The concierge doctor will see you, immediately

By Sarah Willett, SVP, Commercial Banking

Is concierge medicine the wave of the future?

Physicians stretched thin due to high patient loads, heavy administrative responsibilities and shrinking insurance reimbursements may find relief by converting to concierge medicine, also known as retainer-based medicine. This health care model consists of fewer patients per doctor and can be beneficial to patients by providing them more personalized care.

More time, more care…and more cost 
Under concierge medicine, typically, patients receive same or next-day appointments, comprehensive screenings, diagnostic services and 24/7 physician access. Concierge physicians offer detailed physicals and preventive screenings not traditionally covered by insurance, such as blood work to check heart inflammation markers. 

Since concierge medicine focuses on patient education and wellness, it makes sense that the top four concierge specialties are primary care, family medicine, cardiology and pediatrics. Generally, new patient concierge appointments run 60 to 90 minutes with follow-ups lasting 30 to 45 minutes, as compared to 10 to 20 minute doctor appointments in a traditional practice.  

However, longer appointments come at a price, given that concierge practices charge patients annual membership (retainer) fees ranging from $1,500 to $2,700, according to data from Concierge Medicine Today (CMT). Insurers don’t reimburse patients for membership fees -- but do pay for covered services if the concierge doctor sets up his or her practice to bill for them. CMT says 80 percent of concierge doctors accept insurance for appointments and services. 

Concierge patients attain coverage for emergency care, urgent care and specialist visits by signing up for employer or marketplace health care plans. Monthly premiums for those plans are in addition to concierge membership fees, so the cost of medical care can add up for concierge patients.

Concierge patients and practices
But concierge doctors argue their services reduce patient visits to specialists and hospitals, thus reducing overall costs for patients. In a 2015 interview with Healthline, the CEO of MDVIP claimed a 90 percent reduction rate in hospital visits for concierge patients. (MDVIP is a Florida-based company that provides administrative support to primary care doctors who convert to concierge practices; in exchange, MDVIP receives one-third of physician concierge retainer fees).

A 2015 CMT survey states 33 percent of concierge practices are in urban areas, while 42 percent are in the suburbs. Top states for starting a concierge practice include California, Florida, New York and Texas. Concierge doctors are typically 40 to 59 years old, and concierge patients tend to be upper-middle-class baby boomers with annual household incomes of $125,000 to $250,000. 

Pressures on doctors
There are concerns that concierge medicine creates a two-tier health care system for patients. The New York Times reports that Massachusetts General Hospital was founded to serve the poor, but has added a concierge practice with a $6,000 annual membership fee. Another question is whether concierge medicine will further exacerbate the doctor shortage that patients will face in the coming years. Such concerns appear to be valid, because concierge care can be unaffordable for many people, and concierge doctors do see limited numbers of patients.

But doctors see things differently. 

Medical Economics quotes numbers that say 81 percent of doctors feel overextended, and physicians spend 20 percent of their time on non-clinical paperwork. As the health insurance claims process grows more complex, physicians may wish to simplify their operations.

In a concierge office, doctors can be more patient-centered. Longer appointments can mean a less frantic pace, greater career satisfaction and an improved quality of life. Because concierge physicians see fewer people per day, patient-physician relationships can be improved. In addition, doctor administrative workloads are lower, so they don’t require as many staff members. 

This may be why 7 percent of doctors now practice some form of retainer-based medicine (concierge or direct pay), and 13 percent plan to convert to it in full or in part, per the 2014 Survey of America’s Physicians. (This survey was conducted on behalf of The Physicians Foundation by Merritt Hawkins). CMT states that only 12,000 of 904,500 U.S. physicians currently practice concierge medicine, but the rate is growing at 5 percent – 6 percent per year.

For doctors who wish to open a concierge practice, the professional membership group American Academy of Private Physicians (AAPP) suggests that they network, educate themselves on trends, and develop marketing and business ownership skills before making the leap. Physicians who intend to convert from a traditional practice will do best if they have long-standing patients, a solid reputation in the community, and six months or more to inform patients, according to Medical Economics.

Examples of concierge practices:

  • In Pittsburgh, Connected Health opened a 20,000 square foot practice in 2015 in the upscale Wexford area. Per the Pittsburgh Post-Gazette, there are four exam rooms, plus a dietitian, pharmacist, personal trainer and fitness facility. Medical Director Dr. Andrew DeMarco, an internist, has 150 patients. He does not bill or accept insurance, except for prescriptions. He charges a $2,100 annual fee (reduced to $600 for teens, $3,600 and up for customized programs).
  • In Atlanta, primary care physician Dr. Edward Espinosa runs Buckhead Medicine, which he founded in 2008. He sees seven to 10 patients per day at either the hospital, patient’s home, or his office in Buckhead. He has 300 patients, accepts insurance for covered services, and charges an annual fee starting at $1,200 (billed via automated monthly payments).
  • In Chicago, Dr. Lauren Streicher opened her women’s health concierge practice in 2016, at Northwestern Medical Group near the Magnificent Mile shopping district. She focuses on complex gynecological issues and touts extended services and a comfortable, unhurried atmosphere. She accepts insurance for covered services and charges an annual personal care fee of $1,000.

Conclusion
Concierge medicine can be an alternative model for doctors who seek a calmer way of operating their practice. It can also work well for patients who seek a higher level of care and have the means to pay for it. Becker’s Hospital Review examines the idea that hospitals may soon find concierge medicine a viable option too, as it can provide economic benefits and alleviate financial pressures for these institutions just like it can for physicians.