American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Concierge Medicine Is Here and Growing!!

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An increasing number of primary care physicians are downsizing to a concierge medical practice (also termed “retainer-based medicine”). In a concierge medical practice, the physician limits the number of patients in his practice and offers exclusive services for an annual fee. The patient pays a surcharge for increased access and additional services from their physician.1

Advantages to Physician

To maintain income, many primary care physicians are seeing more patients and spending less time with them.2This has led to the “burn out” of some primary care physicians.4

The primary advantage of a concierge practice is that the panel of patients is smaller, ranging from 400 to 600,2compared with a panel size of 2000 to 3000 in a typical primary care practice.5 As a result of the smaller panel size, a concierge physician sees 6 to 8 patients per day compared with 20 to 24 patients for the typical primary care physician.367

The smaller panel size allows the concierge physician to spend 30 minutes or more for each visit and several hours on executive-type annual physical examinations. The extra time allows the concierge physician to offer a comprehensive assessment and customized treatment plan, including lifestyle and preventive services for optimum health.

Concierge physicians are able to respond to phone and e-mail messages, and offer same-day or next-day appointments. There is far less time spent on billing and paperwork.5 The decreased billing results in a lower overhead. Most concierge practices have only 1 or 2 employees.7 Reimbursement is more assured, and income usually equals or surpasses the income for the typical primary care physicians.37 Some report greater work satisfaction and less burnout in concierge practices.8

Advantages to Patient

Patients in a concierge practice appreciate the immediate access to their physician by cell phone, e-mail, and same-day appointments, and minimal waiting time in private, pleasant waiting rooms.3 Visits are 30 minutes or longer and allow patients to present all their concerns.

The physician coordinates care with other providers, with follow-up calls after specialist visit or hospitalizations. Their physician may accompany them to specialist visits and makes hospital and home visits when indicated.6Some laboratory tests and procedures are available at the physician’s office.

Charges

Concierge practices charge an annual retainer that averages $1500 per year to $1700 per year, approximately $135 per month.7 The annual fee has remained stable.4 Medicare does not cover the annual retainer.

Some concierge physicians offer reduced retainers of $200 per year for less-extensive access.4 There is no charge and no co-pay or deductible for office visits, home or hospital visits, or office procedures.79 Most concierge physicians bill Medicare and other insurance for office visits and procedures.5 Patients are not charged co-pays or deductibles.7

Concierge patients still need health insurance for hospitalizations, specialists, and tests performed outside the concierge office.3 Many concierge patients elect high deductible insurance.

Number of Concierge Practices

One of the first concierge practices was established by a noted Los Angeles cardiologist, Myron Prinzmetal in the early 1960s.10 He limited his clinical practice to spend more time in research. Several of his fellows went on to become “Doctors to the Stars in Hollywood.”1112

Concierge practices were established in Seattle in the late 1990s.6 By 2010, there were 2400 to 5000 concierge practices in the United States.5 By 2014, the number had increased to 12,000.2

The increase in concierge practices is due in part to the emergence of organizations that recruit concierge physicians and manage concierge practices. One of the largest, MDVIP, was founded in 2000 and was bought by Proctor & Gamble in 2009. In 2015, they managed practices with more than 800 physicians and 240,000 patients in in 42 states.13

The majority of concierge physicians are general internists; 20% are medical subspecialists2 and 20% are family practitioners.5 Most concierge practices are in large urban areas on both coasts.5

 

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-James E. Dalen, MD, MPH, ScD (hon), Joseph S. Alpert, MD

This article originally appeared in the August 2017 issue of The American Journal of Medicine.

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