Welcome to our PhysicianTrends Blog.  We're here to talk about physicians and how they are changing in the midst of the most massive transformation in our healthcare system since Medicare.
Tuesday, 20 December 2011
DG Comfort

The Pros and Cons of Concierge Medicine

Written by  DG Comfort

Concierge Medicine (CM) is a concept where patients pay an annual fee, similar to a retainer fee that attorneys receive, that allows the payee constant access to their personal physician.  The fee can range from $1000 to $15000 per year, but averages $1500-1800 per patient.  For this fee the patient receives 24/7 access to their personal physician, priority scheduling, and maybe discounts on routine and preventative screenings.  It sounds like a good deal for the patient, but what are the advantages and disadvantages for the doctor?

Concierge Medicine Advantages

The most attractive advantages for any physician in setting up a CM practice is the guaranteed income.  If you can persuade 800 patients to advance you $1500 each to obtain a higher level of medical service, that translates into $1,200,000 in guaranteed income per year.  Depending on what you decide to include for this fee, this can be almost exclusively additional income.  Most CM practices include 24/7 access to the personal physician, handling all correspondence with insurance companies, integrating any referrals necessary, and transportation for invalid patients.

CM practices have a greatly reduced number of patients in each doctor’s practice.  Though no definitive numbers are available, physicians who have switched to CM practices limit the number of patients they see to somewhere between 500 and 1,000.   This compares to the typical fee-for-service practice where the doctor may have an average of 3,000 patients.  The greatly reduced overall case load allows CM doctors to spend more personal time with patients and establish a better doctor-patient relationship.  The reduced stress levels and patient load may be all the reason you need to switch to a CM practice.


Disadvantages of Concierge Medicine

Patients may expect a significant amount of the physician’s time for the fee that they are paying.  If you promise 24/7 availability for your patients, then you must available all day everyday.  There will most certainly be a small number of patients who will be contacting your office for every little ache and pain.  Some of the elderly or lonely patients will contact your office for every perceived physical problem, and even if your staff can handle most of these calls, they can be time consuming and personally draining.  If you promise house calls as one of the services included in your Concierge fee, it may be more difficult to schedule personal time or vacations.  While most patients are reasonable and recognize that you need your time off also, there will be a certain number that feel that they are paying a high fee for 24/7 access to your time, so they will expect that you will provide the time.

Make sure that you can fulfill all the benefits that you promise to provide for your concierge service.  If you promise same day appointments, you need to establish office procedures to allow for emergency (or perceived emergency) office visits.  If you can’t deliver the level of priority healthcare that you promise, it won’t take long for patients to realize that the fee is not worth the cost for them.  It will be very important to maintain an image of a high level of medical care or your attempt at a CM practice will be short lived.

Since the aim of the Patient Protection and Affordable Care Act (PPACA) is to provide the same level of healthcare for all Americans, any attempts by the medical professional to offer differing levels of service for patients who can afford it, is sure to be heavily scrutinized and regulated, if possible.  What form this regulation will take is debatable, but several options that the government has open to them include:

  • Prohibiting CM physicians from participating in Medicare/Medicaid programs
  • Prohibiting CM physicians from receiving any reimbursement from State run insurance exchange policies or programs
  • Extensive scrutiny for violations of any anti-discrimination laws

While CM practices can improve the medical care provided for the patients within the practice and may ultimately reduce healthcare costs through early detection and more personalized care, it has its limitations.  If the patient load of each CM doctor is one third that of a traditional practice, then simple math would require three times as many doctors to care for America’s citizens.  The only other alternative is for non CM doctors to take on more patients, which will ultimately lead to a two-tiered healthcare delivery system, which will lead to more clamoring for the government to do something.  Concierge Medicine has limitations that may benefit some healthcare providers and their patients, but it has a lot of detractors, that may limit its expansion.


Next week:  How to set-up a Concierge Medicine practice.

DG Comfort

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