Tired of hassles at the doctor's office?
Get treated like a king
with concierge health care.
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How often have you waited for an hour to see your
doctor, only to find that your appointment lasts all of 10 minutes?
Have you been overcome by the uncomfortable feeling that something may
have been overlooked due to the "mass production" nature of your
doctor’s office?
"Concierge" health care may be the answer. A
membership at a "concierge" medical office allows you to opt out of the
traditional health care system and wave good-bye to long waits, limited
face time with your doctor and the sense that you’re no more than a
medical chart and insurance claim number.
A
growing number of physicians, who are also fed up with fast-food
medicine, are leaving managed care and traditional practices and giving
patients the option of private membership.
Concierge medicine is sometimes also called:
Boutique medicine
Direct care
Retainer-based medicine
Preventative care practice
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As the brainchild of Seattle physician Dr. Howard
Maron, concierge medicine was first practiced in 1996. Today, there are
about 5,000 concierge doctors in the U.S., according to the Society for
Innovative Medical Practice Design, a concierge medicine trade group.
Patients pay a fixed annual "membership" fee for
personalized service from a primary care physician. This fee can range
from $1,500 to $10,000 depending on the practice and the number of
people seeking services.
Compared to a traditional practice where physicians
see 2,000 to 4,000 patients a year, a concierge doctor has a condensed
workload of 500 to 600 patients. This allows more time for the doctor
to concentrate on a patients needs without being rushed. There is
normally no waiting time for an appointment and some concierge doctors
take walk-in appointments.
Rarely in a traditional practice do doctors still
make house calls, but in a concierge practice this is common. Concierge
doctors are on call 24/7.
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| Individual |
Family |
Corporate |
| $1,800 |
$3,500
(2 people) |
$1,375 per person
(5 to 10 people) |
| |
$5,100
(3 people) |
$1,250 per person
(11 to 25 people) |
| |
$6,600
(4 people) |
More than 25 people: Negotiated |
| Source: Choice Care, Dr. Marcy Zwelling |
There are two types of concierge business models:
1) An annual evaluation model, where a patient pays a fee for a
complete physical with lab tests, and 2) a bundled fee-for-service
model where the practice charges a yearly fee to cover a list of
services. These services typically include: physical exams, blood work,
unlimited office visits and other services (see list below). If you have health insurance, your concierge doctor will submit claims for treatments that are not covered under your membership.
- On call 24/7
- House calls
- No waiting
- Unlimited appointments for your membership fee
- "Executive physical exams" that include a full body scan, screening
for 200 diseases, blood tests for rare conditions and time spent with a
physician going over every aspect of your medical history. These
comprehensive exams can cost well into the thousands through
traditional channels.
- Lab tests
- X-rays
- Coordination of care if you become ill while traveling
- Mental health services
- Well-baby checks
- Acute care visits
- Online access to medical records
- Home delivery of medications
- Hospital visits from the doctor
- Transportation to appointments
- Coordinated care with specialists during travel
- Hotel reservations for family during a medical crisis
- Wellness, fitness and lifestyle screenings
- Weight management
- Nutritionists
Membership fees cover basic services that include
preventive care, routine physicals, longer appointments, next-day
appointments, 24-hour-a-day phone access and e-mail, house calls,
coordination of care when you travel, and a CD with your medical
records.
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Since the mid-‘90s, doctors have defected from
health insurance systems by dropping contracts with managed care
insurance companies and Medicare. They cited paperwork hassles, delays
in reimbursements, battles for approvals, low reimbursements for their
services and restrictions on patient care.
With so many doctors departing for greener
pastures, access to care has become a concern for legislators and
consumer advocacy groups.
A report from the Medicare Payment Advisory
Commission said the number of Medicare patients in search of a primary
care physician in 2007 was up by 24 percent from the previous year.
HMOs have not been winning any fans either. The
American Medical Association has vocalized dismay since 2005, alleging
"health insurers are substituting corporate policy for clinical
judgment, hurting high-quality medical care, [and] causing physicians
to turn away from a managed care delivery system."
In New York, there has been an annual doctor
dropout rate of 10 percent from the state’s largest HMO, the Health
Insurance Plan of New York (HIP), since 2005, according to the Center
For Studying Health System Change. The state's second-largest HMO, New
York Health Net, has been seeing dropout rates of 14 percent in the
last four years.
