Concierge Medicine: A Natural Outgrowth of Consumerism in Health Care

January 28, 2009 – There was an interesting article posted on the World at Work Site today about concierge medicine.

There are several names for this practice; some call it “retainer medicine” or “boutique medicine,” while others call it “concierge medicine”. Whatever the name, it appears to be increasing in prevalence. Virtually unknown 10 years ago, it is a growing niche business.

For a fixed annual fee, medical practitioners offer a limited number of patients the opportunity to pay a fixed annual fee in exchange for "premium services and amenities." These services may include priority/same-day/guaranteed next-day appointments; extended or Saturday appointments; access to the doctor 24/7, with access to the physician's pager, cell phone, and home phone numbers; house calls; telephone and e-mail consultations; and other services.

The growth of concierge medicine has really come from two things: One is a revenue stream for physicians whose income is being reduced in many ways from lower third-party reimbursements, higher costs and the like, while others would like to return to the past when medical care was more personalized.

Some doctors who have gone this way have decided to no longer contract with Medicare and other private insurers, and the main selling point to potential patients is that they supposedly get better and more immediate access to, and more undivided attention from, their doctor.

The cost for such memberships can run as low as $1,000 per year on up to $20,000 or more per year. The most recent ones I have come across have been in the $1,500 to $2,000 per year range. It all depends on a variety of factors, including what services are actually provided.

Some fear that concierge care will result in a two-tiered medical system based upon economics. Concierge physicians would not be satisfying their ethical duties to provide some indigent care.

David R. Donnersberger, MD, JD offers an interesting perspective about Concierge Medicine on the Health Care Blog.

January 24, 2009 – Concierge Medicine From A Doctor’s Perspective - Call it boutique medicine. Retainer medicine. Platinum care. Evoking the pastoral image of a sturdy black doctor’s bag and spectacles, concierge medicine is a small but growing trend among over-worked and over-booked physicians. The practice essentially offers a limited number of patients the opportunity to pay a fixed annual fee in exchange for premium services and attention. Fees can range anywhere from $1,000 to $20,000. Concierge medicine has been dubiously received while transition necessitates limiting a physician’s patient base significantly. Imagine receiving a letter from your doctor of 30 years demanding an annual fee on top of the cost of your normal visits. Hurry your check, and you may be one of the lucky ten percent the practice will keep. Thousands of patients have been outraged to receive just this kind of letter from their family doctor.

I believe concierge medicine can indeed offer significant advantages if mixed with a dose of good, old-fashioned business practice. There exists a happy medium that allows physicians to spend increased time with patients without alienating long-term clients. In our practice, we demand no annual fee. We ask that Medicare patients pay out of pocket for their wellness visit; such payment is only covered when the patient turns 65. The patient can in turn be reimbursed on the insurance provider’s schedule.

If the patient is unable to pay, we will still provide the visit. In considering a concierge practice, physicians should continue to accept patients with Medicare or other third-party payers, but may ask for payment directly before the patient files their own claim. The benefits of a direct payment structure to physicians means a less bureaucratic or “quota”-driven practice. The benefits to patients include same-day appointments, complete and continuous physician access via cell phone, on-site laboratories in clinics, and no anonymous hospitalists in the event of a stay.

Increased attention for patients leads to a much higher rate of satisfaction and comfort.
Concierge medicine, from a doctor’s perspective, is a more gratifying and fulfilling way to practice medicine. Today’s doctors take on patient loads of up to 2,500 to 3,500 patients annually. Longer appointments with concierge physicians means a thorough discussion of patient questions and concerns. More time also translates into a real ability to monitor wellness screens such as mammograms and colonoscopies.

There exists the fear that concierge care will result in a two-tiered medical system based upon economics. In the beginning, this may have in fact been true. But as the practice has evolved over the past decade, so have individualized billing plans. Ideally, physicians should maintain long-standing relationships with patients regardless of their ability to pay out of pocket. About 250 concierge physicians exist in the United States today. Participating physicians report more time to devote to patient care and advocacy, as well as continuing medical education and family life. The result is a revolution in preventative care and a return to a more personal relationship between doctor and patient.

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In keeping with the theme of Consumerism, the emergence of concierge medicine is a natural outgrowth of health care economics. It’s also echoed in Obama’s “you can keep what you have” Health care policy stance. For the very wealthy, perhaps the extra expense is not cost-prohibitive. For the rest of the economic classes, a cost-benefit analysis must be performed to determine it’s true value.

-JS