National Headlines

BOSTON, OP/Ed: ‘In truth, not all of America’s great doctors are moving to the gated communities of concierge care.’

The concierge doctor will see you now

By Alex Beam / The Boston Globe

Published: August 11. 2013 4:00AM PST

For many years, Dr. Edward Legare was my primary care physician. My wife chose him for me. “He served in the military; you’ll like him.” She was right. I liked the citation from the Army’s Tenth Mountain Division on his wall, and I liked his succinct dietary advice — “Eat less fat” — which I assiduously ignored.

After some soul-searching, Legare decided to join a high-end “concierge” practice a few years ago, and asked his patients to pay an extra $1,500 for his services.

I declined.

His group practice shunted me to another talented young internist, Dr. Eric Serrano. Then — poof! He’s gone concierge, too. He wants $1,800 a year, he explains in a letter, “to ensure we have unhurried time together whenever you need me, and you continue to receive the individual attention and services you deserve.”

I’m paying about $10,000 a year for a family health plan, and, like most Americans, I see my doctor about twice a year. Harvard Pilgrim Health Care can’t keep decent doctors around for me to consult with? What’s going on here?

Harvard Pilgrim didn’t want to discuss this issue, but plenty of other people did. Legare and a colleague, Dr. Harold Solomon, praised the concierge doctoring model because the extra income allowed them to get their patient load under control. BC (before concierge) Legare was responsible for 3,800 patients, “It was overwhelming,” he said. “I was worried that I was starting to miss things. I was involved in only about half of my patients’ major medical decisions.”

Both Solomon and Legare said they retained “scholarship” patients, people who they knew might not be able to pony up the $1,500-$1,800 premium for their services. Then Solomon turned the tables on me: You have the money, don’t you, Mr. Beam? Why didn’t you pay?

Fair question. I just bought a new rowing shell, which would have paid for two years’ worth of concierge care. But the concept makes me sick. I entered the workforce just as Health Maintenance Organizations came on the scene, and I never had a problem with semi-collectivized health care. The system provided me with competent doctors and access to decent hospitals if I needed it. Why should I submit to this “concierge” shakedown when I’m already paying so much for health coverage?

But enough about me. In truth, not all of America’s great doctors are moving to the gated communities of concierge care. According to the most recent Medscape survey of over 21,000 doctors, “The percentage of physicians in a concierge or cash-only practice increased very slightly from the previous year, from 4 percent to 6 percent.” More ominously, 15 percent of family physicians said they would no longer accept Medicare or Medicaid payments.

The American Medical Association isn’t overly concerned about concierge care, which it calls “retainer practices.” They “are consistent with pluralism in the delivery and financing of health care,” according to the AMA. “However, they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

“Right now it’s a small trend,” says James Burgess, a health care economist at Boston University. “Some people are worried about creating multiple classes of medicine in the U.S.,” but he isn’t one of them, for now. “It’s going to take a while for the system to find its equilibrium,” he says.

Burgess and others think that retainer practices, sometimes called “direct primary care,” may be part of the health care solution rather than the problem. The idea is this: You pay for your primary care out of pocket, and pay insurance premiums to protect yourself from high-cost medical procedures and hospitalizations.

Companies like Cambridge-based Iora Health Care and others already offer reasonably priced ($50-$70 a month) primary care plans that allow doctors to keep their patient load at manageable (i.e. 600-700) levels. Insurance coverage would be reserved for the big-ticket procedures delivered by, say, hospitals.

“Your auto insurance doesn’t cover new brakes, or basic maintenance,” explains consultant Thomas Charland of Merchant Medicine, “and these direct payment plans work on that model. You pay for primary care completely outside of insurance — it’s concierge medicine for the masses.”

Meet the future, like it or not.

— Alex Beam is a columnist for The Boston Globe.


1 reply »

  1. This is no longer true. Many forms of concierge medicine (more than 62% according to cost less than $135 per month. In Seattle, Washington, one direct primary care clinic offers concierge care to patients for $39 to $79 per month, based upon the age of the patient. The cost of concierge medicine depends upon the services that are offered by the individual doctor. Costs typically range from $1,000 per year to $1,800 per year.

    The big lie in the discussion about this topic across the nation is that Concierge Medicine is only for the rich and it’s ‘elitist.’ Concierge medical programs for patients have actually been proven to save individuals and families money. Furthermore, a recent in a prominent national U.S. newspaper supports this belief, among other sources. The paper reports that the state of Indiana has a high-deductible plan and another that’s a traditional HMO. People in the high-deductible plan spend thousands less than those in the HMO. “The average expense in 2009 for patients on one of these [high-deductible] plans was $6,393,” the paper writes, “compared with $8,570 for patients enrolled in a more traditional health maintenance organization plan.”

    Some programs cost as little as $10 per month for children. A practice in Wichita, KS offers flat monthly fees ranging from $10 per month for kids and $50 ,$75 or even $100 per month for adults based upon age. Members of that concierge medical practice receive unlimited access to the doctor at their home, work or the doctor’s office along with unlimited “technology visits” like cell phone, web cam, email and texting. Furthermore, many concierge physicians offer access to wholesale pricing on prescriptions, lab tests, imaging services and medical supplies for pennies on the dollar.

    Concierge Medicine Today recently submitted data to a prominent financial magazine stating that: ‘Utilizing a blended rate based upon national averages for current fees charged for concierge medical care, an estimated 9,285,714,286 people could be provided concierge medical care with the 13 trillion dollar debt. Carrying this out 928,571,429 people could be provided this care for 10 years. These figures are based upon information obtained through average pricing surveys conducted from 2009-2010 by The Concierge Medicine Research Collective.’

    Here’s the upshot: When you combine high-deductible health plan policies with a concierge medical program, you empower people and families to make better decisions about their health care, they in turn receive more comprehensive medical care and then the savings happen and stronger relationships occur between the physician and their patients. One California concierge physician recently made the statement that truly encompasses this fact when she says her patients can say ‘I no longer have a doctor who needs to look at my chart to know my name.’

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