Concierge medicine

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There are typically three primary types of concierge medicine business models practiced today. Variations of these models exist, although most models usually fall into one of the following categories.

The Fee for Care ('FFC') is an annual retainer model, where the patient pays a monthly, quarterly, or annual retainer fee to the physician. The retainer fee covers most services provided by the physician in his/her office. Often, vaccinations, lab work, X-rays, and other services are excluded and charged for separately on a cash basis.

The Fee for Extra Care ('FFEC') is similar to the FFC model, however, the additional services are charged to Medicare or the patient's insurance plan. Some of the benefits and services typically included in these two retainer models are: same day access to your doctor; immediate cell phone and text messaging to your doctor; unlimited office visits with no co-pay; little or no waiting time in the office; focus on preventive care; unhurried atmosphere; cell phone, text message, and online consultations; prescription refills; and convenient appointment scheduling.

FFC or retainer plans may typically not be purchased with pre-tax dollars utilizing HSA and/or FSA accounts because it is not a fee incurred for a service. Instead, it functions more as an insurance policy where fees are paid in anticipation of an expense.

There is also a hybrid concierge model where physicians charge a monthly, quarterly, or annual retainer or membership fee for services that Medicare and insurers do not cover. These services may include: email access; phone consultations; newsletters; annual physicals; prolonged visits; and comprehensive wellness and evaluations plans. For all covered services, these providers will bill Medicare and insurance companies for patient visits and services covered by the plans.[http://conciergemedicine101.com/models.html "Business Models Used In CONCIERGE MEDICINE" Concierge Medicine Today, 2011] This model allows the physician to continue to see their non-retainer patients while billing their "concierge" patients a fee for the increased or "special" services. Some concierge practices are cash-only or 'direct' primary care practices and do not accept insurance of any kind. In doing so, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients.[http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1200.htm "Cash-Only Healthcare Still Works" Physicians Practice Journal, July 2008]

Concierge physicians care for fewer patients than those in a conventional practice, ranging from 50 patients per doctor to 1,000, compared to 3,000 to 4,000 patients that the average traditional physician now sees every year.[http://www.physicianspractice.com/index/fuseaction/qa.details/qaID/115.htm "On Panel Size" Physicians Practice Journal, June 2005] All generally claim to be accessible via telephone or email at any time of day or night or offer some other service above and beyond the customary care. The annual fees vary widely, ranging, on average, from US$195 to US$5,000 per year for an individual with incremental savings when additional family members are added. The higher priced plans generally include most "covered" services where the client is not charged additional fees for most services (labs, xrays, etc.). Some of the other benefits of concierge healthcare are: in-home visits, worldwide access to doctors, and expedited emergency room care.{{citation needed|date=September 2015}}

An informal one-year summary of findings related to the concierge medicine marketplace in the US was released in February 2010.{{cite web |url=http://www.askthecollective.com/|title=The Concierge Medicine Research Collective - Est. 2007 |website=The Concierge Medicine Research Collective - Est. 2007 |year=2010 }}{{full|date=December 2019}} The summary of the study concluded that at the end of 2009, over 66% of current U.S. concierge physicians operating practices were internal medicine specialists; and the second most popular medical specialty in concierge medicine was family practice. The study also noted that the number of concierge dental and pediatric practices increased markedly since February 2009.

In 2004, the Government Accountability Office counted 146 such practices, mostly concentrated on the US east and west coasts with practices such as MDVIP, [https://hoagconciergemedicine.com/ Hoag Concierge Medicine], and [https://signaturemd.com SignatureMD] being among the oldest. {{asof|2006}} the American Medical Association did not track the number of concierge practices because the concept was so new."Boutique Medicine: When wealth buys health", CNN.com, October 19, 2006.{{full|date=December 2019}} Lower-cost concierge medical business models have also been attempted, such as GreenField Health in Portland, Oregon, which charged an annual fee between $195–$695 depending on age. Another is One Medical, the first major low-cost concierge medical group to attempt this model in a large scale, which requests a $199 annual membership fee."Concierge Medical Care With a Smaller Price Tag", NYTimes, January 31, 2011.{{full|date=December 2019}}

Direct primary care (DPC) is a term often linked to concierge medicine. While the two terms are similar, concierge medicine encompasses many different health care delivery models, including direct primary care. Both are variants of traditional primary care common in the United States, typically based on health insurance.