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Often, patients decide to use money from a health
spending account to pay the membership fee. Some concierge practices
require patients to carry a catastrophic health plan, at a minimum,
when they become members. A catastrophic health plan is generally used
for emergency medical care such as hospital stays and surgery.
MDVIP, a preventative care practice based in West
Palm Beach, Fla., opened its doors in 2000 to address the growing
frustration of patients and doctors over mismanagement of health care.
"A traditional doctor’s practice involved trying to
provide medical care to 2,500 patients, who could only be seen by a
doctor for eight to 10 minutes," explains Darin Engelhardt, president
of MDVIP. "It should not be typical for a patient to expect to finish a
copy of War and Peace while they wait to be seen by a doctor."
MDVIP provides services that are generally not
covered by private health insurance or Medicare such as alternative
care (acupuncture, chiropractor), executive physicals and care outside
the U.S. They take all types of insurance plans. Engelhardt notes that
MDVIP takes patients who don’t have health insurance, and having
insurance is not a prerequisite to care.
Patients with chronic conditions often find the
concierge model appealing. "They come to us looking to get prevention
and wellness that is beyond the scope of what traditional insurance
products offer," says Engelhardt. "A smaller setting allows the
physician to be far more engaged as a manager of chronic conditions."
David Rothman, a retired FBI agent from California, and his wife Mary Lou have been going to a concierge doctor for 15 years.
"If you can afford it, it’s worth it, especially if
you have medical problems," says Rothman, who is a patient of Dr. Marcy
Zwelling-Aamot, a concierge doctor in Los Alamitos, Calif. "There is
nothing better than being able to pick up the phone and speak to your
doctor directly. Since my doctor no longer has 4,000 patients, I’m able
to reach her when I need her. If I go to the emergency room, she will
meet me there if it’s local and talk to any attending physician about
my medical care. I like that comfort."
Rothman adds that another advantage is being able
to deduct his concierge doctor’s fees off his taxes. If medical
expenses exceed 7.5 percent of your adjusted gross income, you can
deduct medical expenses from your taxes.
MDVIP says patients generally fall into three main
categories: those who are over age 55 who require disease management,
middle-aged patients concerned with preventive care and traveling
executives.
The physician benefits as well. According to the
Society for Innovative Practice Design, if a concierge membership costs
$1,000 annually and the doctor sees 600 patients, the practice brings
in $600,000 per year. If 53 percent of that goes toward operational
costs, the physician makes an annual income of $318,000. The nationwide
average yearly income of a primary care physician (who is on the lowest
salary tier for physicians) is $100,000 to $200,000.
If you value your time and like the security of
knowing your doctor is just a phone call away, concierge medicine may
be your ticket out of the crowded doctor’s office.
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Visit the Society for Innovative Practice Design's physician database.
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Use MDVIP’s nationwide referral service.
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Check the phone book for physicians advertising concierge health care.
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Word of mouth from friends, family, co-workers.
| Are concierge medical practices selling a form of insurance — and doing so without being licensed?
The Maryland Insurance Administration has determined that the "annual
evaluation model" of pricing is not insurance if the fee falls in line
with the market value of the services provided. Therefore, a concierge
practice using an annual fee would not be regulated by the insurance
commission. In order to prevent a "bundled fee-for-service model" from
being regulated, concierge practices would have to outline the services
provided in their patient contracts and then implement an annual fee
that does not surpass the market value of an executive physical, in
addition to limiting the other services provided in the fee. Physicians can provide an annual physical exam but they
must reduce their other services to one follow-up visit and limit the
number of office visits. Services provided must also be clearly spelled out in contracts with patients.
Concierge
contracts in Maryland must state that both the patient and the
physician have the option to terminate the contract at any time. When
the contract is terminated, the physician must refund the patient their
retainer fee on a pro-rated basis. The Maryland Insurance Administration also asked new and
current concierge physicians to contact them so they can go over their
written agreements to make sure doctors are not inadvertently selling
insurance without a license.
Source:
Maryland Insurance Administration report on "Retainer" or "Boutique" or
"Concierge" Medical Practices and the Business of Insurance, January
2009 |
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