Op/Ed: ‘Am I being asked to pay fees or for a concierge plan because other patients’ insurers don’t pay as well as mine does?’

By Noah Schneider | Yahoo Contributor Network

patient guide dpc smallJANUARY 30, 2014 – The large envelope from my doctor that arrived in the mail had me puzzled. I wasn’t expecting anything from him and I couldn’t imagine what he would need to tell me that couldn’t have been done more easily with a phone call.

Upon opening the envelope I was greeted by the newest wave of medical practice – Concierge Medicine.

“The medical practice has been dramatically deteriorating for the past several years,” Dr. Ivor G. (last name withheld on request), a prominent doctor in Los Angeles, said. “In order to maintain an exceptional level of service, I am obliged to follow the lead of most other physicians and offer an Enhanced Access Membership Program.”

As I discovered the Enhanced Access Membership Program – sometimes referred to as Boutique Medicine – is another word for Concierge Medicine, a fast rising service in the field of medicine. Was it something that was right for me? I needed more information and set out to find it. What I found might also be useful for you.

According to an article in the Los Angeles Times, concierge medicine started in the 1990s in Seattle. Since then the number of medical practices that have switched to or opened concierge services has ballooned. The Wall Street Journal reported in 2013 that there are now an estimated 5,500 concierge practices nationwide.

The growth of concierge practices has also given birth to a network of publications, online forums, and related services and informational tools. Concierge Medicine Today (CMT) calls itself “the industry’s oldest and most respected news organization in concierge medicine and direct primary care” and it offers a wealth of information particularly for the medical community involved in or thinking of getting into concierge medicine.

How Does It Work?

So, how does Concierge Medicine Work? Wikipedea defines it as a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care.” So, in addition to whatever insurance coverage you have – even Medicare – your doctor may ask you to chip in additional annual or monthly fees in order to receive a spate of “special services.” A physician may also charge a fee for services he or she didn’t charge before, unless you agree to the concierge membership plan. This doesn’t mean you won’t get good service or receiving lesser care If you don’t sign up, physicians like Dr. G. are quick to point out.

What’s included in a concierge program? Typically, reports CMT it will “include 24/7 access to a personal physicians’ cell phone, same-day appointments with no waiting, personal coordination of care with specialists, personal follow up when admitted to a hospital or ER, house calls, and more.”

How Do Doctors Benefit?

The rise of Concierge Medicine has been and continues to be a boon for doctors. CMT reports that while a typical physician (one who is not practicing a concierge program) has a patient load of 2,500 or more patients, a concierge physician generally limits their practice to between 300-600 patients or more. Where do all of those patients who don’t sign up for the concierge program? Presumably, they pay the extra fees for their doctor visits or seek out another physician.

41 concierge medicine checklistIn a three-year study, CMT found that more than 60 percent of current U.S. concierge physicians operating practices today are internal medicine specialists. The second most popular medical specialty in concierge medicine is family practice.

Five years after opening their concierge practice – or converting to one – CMT found that 83 percent of current concierge physicians are ‘very satisfied’ or ‘satisfied’ with their concierge practice and believe they made the right choice. Only eight percent felt they had made a mistake in going to a concierge practice. In addition, in a 2012 survey, CMT found that almost 90 percent of all current concierge doctors are doing ‘better’ financially.

How Much Does It Cost?

Beyond the cost of your insurance premiums and any deductibles, a concierge practice’s charges vary greatly. The Wall Street Journal articles say basic clinics practicing concierge medicine may charge $50 to $100 a month for primary care, better access to doctors, etc.

CMT says of the 5,500 concierge practices in the U.S., two thirds charge less than $135 a month, but that’s a significant increase over the 49 percent who charged that much just three years ago. And the practice is growing at a rate of 25 percent a year, according to the American Academy of Private Physicians.

To sign up for the plan I was asked to sign a contract (even if I didn’t want to join a plan), provide payment, and submit it. Clearly the contract was not written by my doctor and has lots of ‘legalese’ that is difficult to understand (another reason I’m not signing up quickly).

What Choice To Make?

In my case, my doctor’s Enhanced Access Membership Program offered me three options (see chart). I could continue as I have with no enhanced service for which I would pay no additional fee for routine office visits; or $600 a year for a ‘silver’ plan which seems to offer little more than ‘enhanced’ access such as ‘priority’ appointments; or a ‘platinum’ plan which includes all that is in the silver plan, plus things like direct email with my doctor, validated parking, same day results of tests, and more.

A typical "concierge' medical plan with options. Photo Credit: Noah Schneider

A typical “concierge’ medical plan with options. Photo Credit: Noah Schneider

While everyone must make their own choice, I found the options for enhanced care less than overwhelming. Do I really need my doctor to validate my parking for several hundred dollars a year? One of my frustrations with office visits is the sometimes long wait before I’m seen by my doctor. While the concierge options offer priority service, if all his patients were to make the switch to the concierge program, how could he possibly see me any faster than he has before?

Thankfully, I’m pretty healthy and I don’t need much more than my annual visit at this point. So, are my out of pocket costs if I don’t sign up for concierge medicine going to be less than what I would be charged for one of the plans? Probably not. But, it’s hard to know because no information is given as to what the costs will be if I don’t sign up for a plan.

There’s also the issue of what my costs actually are. When I get a statement from my insurer showing how much my doctor charged, it has no relationship to what the doctor ended up getting paid. So, it’s hard to know how much my office visit actually cost and what the gap is that he is asking me to pay for better services. Am I being asked to pay fees or for a concierge plan because other patients’ insurers don’t pay as well as mine does?

The Fear Factor

Part of the concierge phenomenon is an element of fear. If I don’t buy into the plan am I really going to get the same level of service? If I ever get sick and really need fast service will I be told, “not until you sign up for a plan.'” Like any insurance, you pay because you are protecting yourself against what might happen, not what has happened. And, concierge medicine has a great deal in common with insurance coverage. I might never need some of the benefits of such a plan, but when something happens I might be made to feel like, “I told you so.” In fact, a study by the University of Maryland School of Law, pointed out that “some critics of these arrangements contend that the physicians are taking advantage of vulnerable patients who fear abandonment or feel compelled to pay the retainers in order to continue receiving necessary medical care.”

There’s no doubt that concierge medicine is on the rise. The legal and legislative aspects of the concierge model will continue to be debated and the University of Maryland study points out some of the legal ramifications of these programs (for example, the little known clause in the Medicare program that seems to legitimize these plans).

The decision to go with or not go with a concierge program should be carefully thought out. As for me, I’m taking a wait and see approach. After my next visit or two I’ll see how I feel. Has anything changed? Are the extra costs I’ll incur for not enrolling in a plan going to exceed what it would have cost me if I had enrolled?

I have to admit that I’m not enjoying having to make a choice and I would rather my relationship with my doctor remain just as before. But, you and I are likely to face a future where medical care is very different whether you like it or not. Making a careful and thoughtful choice is important. So, have a conversation with your doctor (hopefully you won’t be charged for that), weigh your options, and decide what is in your own best interest.


Published by Noah Schneider

A writer with a B.A. degree in journalism from a prestigious California university, I’ve been a professional communicator for more than 30 years. My work has been published in a number of outlets, plus a…  View profile

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