Retail clinics and membership medical: Different models for health care

Filed Under: Costs, Patients, Providers

SUMMARY: Retail clinic health care, direct primary care and membership medical — what happened to the old doctor’s office? Things have changed: New practices include walk-in clinics and urgent-care locations; their rise is a response to changes in the marketplace. We help you sort it all out. Read on for details, or …

 

 


How much does a walk-in clinic visit cost?

Well, that depends.

Retail health clinics have been around in some form for more than a decade, but are now gaining popularity because of convenience and competitive prices. They operate out of chain pharmacies, grocery stores and “big box” stores such as Walmart; they may also operate out of store-fronts (here in New York, that’s common) or in locations like malls. But other than that, what distinguishes these clinics from primary care facilities?

Retail clinics are often staffed by a pharmacist or a nurse practitioner who will see patients suffering cold symptoms and other non-emergency issues. The retail clinics, which are often nestled in a back corner of the store, may also offer services like flu shots.

(For distinctions between urgent-care and walk-in clinics, with a skip over retail clinics and membership health, read a previous post.)

Recently, we wrote a blog post on retail pharmacy chains offering shots; you can read that post here.

Convenience and price

At retail clinics, convenience is one draw – it’s often easier to walk in without an appointment to your local big-box or storefront clinic than to make an appointment at your primary care center, or to get care if you don’t have a primary care physician. (Some retail clinics participate in insurance plans, and sometimes they don’t. Always check.)

The other attraction to retail health is price.

“In 2009 the Rand Corp. compared care and costs for treating three common illnesses in different settings,” according to a May 2012 article for Kaiser Health News by Michelle Andrews. “In that study, retail clinics cost at least 30 percent less than physicians’ offices, urgent care centers and emergency departments, while the quality of care was at least as good.”

Often, too, people tell us they like retail clinics because prices may be posted, so you generally can know in advance. That’s comforting for many.

Not all agree that the quality of care is as good.

And, price should not be the primary determiner for medical care, said Dr. Michael Carlin, medical director of Greenpoint Diagnostic Imaging in Greenpoint, Brooklyn.

“Usually with medicine, you get what you pay for. It’s better to see a primary care physician who knows you and has a sense of your history,” Carlin said. “We do diagnostic testing and it’s a common misperception that it doesn’t matter where you get a test done. But it does. It’s not the test, but who’s interpreting the study that matters. That’s why a primary care physician is important.”

Another model: membership medical

An alternative to retail health clinics are membership medical groups, also called “concierge medicine.”

The concept behind membership medicine is that the patient pays an annual fee (the retainer or membership fee) in exchange for members-only access to care. Membership medical groups differ in the level of service provided and the annual or monthly fee charged.

For some, the term “concierge medicine” has an added sense of expense or entitlement to enhanced services, while “membership medicine” carries a connotation of affordability. In common usage, the two terms may be interchangeable.

Depending on the model, many membership medical and concierge practices do not cover either hospitalization or certain specialists.

One Medical Group, which has offices in New York, San Francisco, Washington, Boston and Chicago, offers an annual membership fee of $199. The membership group accepts various insurance plans, depending on state. New York clinics accept the following insurance plans:

  • Aetna
  • Blue Cross- Blue Shield (Anthem/Empire/Wellpoint)
  • Cigna
  • GHI/HIP (an Emblem Health company)
  • Oxford (Freedom and Liberty)
  • PHCS/Private Healthcare Systems (Multiplan provider network)
  • United Healthcare (including The Empire Plan)

(Important update: In late 2013, OneMedical in New York told us that it was not accepting any New York State Affordable Care Act plans, from any carrier. So — as we said, always ask.)

The patient is typically responsible for the co-pay or deductible. As for the One Medical Group membership fee, it is often not covered, but if your insurance plan has a health savings account (HSA)  you may be eligible for reimbursement. Always ask.

Patients without health insurance pay $150 out-of-pocket for an initial doctor visit and $100 for each subsequent appointment. Medical procedures range from $90 to $160 and injections cost $25 to $150. Here’s a pricing page for the New York City OneMedical group.

AMG Medical Group, with locations throughout New York City, offers monthly membership plans that vary from $49 a month (basic) to $139 a month (premium plus). For a full list of what each plan includes (a basic plan covers routine medical complaints, while the more advanced plans include procedures such as steroid injections, pap smears and x-rays) go here. To read a New York Times article about AMG, go here.

AMG accepts one insurance company: Easy Choice Health Plan of New York, which says on its web site that it is  a New York State Licensed HMO that was founded by 12 New York City physicians.

In California, Scripps Health offers two concierge medical centers in the San Diego area (La Jolla and Carmel Valley). The annual membership price is $3,000 per individual and $6,000 per family. Scripps Health doctors (who are internists) will see patients with all conditions — minor cold and flu symptoms to more serious concerns.

Scripps accepts most PPO insurance plans. If you’re paying out of pocket, the cost of follow-up visits depend on the condition treated.  Initial “meet and greet” consultations with a primary care physician, however, are free.

There are a number of other membership practices and concierge clinics throughout the United States.

These may include direct-pay medicine, explained in this blog post and also in this one.

So, how much will it cost?

We have collected cash or self-pay prices over a number of metro areas for walk-in, urgent care, direct-pay and membership medical practices. Those charges may vary, depending on whether your insurance covers all or part.

But the cash or self-pay prices vary a lot. Our New York area provider price survey shows a range from about $75 a visit up to $351.

Our Los Angeles area provider price survey shows a range from about $20 a visit up to $300.
Our San Francisco area provider price survey shows a range from about $99 a visit up to $310.
Our Dallas-Fort Worth area provider price survey shows a range from about $75 a visit up to $375.
Our Houston area provider price survey shows a range from about $75 a visit up to $250.

The takeaway: Questions to ask

As we always say, know before you go.

Questions to ask:

  • Do you accept my insurance plan?
  • How much will this cost? How much will this cost ME?
  • What medical services do you provide?
  • What practitioner is on duty now—a doctor, a nurse practitioner?
  • What practitioner will I see when I come?
  • What is your staffing level in off hours?
  • Are lab and other tests included? If not, how will they be done, how much will they cost, and how will they be paid?
  • Is this covered by insurance without a copay? If not, why not?
  • Do you have a sliding scale based on income, family size and other factors? How does that work?
  • Is there a separate charge for any and all other services, or is it all included in the price you just named?

Call before you go. Ask how much you will be charged. Take notes. Take names. Take numbers.