top-notch team. This includes both your internal clinical team—the doctors, nurses, and support staff—as well as an external consulting team.

Consultants can help you manage the business side of concierge medicine conversion. There can be literally hundreds of small tasks that you need to accomplish in order to convert to a concierge practice, so it’s important that you have the best legal, marketing, financial, and operational support. This professional team can help you avoid missing any little things or making common mistakes that new concierge doctors make when switching to your new model.

One of the most critical members of your internal team is your customer service and membership representative. This person will be charged with responding to prospective members’ questions, signing up patients, and retaining your existing patients. This is more than just a basic administrative role, so fill the position with someone who has exceptional people skills, a track record in sales, and the ability to connect with your current and future clients.

Tell Your Patients the Right Way

The most critical component of any transition is informing your patients, and this is something that requires meticulous planning and preparation to ensure it’s done right. Most patients don’t know much about concierge medicine, so be ready to answer questions about the model, the benefits, fee structures, and more. It’s best if you carefully craft a letter to your patients with your marketing team, and time its release appropriately as part of your overall marketing strategy.

Become a Marketing Guru

Most doctors are not marketing professionals, but to run a successful concierge practice you must learn the basics of marketing and become skilled at selling your practice to prospective patients. You don’t have to do the day-to-day marketing activities (in fact it is better if you hire a consultant or firm for this), but it is your practice, so you will be the person to articulate your brand and message and approve branding materials and advertisements that showcase your practice. Take some time to learn the basics about marketing a concierge practice so you can successfully recruit and retain patients.

Concierge medicine can be very rewarding, but the transition to a successful practice requires significant planning and preparation. Use these tips to make sure you do it right.

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Concierge Medicine and Insurance: How it Works

23254695_blogIf you’re a patient considering joining a concierge medicine practice, or a healthcare provider thinking about transitioning your practice to a concierge model, you may have a lot of questions about how insurance works with the private medicine model. The laws and relationships between insurance provider and private doctor can vary from state to state and from practice to practice, but here are answers to some of the most common questions.

Do I Need Insurance to Participate in a Concierge Practice?

For most patients, the answer to this question is no, but many private physicians still recommend that patients carry some level of insurance. The monthly or annual fees for concierge medicine often cover basic and preventive care, so you might discover that you can make some changes to your existing insurance plan. It’s a good idea to still have a major medical plan or a high deductible plan for catastrophic illness or injury, and also a health savings account in case you require hospitalization or other specialty care.

What Do Concierge Fees Cover?

The costs of concierge fees and what they cover varies from doctor to doctor and from state to state, but generally they cover basic preventive care. At a traditional doctor’s office your insurance generally requires that you pay a co-pay to see the doctor for any appointments, then you pay for the full cost of any additional lab tests or procedures until you meet your deductible. Many insurance providers also require that you pay a co-insurance of around 20 to 30 percent until you reach your out-of-pocket maximum for the year.

With concierge medicine, most offices include things like general appointments, annual physicals, and consultation for wellness and preventive care in their monthly or annual fees. The concierge doctor will not bill your insurance, and you won’t be required to pay the co-pay, meet the deductible, or pay co-insurance for these basic checkups. Every concierge office is different, though, so it’s a good idea to talk to the doctor to clarify how their cost structures work.

What About Lab Fees and Other Costs?

At a traditional doctor’s office the cost of lab work or other procedures would be part of the cost you pay toward a deductible or out-of-pocket maximum. Many concierge doctors offer patients the opportunity to get lab work, imaging, medication, and basic procedures at a very reduced rate so they can pay with cash. By eliminating the need to involve insurance providers in this process, providers can often offer better prices. In addition it eliminates the need to get approval from an arbitrary third-party provider before offering services. This model is also helpful for patients that have very high deductible insurance plans or insurance that is intended for catastrophic illness or injury.

Can I Participate in Concierge Medicine if I have Medicare?

Medicare participants can definitely join a private physician’s practice, but it does require that the doctor not bill Medicare for services that are provided under the concierge medicine fees. Medicare can still help cover the cost of things like laboratory testing, medications, specialty care, and hospitalization if necessary.

What Should Concierge Doctors Know About Insurance?

Private doctors need to be aware of the laws regarding insurance and concierge medicine. If your office chooses to implement a hybrid model and bill insurance for some procedures that are not covered by your concierge fees, then your staff must be careful not to double-bill for items that are covered under the monthly or annual retainer fees. Doctors’ offices must also be careful not to double-bill Medicare for patients over 65 that have the government-provided health plan.

While it may seem like joining a concierge practice would increase costs, many patients find that they can purchase a high-deductible insurance plan and/or invest in a health savings account, pay the monthly concierge fees, and still end up breaking even or saving money by avoiding the hefty co-pays or higher premiums that come with traditional care.

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The Benefits of Joining the AAPP

Striking out on your own to open a concierge practice can be an exciting prospect, but the idea of being totally aapp_logoalone in your new career can also be pretty frightening. Many primary care physicians who work in traditional settings are part of a hospital group, in a large medical office, or subordinates of healthcare administrators and other doctors. Those who decide to change their model of healthcare delivery to private medicine in the hopes of offering better and more comprehensive care to patients may believe that they have to fly solo.

Fortunately that does not have to be the case. Many new and existing concierge doctors have discovered the benefits of joining the American Association of Private Physicians (AAPP), a nonprofit professional organization dedicated to fueling the growth of concierge and value-based practices throughout the U.S. Whether you have been practicing private medicine for a long time or you are new to the model, being part of this organization can help you improve the quality of your patient care, empower your patients, and reduce the costs of providing quality care. Here are just a few of the benefits that AAPP membership offers.