Direct Primary Care 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.[https://www.signaturemd.com/CONCIERGE-MEDICINE-FOR-PATIENTS/ " CONCIERGE MEDICINE FOR PATIENTS" signatureMD] {{webarchive|url=https://web.archive.org/web/20140408215955/https://www.signaturemd.com/CONCIERGE-MEDICINE-FOR-PATIENTS/ |date=2014-04-08 }}

DPC practices remove one of the financial barriers to accessing care whenever it is needed: the DPC annual fee often includes most or all physician services. This model does not rely on insurance co-pays, deductibles, or co-insurance fees, in contrast to models such as MDVIP and 1 on 1 MD, where the annual fee is structured to cover a wellness plan[http://www.mdvip.com/patient/yourwellnessplan.aspx mdvip.com] {{webarchive|url=https://archive.today/20110714063530/http://www.mdvip.com/patient/yourwellnessplan.aspx |date=2011-07-14 }}[http://www.vvmed.com/one_on_one.html 1 on 1 MD] {{webarchive|url=https://web.archive.org/web/20140106234234/http://www.vvmed.com/one_on_one.html |date=2014-01-06 }} so that doctors may charge insurance or Medicare for most other services.

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 flat rate fee whereas concierge models usually charge an annual retainer fee and promise more access to the doctor.

The concierge medicine model, although not the term,{{cite magazine | title=The "Highly Attentive" Approach | magazine=Worth | date=July 2005 | url=https://www.md2.com/images/press/source/WORTH_-_The_Highly_Attentive_Approach.pdf}} originated with MD² International, which was founded in 1996 in Seattle by Dr. Howard Maron and Dr. Scott Hall.{{r|Knope 2010|p=12}} At the time, Maron was physician for the Seattle SuperSonics sports team, and sought to provide luxury primary care services similar to what he had been providing these athletes.{{cite book | last=Knope | first=S.D. | title=Concierge Medicine: A New System to Get the Best Healthcare | publisher=Rowman & Littlefield Publishing Group, Incorporated | year=2010 | isbn=978-1-4422-0708-0 | url=https://books.google.com/books?id=vQa_AAAAQBAJ&pg=PA12 | access-date=27 June 2019}}{{rp|12}} MD²'s model included physician patient loads of 50 families,{{r|Knope 2010|p=13}} dramatically reduced compared with the conventional American patient load of about 3,000 patients per year. Advantages include very quick access to your personal physician as needed, and the ability to see doctors in any of 10 major cities at a greatly increased cost.{{cite news|url=https://www.wsj.com/articles/SB10001424052702303812904577295501951423484|title=Is Paying for 'Concierge' Health Care Worth It?|first=Karen|last=Blumenthal|date=23 March 2012|work=Wall Street Journal}}{{cite news | last=Williams | first=David E. | title=Boutique medicine: When wealth buys health | work=CNN | date=20 October 2006 | url=http://www.cnn.com/2006/US/10/19/bil.healthy.wealthy/}}"The Highly Attentive Approach," Worth magazine, July 2005.

MD² clients have insurance to cover additional services beyond primary care, but MD²'s fees cover the full costs of their services and MD² does not bill insurance.{{r|Knope 2010|p=13}}

MD²'s approach became widely known very quickly, and many physicians sought to emulate the model in a less costly fashion.{{cite book | last1=Prince | first1=R.A. | last2=Schiff | first2=L. | title=The Influence of Affluence: How the New Rich Are Changing America | publisher=Crown Publishing Group | year=2008 | isbn=978-0-385-52529-9 | url=https://books.google.com/books?id=UhLAr5NOtmYC&pg=PA103 | access-date=27 June 2019 | page=103}} MDVIP emerged as a competitor to MD² with a similar model, but they opted to bill insurance in addition to charging client fees and have patient loads of up to 600. This enabled them to charge substantially lower rates.{{r|Knope 2010|p=13}} In 2006 [http://signaturemd.com SignatureMD] was founded which offered more flexible conversion options. By 2010, one quarter of all doctors operating with a concierge medicine model were affiliated with MDVIP.{{r|Knope 2010|p=153}} In 2017, a new company named Forward, started by former Google and Uber employees with strong venture capital support, began offering concierge medicine services for {{inflation|US|149|2017|fmt=eq|r=-1}} per month.{{cite news | last=Robinson |first=Melia |title=Google and Uber alums have created a doctor's office that's like an Apple Store meets 'Westworld' - and it's expanding nationwide | website=Business Insider | date=15 November 2017 | url=https://www.businessinsider.com/san-francisco-forward-office-tour-2017-1}}{{cite news | last=Swartz | first=Jon | title=Forward puts Apple Store shine on doctors office | work=USA Today | date=17 January 2017 | url=https://www.usatoday.com/story/tech/2017/01/17/forward-puts-apple-store-shine-doctors-office/96405836/}}

Common services include 24/7 phone access, same-day appointments, short waiting times, preventative health and wellness services, and accompaniment when seeing specialists or in the emergency room.{{r|Knope 2010|p=15}}

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In the next one to three years, do you plan to switch to a cash/concierge practice?

