Someday soon you may find out he or she is converting the practice to “concierge” or “private” medicine. It’s becoming a trend.
Already, according the American Association of Private Physicians, more than 4,400 physicians in the U.S. have established concierge practices, which means they charge a fee – ranging from $60 to $200 per month — for you to be part of their medical practice. That’s the basic fee only – additional services aren’t included.
Part of what’s driving the trend, experts say, is the tsunami of people – estimated at about 30 million – expected to get health coverage in 2014 when the Affordable Care Act is fully implemented. The American Association of Medical Colleges estimates there will be a shortage of 45,000 primary care doctors by 2020.
Proposed changes in Medicare – considering income-based pricing and raising the eligibility age – may also mean lower payments to doctors. That, too, is prompting physicians’ interest in a concierge-type model of practice. Because the fee doctors charge is up to them, the concierge model could serve as a financial buffer to federal cost-cutting.
Physicians are tired of what they often call “conveyor- belt medicine,” where they have only a short time to see patient after patient. They’re also unhappy with the hassles of dealing with insurance companies and Medicare. Concierge medicine promises to give them more time with fewer patients, while maintaining or increasing their salaries.
In return for the fee, doctors promise to limit the size of their practice to help ensure you can see and talk with them virtually on a moment’s notice. Many of these physicians accept health insurance and Medicare to cover appointments and any lab work or tests done in their medical office. Some include an enhanced annual physical into the arrangement.
But other doctors see themselves now as part of “private medicine,” and do not accept health insurance at all. It’s called having a “direct financial relationship between physician and patients.” These physicians have ditched third-party reimbursement and Medicare completely.
Most patients who subscribe to these practices, even if they have the money to pay for visits with cash, will still need health insurance to cover the big-ticket items like advanced testing (such as MRIs and CAT scans), emergency department visits, outpatient surgery and hospitalization, as well as the cost of seeing specialists.
Upscale practices promise special attention. In concierge and private practices, physicians often give patients a direct cell phone number with which to contact them directly, communicate by e-mail, make house calls, focus on preventive care, and provide consultation should it be needed when you’re traveling.
MDVIP (mdvip.com), which has 580 doctors in 40 states and seems to be growing, was recently bought by Procter & Gamble, another sign of growing interest in the trend. Physicians who sign up with MDVIP promise to limit their patients to a total of 600 (most non-concierge practices average between 1500 and 3000 people per physician). They charge $1,650 on average annually per patient.
When physicians decide to make the switch to the concierge/private model, they typically send their patients a letter announcing their decision. If you are willing to pony up the annual retainer, you can stay, and if you’re not, you suddenly find yourself out on the street, needing to find a new physician right away.
What to do? Here are some tips:
*Wondering if you might someday want or need to be in a private or concierge practice? Many physicians in such practices are already developing waiting lists. If so, get in line, just in case you might decide to opt for that in the future.
*Ask your physician if he or she has plans to make any changes in the practice, including retirement, and when. Better to know ahead of time than to be caught in the lurch, especially as the physician shortage continues to heat up.
*If you are considering joining a practice with an annual or monthly retainer, you may be able to use a Health Savings Account or flexible spending accounts to pay those bills. Talk with your accountant.
*Fees may be tax deductible if health expenses are greater than a percentage of your adjusted gross income. For 2012 tax returns, your expenses need to be 7.5% of your adjusted gross income in order to qualify for a deduction, but for tax returns next year (based on 2013 income), they’ll have to reach 10% of your adjusted gross income. In other words, the deductibility bar is being raised. Ask your accountant if that option might apply to you.
*Remember that you will still have to plan to handle the cost of specialists, diagnostic tests, outpatient surgery, emergency department visits and hospitalization.
Barbara Bronson Gray, who writes the blog bodboss.com, is an award-winning writer and a nationally recognized health expert. She’s a regular contributor to HealthDay.com, preparedpatientforum.com and thirdage.com. Barbara has worked in hospitals, as a nurse and as an administrator, led a major healthcare magazine, created a website for WebMD, and served as a leader of global communications for Amgen, the world’s largest biotech company. She continues to write and speak about healthcare and has a communications consultancy. Follow her on Twitter: @bbgrayrn.