Online and In-Person Collaboration and Networking

Joining a professional organization like the AAPP gives you instant access to an entire network of people who are in the concierge medicine industry through resources such as:

  • Online forums to ask questions, discuss current trends, and learn about innovation in the industry
  • Venues, events, and opportunities to network with other concierge doctors
  • Easy-to-use and comprehensive directory of concierge physicians so you can find and connect with other doctors in your area

These networking and engagement opportunities give you a chance to meet with thought leaders in the industry, learn about new innovations in practice models, and discuss your questions with people who are currently practicing concierge medicine. They are also a great resource to help you explore policy arguments, shape public discourse, and proactively advocate for the future of patient care with a group of supportive, collaborative, and committed peers in the industry.

Updates on Important Legislative Actions

The healthcare landscape in the U.S. has shifted dramatically in the past few years, and it continues to evolve today. As a concierge doctor it is important to keep up with all the important legislative changes and potential changes because they can have a significant impact on your practice. Many physicians don’t have the time to study all the laws, so a membership in AAPP can save time by helping you stay apprised of relevant local, state, and federal laws.

Educational and Professional Development Opportunities

AAPP membership also provides extensive educational resources and professional development opportunities. Members can attend local or national conferences and events, and access articles, topics, and webinars with advice for physicians from the comfort of a home or office.

Discounted Medical Malpractice Insurance Program

Every physician knows the importance of having quality medical malpractice insurance—and many physicians also know how expensive this protection can be. With a membership in AAPP, you get access to an endorsed medical malpractice insurance program through Contemporary Insurance Services with nationwide coverage, competitive rates, and discounts for members.

Bargaining Power

If you have ever been part of a large hospital or medical group you know the power that size can have on vendor negotiations. You don’t have to lose that bargaining power when you transition to a small private concierge practice—AAPP gives you a large network of private doctors in your area and throughout the U.S. to help negotiate manageable costs.

Robust Resources

Finally, AAPP membership provides access to a variety of resources that can build your business and ensure you are offering the highest quality patient care. You can access organized research initiatives to demonstrate the economic and clinical advantages of private practice models to your patients and healthcare colleagues, and get guides to grow your practice while avoiding some of the most common errors that new concierge physicians make. You will also get a comprehensive directory of vendors and resources to help establish and grow a successful practice.

Many concierge physicians have discovered the benefits of membership in the AAPP. Find out more about how it can benefit you, and join us today.

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A Comparison of Public and Private Medicine

Most patients today are familiar with the traditional model of primary care. That is, they belong to a medical practice where the doctor carries a large patient load (several thousand patients), schedules dozens of appointments every day, and spends very little time with each patient.

stethoscopeHowever, there is another way that you can receive care, and in many cases patients are finding that it offers several perks and benefits that the traditional model for care delivery does not. It is called concierge medicine, and here is a quick comparison of how it differs from the primary care model that you already know.

Costs

There is a myth that concierge medicine is only for the very wealthy, or that it costs several thousand dollars per month. The truth is that it is becoming more and more affordable for families at all income levels who want better care.

Private Medicine: Most concierge doctors charge a retainer or fee to be part of the practice. This generally does not take the place of insurance, and is an additional cost beyond what you are paying to your insurance provider. Fees are paid annually, quarterly, or monthly, and can range from as low $600 to as much as $15,000 or more per year. With many preventive care needs covered under the retainer, patients often find they can change their insurance coverage to a high deductible plan just to cover catastrophic illness, which may even reduce your overall healthcare costs each year.

Public Medicine: Patients of a traditional practice will often use insurance to pay for care, and the average insurance premium paid by employees in 2011 (since a majority of patients get insurance through their employer), according to the Kaiser Family Foundation, was $921 for an individual and $2,124 for a family. In addition, doctor’s visits often require a co-pay ranging from $15 to $40 per visit, and if you need any additional procedures, you will have to pay out of pocket until you reach your deductible.

Appointment Wait Time

One of the perks that many patients appreciate with concierge doctors is the ability to get same-day or next-day appointments any time you call.

Private Medicine: The average wait time for patients to get an appointment is less than 1 day for members of private medicine practices. In addition, many private physicians offer patients the ability to contact them 24/7 by phone, email, and on social media to get immediate answers to questions and concerns.

Public Medicine: Wait times to get an appointment vary depending on where you live, but the U.S. average is 20.3 days—nearly three weeks—according to the Associate of American Medical College’s Center for Workforce Studies. If you have a chronic condition or something serious occurs, waiting three weeks could significantly affect your health.

Focus of Care

Traditional primary care physicians are required to carry very high loads of patients in order to make a living, which means less time to spend with each patient. That often translates to a different focus when they meet with each patient.

Private Medicine: Your physician will generally spend at least 30 minutes with you, and up to 60 minutes each year during your annual physical. The focus is on managing any chronic conditions you have and preventing future health complications through a comprehensive health and wellness plan. This model also allows for better follow-up since patients can keep in touch with doctors via cell phone, email, and social media. Studies have shown that this translates to as much as 53% fewer hospital visits for concierge patients.

Public Medicine: When the doctor has to see as many as 50 patients per day, he or she will only have about 10 to 15 minutes to spend with each patient, and the focus is on treating existing diseases with little or no attention paid to preventive care. Generally that means offering a quick prescription or treatment with little or no time spent reviewing medical history and examining symptoms from a holistic perspective.

There are several key differences between private and public primary care physicians. If you like the idea of having better access to your doctor, and a more in-depth doctor-patient relationship, concierge medicine just might be right for you.

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