Why Concierge Medicine Is Not The Solution To Primary Care Woes
My Practice Partners On A House Call
My friend and Better Health contributor, Toni Brayer, recently polled her blog audience about their opinion of concierge medicine. She describes concierge medicine this way:
Also known as “retainer” practice, concierge is a growing type of medical practice where the patient pays the physician an up front fee (retainer) for services. The fee can range from $100/month to $20,000/year, depending upon the practice and the services offered. The fee usually covers all visits to the doctor, phone calls, more prompt service and email access. Labs, tests, Xrays, referrals to specialists, and hospitalization are not included.
Her readers responded:
- 59% of readers agree with the principle of concierge and would pay the retainer if they could
- 21% think it is “elitist” and unfair
- 18% don’t have a clue what “concierge medicine” is
I think the concierge model doesn’t accomplish what we need in health reform – expanding the primary care base. It actually just decreases the common person’s access to physicians.
My practice uses a “pay-as-you-go” model with time-based billing. That means that I charge for my time only – I can do house calls, office visits, small procedures, webcam visits, email, phone calls, texting… Whatever is both appropriate and convenient for the patient.
Patients end up needing 10 minutes of my time in many cases – and spend $300/year on their primary care needs. This allows me to see more patients, streamline my practice with technology, save people money, and have fun in the process.
I predict that my practice model will eventually overtake the concierge approach in popularity because it’s less expensive and solves the access problem. Of course, it is cash-only… if patients want to submit claims to their insurers for reimbursement they can go right ahead. But when a visit with me costs about the same as some copays… why bother? 
In my opinion, people should just switch to high deductible plans and pay cash for primary care.
While I can certainly appreciate the term “pay as you go”…whether this physician realizes it or not, they are practicing “concierge” medicine. The term “concierge” be it seen in the marketplace or not is a term and model that’s here to stay. While I agree it might not be the nation’s solution to an ailing health care system, it’s certainly a strong, affordable and non-elitist answer for the uninsured. Concierge Medicine Today recently released some growth expectations numbers to the concierge medicine marketplace and medical community and noted that…”Concierge medical practices have increased tenfold over the past four years, resulting in at least 5,000 such practices now, compared with just 500 in 2005, according to the Society for Innovative Medical Practice Design, which projects that by 2012 there will be 17,000 concierge practices.
The society’s chairman, Dr. T.homas LaGrelius, said those numbers are a “guesstimate,” based on a 2008 Physicians’ Foundation-sponsored survey of 300,000 primary care doctors. In that survey, nearly half the respondents said that in the next three years they plan to reduce the number of patients they see or stop practicing entirely.”
Source: http://conciergemedicinetoday.com/growth.html
Jay, I agree with you and STRONGLY disagree with the statement in this opinion that states ‘I think the concierge model doesn’t accomplish what we need in health reform – expanding the primary care base. It actually just decreases the common person’s access to physicians.’
According to Concierge Medicine Today’s fall 2009 research poll, when they asked currently practicing ‘concierge physicians’ ‘financially, how is your practice doing compared to one year ago?’ over 100% of physicians surveyed said Better or No Change. 72% also responded saying their concierge medicine practice was actually doing better than this time last year (while less than 28% indicated ‘no change’).
It’s clear that concierge medicine can provide an affordable, cost effective and straightforward relationship with a doctor. Furthermore, there are a lot of physicians out there that also see concierge medicine as a life-line to those primary care physicians across America considering alternative structures in their practice.
The Physicians’ Foundation Study (http://conciergemedicinetoday.com/pmdstudy.html) talks about the shortage of primary care doctors. I think concierge medicine can also be attractive to almost any medical resident and/or experienced physician that wants their future in medicine to be rewarding and fulfilling in the years ahead. I just read that Concierge Medicine Today also asked ‘current’ concierge physicians across the U.S., ‘before you started your concierge medicine practice, did you consider going into another career field outside of health care and medicine altogether?’ Over 60% of concierge physicians responded stating yes, ‘I seriously considered entering another career field outside of medicine before I decided to practice “concierge” medicine.”‘ If that’s not a huge red flag to the media, public and physicians I don’t know what is.
My second point is the $20,000 price tag the media wants to attach to “concierge” care. It should be clearly noted that there are A LOT of “concierge” medicine practices that offer monthly membership lower than $100. You can find a list of those physicians offering these prices in many places on the internet, but I would suggest people contact either Concierge Medicine Today (www.ConciergeMedicineToday.com), PriceDoc, SIMPD or the Direct Primary Care Coalition.
My last point is that to truly understand the definition or “concierge medicine”, you should know what it’s not and then learn what it is. Concierge Medicine refers to those primary care and family practice physicians who have chosen to provide healthcare services in a more convenient, accessible and cost efficient manner to their patients. These physicians charge patients a membership fee ranging from $600 to $1,800/year and higher. In exchange for this fee, concierge practices generally include 24/7 access to a personal physicians’ cell phone, same-day appointments with no waiting, personal coordination of care with specialists, personal follow up when admitted to a hospital or ER, house calls, and more.
While a typical physician can carry a patient load of 2,500+ patients, a concierge physician generally limits their practice to between 300-600 patients or more. Concierge medicine is also referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S., according to SIMPD.
Direct primary care (DPC) is a term often linked to its companion in health care, ‘concierge medicine.’ Although the two terms are similar and belong to the same family, concierge medicine is a term that fully embraces or ‘includes’ many different health care delivery models, direct primary care being one of them.
Similarities
DPC practices, similar in philosophy to their concierge medicine lineage – bypass insurance and go for a more ‘direct’ financial relationship with patients and also provide comprehensive care and preventive services for an affordable fee. However, DPC is only one branch in the family tree of concierge medicine.
DPC, like concierge health care practices, remove many of the financial barriers to ‘accessing’ care whenever care is needed. There are no insurance co-pays, deductibles or co-insurance fees. DPC practices also do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent (See Sources Below).
Differences
According to sources (see below) DPC is a ‘mass-market variant of concierge medicine, distinguished by its low prices.’ Simply stated, the biggest difference between ‘direct primary care’ and retainer based practices is that DPC takes a low, flat rate fee whereas omodels, (although plans may vary by practice) – usually charge an annual retainer fee and promise more ‘access’ to the doctor.
According to Concierge Medicine Today, the first official news outlet for this marketplace, both health care delivery models are providing affordable, cost-effective health care to thousands of patients across the U.S. MDNewsToday is also the only known organization that is officially tracking and collecting data on these practices and the physicians — including the precise number of concierge physicians and practices throughout the U.S.
“This primary care business model [direct primary care] gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach,” said Norm Wu, CEO of Qliance Medical Management based in Seattle, Washington. “One in which the provider’s incentives are fully aligned with the patient’s incentives.”