Concierge Medicine: Why It May or May Not Work

Maybe we dodged a bullet. A feisty government reform bullet that planned to cut nearly 27% of Medicare payments to doctors, substantially diminishing their reimbursements. Still, the recent brush with healthcare reform's cost-cutting shears, coupled with the woes of an imminent "fiscal cliff" and an economy that continues to sputter, has many physicians actively re-evaluating their plans for their future livelihoods. And that's not to say that the Federal Government is done amending the current structure of Medicare (most likely as a result of spending $486 billion on it in 2011) as proposals to raise the eligibility age and implement more income-based pricing abound. As it goes currently, Medicare reimbursements usually only cover a physicians basic overhead (i.e. keeping the lights on) with not much left over for their salary. For many, this scenario proves a breeding ground for distinct departure from the norm and a step into a new model of practicing medicine.

Enter: Concierge Medicine

The term "concierge medicine" may come coated in a number of connotations…maybe it's the fancy French etymology. By way of explanation, the format utilizes a practice model that practically sidesteps the insurance component of medicine altogether. Willing patients pay an annual fee (the current annual average fee comes to about $1,800) in exchange for their physician to be on call for them 24 hours a day 7 days a week. None of these medical costs are reimbursed by insurance, and most concierge physicians will devote their time full tilt to a few patients, rather than have their services spread thin over many.

Perhaps it comes off like an outlying trend, a move too maverick and renegade for the average primary care physician. However, a recent study conducted by Merrit Hawkins group found that almost 10% of physician practice owners in the United States plan to phase their traditional approach into the concierge style of medicine. What's more telling is that currently, about 4,400 private physicians practice concierge medicine in the United States. This indicates a 25% increase from the amount in 2011. With results taken from a 600,000 total of practicing doctors, this evens out to about 1.5 million American patients who seek care under the watch of a concierge physician. It's a substantial sector of the medical community, and one highly worth investigating for the curious practice owner and fiscally-minded physician.

Patients: What's to Like

Often colloquially termed "boutique," "personalized," "private-physician" or "direct physician" practice, concierge medicine stakes its claim by putting all a physician's resources directly into the forefront of thorough and immediate patient care.

In the eyes of many patients, the concierge route adds up to a less stressful approach to traditional medicine practice. Since patients pay more money in the form of a standardized fee, they get more face time with their physicians. Gone is the frustration of a rushed 10 minute visit, as many concierge physicians offer physicals that can last a few hours (if the patient wishes), and many feel confident knowing that their money is going directly back into the healthcare industry…and not that of insurance.

 Fence walkers may note that different levels of concierge care exist, and in some cases the type and extensiveness of a physician-patient relationship may be predicated on a predetermined price. On one end of the spectrum, patients may wish for a completely flexible patient to be on call under any circumstance, even sometimes taking them on vacation. Others may prefer a less inclusive method, that still grants them quality care and visit time.

Additionally, some concierge services will still accept Medicare, but they won't rely on it to meet their costs. In these instances, the annual fee they charge their patients helps offset any future budget cuts to the Medicare program, and keeps patients covered.

Concierge Medicine = Proactive and Holistic Health

Some medical experts champion concierge medicine as a step towards more proactive medicine. Traditionally, especially as healthcare becomes even more strained, physicians treat patients in a "reactive" setting rather than a preventative setting. That is, only in disparate blocks after something goes wrong. Concierge medicine also offers a more "big picture" approach to maintaining patient health. Rather than simply plugging up leaks and cracks that appear after the fact, concierge physicians help patients cultivate whole-body health to prevent problems further down the line. “The incentives now are for piecework and symptomatic care,” said Robert Williams, director of Deloitte’s life sciences and health-care consulting practice.

Other studies of concierge medicine highlight its lower hospitalization rates, and better overall public health as a result of the holistic approach. Two recent studies financed by the MDVIP and published in the American Journal of Managed Care illustrated a 79% reduction in hospital admissions for Medicare patients in concierge-style environments versus those in traditional practices. The studies also highlighted a 72% decrease for those patients between the ages of 45 and 64 who used commercial insurance in these types of practices.

