10/13/2014 06:23 pm ET Updated Dec 13, 2014

Doctors to Patients: Pay Up or Pack Up

If you've had a great longtime relationship with your family doctor, get ready for a shock. He may be getting ready to "unfriend" you.

You'll find out in a letter announcing that his practice is joining a wellness program to provide you with better care. Among other things, you won't have to wait more than day or two for an appointment and the doctor will be able to devote a lot more time to you when you need to see him. Appointments will start on time. No more spending half an hour or more in the waiting room with old magazines and no more feeling your appointment has been cut short when the doctor signals your time is up. Sounds great, no?

Then comes the fine print.

Membership in the program typically costs $1,650 per year per person (a fee not covered by insurance). For this you are promised not only quick appointments and "unhurried" visits with the doctor but a customized preventive health regimen that includes things like referrals to specialists, fitness and nutritional advice, hearing, vision and heart health.

Little does it matter that a number of the benefits of "wellness screening" won't apply to you because of your age or physical condition or that many or most of these benefits are what any good doctor would provide in the ordinary course of your treatment.

For example, one of the "new" benefits is the dietary counseling. If you see the doctor about your high blood pressure and he notices how much weight you have gained he is now likely to tell you to go on a diet. Just like always. The only difference is that the program will provide diet information for you -- the kind of information freely available on the internet, from health magazines or from any good weight-loss program.

The program also offers an electronic medical history with information about your operations, medications, lab-test results. Just like the files doctors now keep or are offered by health providers like Blue Cross with its "My Blue" or which many patients already keep themselves. And since January 1, 2014 all doctors and other health-care providers are required to computerize patient records in order to maintain their existing Medicare and Medicaid reimbursement rates.
One important assurance of wellness plans that may have real value to prospective members is the guarantee of an appointment within two days. But the promotional material doesn't spell out whether this guarantees that you will see the doctor himself or be referred to a physician assistant. Many people have complete confidence in PA's but there are many others who expect for their money to see a licensed MD who has attended medical school, served a rigorous internship and is doing all the things necessary to keep current and maintain his status in good standing.

Another unanswered question concerns the "unhurried office visits that last as long as you need." Who decides if this is 15 minutes, half an hour or longer? Suppose you don't feel you are finished before the doctor indicates time is up? And how does the unpredictable amount of time spent in these more leisurely office visits affect the promise to start appointments on time?

One very important thing to find out before you decide is how many patients will be in your plan. If you routinely have to wait for 30 minutes or more to see your doctor it may be a good sign his patient load is more than he can safely handle. So you should ask how many patients will be cut to qualify for his participation in the program and how many members there will be when the plan kicks in. Incidentally, according to the Academy of Family Physicians the average patient sees his doctor 3.19 times a year so if you are "average" you will in effect be paying a premium of more than $500 per visit based on an annual fee of $1,650.

By learning the number of others to be enrolled in the plan and multiplying by $1,650 you can, if you are curious, find out how much the doctor will be making by imposing this get-in-or get out patient ultimatum. (He pays about one-third of the income generated to the managers of the plan for administrative and other support services.)

After you check everything out and believe the benefits outweigh the cost, there's nothing stopping you from signing up to be among the privileged few who will be pampered by the doctor.

The problem is: what happens to the many who can't afford it, can't be convinced, or can't be coerced into joining? For a man and his wife, membership typically runs about $3,300, a considerable sum for those on limited budgets.

Those who opt out are offered a window of several months to find another doctor before the weeding-out process kicks them off the rolls.

For those who decide against joining, especially those on Medicare, finding a new doctor may not be easy at a time when more and more of them are refusing to accept new Medicare patients. It is not unreasonable to speculate that until they do their health may be at risk. Missing exams, routine checkups and missing appointments during which preliminary indications of a developing problem or the recurrence of an old one are not discovered can lead to serious and possibly even fatal illness.

Membership in wellness programs has grown rapidly and it may strike some as highly ironic that so soon after the Affordable Care Act has been passed to help the poor get health coverage that some doctors' groups are shrinking the number of low-income patients they treat.

The open question is whether these plans are inspired by altruism or the profit motive.

Successful plans reportedly can increase a doctor's income by as much as 60 percent. And the well-heeled patients who can afford "concierge medicine" (so-called by critics who worry it will create a two-class system of medicine) are said to be highly satisfied and renew at a very high rate. They have great doctors who have been carefully screened. In the largest national plan, which has more than 200,000 paying members, only 12 percent of physicians who want to participate are approved.

Not so happy are the patients who have been dumped and been sent packing by someone they thought of as a trusted old friend.

John Donnelly is retired public relations executive with terminal cancer. His wife has joined a wellness program not for the benefits offered but because she is afraid she will not be able to find a doctor as good as the one she now has.