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Academy News: June 2003 Concierge medicine: fad or future State by state, small numbers of physicians are developing medical practices that have come to be known as “concierge” or “boutique” medical practices. Although the number of such practices is very small, they have attracted much public attention and engendered much heated debate. At one extreme, it is said these practices represent an innovation that restores the deep and personal physician-patient relationship that has been eroded by the prevailing insurance coverage model of medical care. The counter position is that concierge medicine is, by its very nature, elitist and unethical with physicians providing more care for fewer patients, thus increasing the burden on the remainder of the health care system. Concierge medical practices can take different forms but common distinguishing features include: an annual fixed fee for a defined range of services, highly personalized service and a small panel of patients. Depending on the scope of included services, yearly retainer fees range from several hundred dollars to $10,000 or more. Additionally, practices limit their size so as to provide more personalized care and immediate access. Generally, the smaller the practice, the larger the retainer and more personalized the care. Some practices continue to bill insurance companies for covered services while others leave this responsibility to the patient. In some instances, a practice may develop a concierge service in addition to their traditional service. Usually, when patients need care not available in the practice, such as specialty consultation, the patient is responsible for these costs. Concierge practices offer more personalized health services that are not normally available in a traditional medical practice. These services may include items such as home or after-hours visits, same-day visits, no-waiting visits, periodic preventive care, lifestyle consultations, family consultations, around-the-clock, direct access to the physician, e-mail, online personal medical records and highly coordinated specialty care, including the physician accompanying the patient to a specialist consultation. Physicians in concierge practices cite the advantages of being able to spend more time with patients and practice a more personal form of medicine, something that was impossible in their previous practice situation. They concentrate on education and prevention, which they argue should result in better overall health for their patients. In addition, time previously spent in practice management can now be spent in activities that enhance patient care. Physicians also feel that they have regained control of their practices and their personal lives. Concierge practices face legal and regulatory scrutiny. Federal regulations raise concerns of possible double billing or violation of laws limiting charges to Medicare beneficiaries. Contracts with health plans, networks and IPAs may limit a practice’s ability to collect additional fees directly from patients or may have language that binds a practice to treat its members in a “non-discriminatory” manner. In some states, regulators raise the issue that medical practices offering a bundle of services for a fixed fee can be interpreted as providing insurance and therefore are subject to state insurance statutes. Conversion of a traditional medical practice to a concierge practice, if not done appropriately, may lead to allegations of abandonment. Obviously, expert legal advice is necessary. Despite these hurdles, physicians in small numbers have cautiously and successively developed concierge practices. Additionally, there are now efforts to franchise such practices. (See www.MDVIP.com) At present the concierge practice model seems more suited to primary care. Specialty care when it is episodic, consultative or procedural does not lend itself to a concierge practice model. The highly personalized service aspect of the concierge practice model, however, has in some cases been successfully incorporated into specialty hospitals and specialty centers of excellence. Specialty practices that care for common chronic conditions, such as diabetes, cardiac disease and asthma, where the specialist becomes the principle physician, may be in a position to develop concierge practices. So, is concierge medicine a passing fad or the future? It should come as no surprise in an affluent society with numerous $5,000 per night luxury hotel suites and $50,000,000 personal jets, there are those individuals quite willing to pay annual retainers of $10,000 or more for personalized health care. This will continue but be limited to a very small minority of practitioners in large population centers. The big question is: What is the future market for more modestly priced personalized health care? The answer will depend on several factors. First, the purchaser patient, now using his own discretionary funds, must see value in the added services of the concierge practice. Second, possible governmental legislation and regulation has the potential to impede or facilitate the trend toward concierge medicine. Third, insurance and managed care companies can choose to resist this trend or alternatively facilitate this trend by developing new products that leverage the concierge care concept. Finally, a sufficient number of physicians must be willing to risk this change in practice. |
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