These statistics also transfer to good management of chronic conditions. According to a study published in the International Journal of Person Centered Medicine, patients in concierge-style practices better managed their chronic ailments, and as a specific example cited that 83% of patients with diabetes showcased good blood pressure control, against the 50-60% that is the national benchmark.

Many insiders also point to the fact that personalized-medicine patients remarkably insulated from the ups and downs of health-care inflation, at least in terms of their annual retainer. These fees stay stable (according to a study by the American Academy of Private Physicians) and flat, with the exception of insurance premiums rising. And with a decreased patient workload, it may stave off the debilitating effects of physician burnout.

The Other Side

Though concierge method isn't exactly new, it still draws critics. One of the more prescient concerns with introducing concierge healthcare is the "exclusivity" of it all. While patients will receive top-notch treatments, some consider it a system only suitable to American citizens of certain means. This is to say that the idea of personalized physician-patient care introduces a "two-tiered" system of healthcare, and divides the populace on important issues, drawing a line between perceived "haves" and "have-nots." It may be perceived as "elitist" and catered only to the affluent.

Furthermore, when physicians abandon traditional models of medicine in favor of the concierge method, they cut their patient load by approximately 80%. This means that other physicians in their respect regions and field need to pick up the slack, further burdening resources and potentially putting a greater strain on the already growing problem of primary care physician shortage.

How it Will Play Out

According to a post by John Schumann on KevinMD.com, the concept of concierge medicine is "win win lose." Physicians seeking financial security win, patients who are already on board with the model win, but the losers are everyone else. "Very few people can, or will, opt to this model," he says.

Not all share this view though. Johns Hopkins’ Dr. Wu says the country already has a multi-tiered health-care system, with some people on government insurance, some on private insurance, and others served by veteran’s plans or community clinics. There isn't always a stark divide between haves and have nots and the passage of the Affordable Care Act will only create a new class of patients termed “have somes.”

Ultimately, the method has its pros and cons, and tightening economic decisions can only bolster its appeal.

References

Dudley, Steve. "Concierge Medicine Has a Cost for All Patients."

Los Angeles Times. Los Angeles Times, 27 June 2011. Web. 18 Feb. 2013. 

Here and Now. "New Trend In Health Insurance: Low-Cost Concierge Medicine."

Hereandnow.org. WPUR FM, 10 Dec. 2012. Web. 19 Feb. 2013

Leonard, Devin. "Is Concierge Medicine the Future of Healthcare?"

Businessweek.com. Bloomberg, 29 Nov. 2012. Web. 18 Feb. 2013. 

McClung, Dave. "Concierge Medicine News." Concierge Medicine News.

Concierge Medicine News, 1 Feb. 2013. Web. 18 Feb. 2013. 

O'Brien, Elizabeth. "Why Concierge Medicine Will Get Bigger: Practices Could

Shield Patients From Health-Care Turmoil." Marketwatch.com
The Wall Street Journal, 17 Jan. 2013. Web. 18 Feb. 2013. 

Schumann, John, MD. "Concierge Medicine: Winners and Losers." KevinMD.com.

KevinMD, 10 Dec. 2012. Web. 19 Feb. 2013.

 

Dylan J. Chadwick

 

Dylan Chadwick is a graduate of Brigham Young University where he earned a Bachelor of arts in English and a minor in Spanish. Though spending his formative years in Cardiff Wales, he came to adolescence in Elizabethtown Kentucky, and considers it his home. He received the Eagle Scout Award, served a voluntary humanitarian mission to inner-city Los Angeles from 2007 to 2009, and once met Alan Alda on a golf course. He's an avid writer who cut his teeth contributing to student papers and continues writing for various print magazines, blogs and web resources. A ravenous fan of baseball, rock music and Dan Aykroyd-era Saturday Night Live, he plans on one day utilizing these interests in a Masters degree in American Studies and Literature. He also maintains a freelance illustration company on the side.