Suppose at your next office visit, that your physician asked you to pay $3,000 a year for the privilege of being his or her patient? In return for an annual fee that runs from $1,500 to $20,000, you get special attention. If you chose not to pay, you have to find a new doctor. Oh, you will have to file your own claims with your health plan and accept out-of-network coverage, too.
More and more health plan participants are encountering exactly this scenario. Welcome to “concierge medicine,” or retainer medicine, the latest trend among physicians to increase their incomes and reduce their workload. Here’s how it works: a physician office practice decides to become a concierge practice. Each patient in the practice is approached to pay the annual fee and sign a contract. In return for the annual retainer, physicians promise longer office visits, same-day appointments, shorter waiting times, and better access to the physician, sometimes including their cell phone numbers.
Medicare, which is concerned about the legality and potential access problems, commissioned a study in 2004
http://www.gao.gov/new.items/d05929.pdf
which found several hundred physician practices nationally had already converted. Since then, the number of physician groups becoming concierge has increased rapidly. Most major health plans will not allow physicians to charge access fees to their members, so many of these physicians drop their health plan contracts, and many drop out of Medicare as well. An employer’s health plan members who see one of these physicians must pay the annual access fee out of their own pocket and seek out-of-network reimbursement for physician services if they are enrolled in a PPO.
What’s in it for physicians? Their patient loads drop, from an average of about 3,000 to about 600, depending on the type of practice. And their incomes soar – from an average of $150,000 per year to $400,000, according to one source:
http://www.aarp.org/bulletin/yourmoney/a2004-11-11-boutique.html
Instead of seeing more than 100 patients per week, they see about 30.
So what’s wrong with a little physician entrepreneurship? First, there is no evidence that patients in concierge practices have any better outcomes – they just pay more. Second, we already have a shortage of primary care physicians, and each practice that converts to concierge leaves about three-fourths of their patients to seek coverage from a shrinking pool of physicians. And finally, these same physicians were trained at huge public expense with their education heavily subsidized by the US public. This is no way to repay our trust.
#1 by Wayne M. Burr, MD on May 3rd, 2007
The concierge medical practice model in Fort Myers, FL has been well received. This is where I practice, and in general I have had positive feedback from my patients and the community. The concierge model gives the patient another alternative to manage their healthcare. The patient has immediate access to their physician with same or next day appointmets, phone accesibility via the physician’s cell phone, urgent medical attention in the patient’s home or office when appropriate, and in my office they have access to other ancillary care such as dietitian and personal fitness consultation. The concierge physician is able to personally oversee the patients care to include scheduling of diagnostic testing and specialty consultation which in a non-concierge practice is delegated to the office staff. This type of practice model is not suited for everyone, but for those patients who have tired of the traditional primary care office and feel that their care is marginalized by the perceived lack of physician time, this is an attractive alternative. Patients should have a choice in how they manage thier most important asset–their health. We as physicians should have the resources to be able to give the patient our most valuable commodity–our time. I do not forsee the concerge model replacing the current status quo, but the concierge practice does give the patient an important choice. Wayne M. Burr, MD
#2 by Dr. Christopher Coulter on May 9th, 2007
Other physicians share your experience that the concierge model can be well received by patients, primarily because they appreciate the better access and enhanced services. I think a good case can also be made that it encourages diversity in our health care marketplace and that it promotes consumerism and shared decision making with patients. The more widely it is adopted, however, the more severe the impact on our strained health care system. Most concierge practices reduce their patient load by three quarters, dispossessing a large number of patients. It also adds a new financial load onto a health care system already threatened by unsustainable costs. Finally, it ignores those unable to pay the additional up-front costs. I think we can do better. Chris
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