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By 2000, there were a handful of concierge medicine providers in the United States.{{r|Knope 2010|p=12}} In 2005, there were about 500 physicians practicing using the model.{{r|Marcinko Hetico 2010 p. 562}} By 2008, there were over 100,000 people contracting with about 300 physicians.{{r|Prince Schiff 2008 p. 103}} By 2010, there were over 5,000 physicians{{cite book | last1=Marcinko | first1=D.E. | last2=Hetico | first2=H.R. | title=The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition | publisher=Springer Publishing Company | series=Springer Series | year=2010 | isbn=978-0-8261-0575-2 | url=https://books.google.com/books?id=pRnTps2S1rcC&pg=PA562 | access-date=27 June 2019 | page=562}} in over 500 providers using the model.{{r|Knope 2010|p=12}}

From 2012-2018, the Physicians Foundation has conducted a biennial survey of physicians and found that between 4.5-8.8% plan to switch to a concierge model each time.{{cite web |last=Hawkins |first=Merritt |date=September 2018 |title=America's Physicians: Practice Patterns & Perspectives |publisher=Physicians Foundation |url=https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf#p=14 |page=14}}

In 2012, there were 4,400 private physicians – a 25% increase from 2011.{{cite news|url=http://www.marketwatch.com/story/why-concierge-medicine-will-get-bigger-2013-01-17|title=Why concierge medicine will get bigger|first=Elizabeth|last=O'Brien|newspaper=Marketwatch }}

The concept of concierge medicine has been accused of promoting a two-tiered health system that favors the wealthy,"Your Own Private Doctor" by Mary Duenwald, Departures magazine, November/December 2004. limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. Detractors contend that while this approach is more lucrative for some physicians and makes care more convenient for their patients, it makes care less accessible for other patients who cannot afford (or choose not) to pay the required membership fees.United States Government Accountability Office, Report to Congressional Committees, [http://www.gao.gov/new.items/d05929.pdf "Physician Services: Concierge Care and Characteristics and Considerations for Medicare,"] August 2005.

In early 2008, it was reported that one health insurer was dropping from their provider networks some physicians who charge an annual fee. Another insurer also expressed opposition to annual fees. Other insurers do not oppose concierge medicine as long as patients are clearly informed that the fees will not be reimbursed by their health plan.Lynn Cook, [http://www.chron.com/disp/story.mpl/headline/biz/5618372.html "Insurers, doctors at odds over 'concierge' care"], Houston Chronicle, March 13, 2008.

In 2003 and 2005, several members of Congress introduced or cosponsored bills that would have prohibited physicians from charging retainer fees. No action was taken, and it appears that no similar bills have been introduced in more recent Congresses. In the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the Congress directed the GAO to study concierge care and its impact on Medicare patients. The GAO report, published in 2005, concluded that the "small number of concierge physicians makes it unlikely that the approach has contributed to widespread access problems". In its comments on that report, DHHS noted its agreement with GAO's findings and stated that it would continue to monitor the trend. No specific information is available on monitoring activities.{{cite news|url=http://www.huffingtonpost.com/2011/04/02/concierge-medicine-medicare-health-care_n_844042.html|title=Spread Of Concierge Medicine Prompts Medicare Worries|work= Huffington Post|first= Ricardo |last=Alonso-Zaldivar|date= February 4, 2011 |time=11:14 AM ET}}

The USA Network television series Royal Pains focuses on such a doctor's introduction to the practice of concierge medicine. A young doctor becomes a for-hire physician for the wealthy residents of the Hamptons.

Also on USA Network television series Rush focuses on a doctor who serves rich, secretive clients.

The Robin Cook novel Crisis focuses on a medical malpractice trial involving a doctor practicing concierge medicine.

• Direct primary care
• House call
• VIP medicine

{{Reflist}}

• [https://www.medicare.gov/coverage/concierge-care Medicare - Concierge Care]

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Category:Healthcare in the United States

Category:Primary care