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LEGAL: ‘Some argue that concierge medicine discriminates against the poor, allowing access to better health care for wealthier Americans.’ -SAC Litigation Team

Membership Has Its Privileges

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Subscribe-to-our-NewsletterNovember 29, 2014 – Concierge medicine has been gaining popularity in the United States over the last 10 years and in the last few years has grown at an exponential rate.

What is concierge medicine?

It means that you as the patient pay a membership fee or premium to a certain doctor or medical group. In exchange, that doctor or medical group promises to reduce their patient load to the point where they can offer you much more personalized service. The fee you pay depends on the level of service that concierge doctor offers, but usually the fee is about $1,500 to $4,000 per year (sometimes less and sometimes far greater).

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Sound expensive?

Well, how long did you wait to see your doctor on your last visit? You arrived right on time for your 2 pm appointment and the staff called you back at 3 or 3:30 pm. And then you waited another 30 minutes for the doctor just to get to you. When the coveted medical attention actually arrived, you found a frazzled and stressed-out doctor who spent 10 minutes with you, trying his or her best to listen and understand and provide great care, but all the while knowing that they have other patients waiting. Why? Because the doctor had double, triple or quadruple booked your time slot! In fact, you expected this to occur. You brought a book or computer and tried and get some work done knowing there would be a long wait, all the while the nice people sitting around you who are also patiently (usually) waiting their turn, in what is often times a cramped and crowed waiting room, may be contagious or may be talking loudly on a cell phone. Does this unpleasant experience sound familiar? Welcome to the state of insurance based medical practice in 2014.

Many doctors and many patients have had enough.

With concierge medicine there is no wait time. If you have a 2 pm appointment, the doctor will see you at 2 pm. If you need to see a doctor quickly, you can get same day or next day appointments instead of being told that the next available appointment is 30 days out (or longer!). And when you see your concierge doctor she or he will spend some quality time with you; 30 minutes, 60 minutes, whatever the need is on that day. Many concierge doctors also develop personal and customized treatment plans just for you including lifestyle and preventative plans. Many will even make house calls. You also do not have co-pays or deductibles. As one credit card company used to advertise –

“Membership has its privileges.”

How do they do this? Most concierge doctors do not take insurance. This cuts their overhead by as much as 40%. No longer does an insurance company decide what they will and will not pay for, or inexplicably reducing a billed fee of $100 for an exam to $10 just because they can, or telling you the patient which doctor you can and cannot be treated by. As well, the doctor offices do not have to put up with expensive and convoluted insurance billing processes. This freedom in turn allows the doctor to see fewer patients and provide the quality and personalized care that they imagined they would be able to provide as they studied their way through medical school. Most concierge doctors have a patient load of 300-600 patients, allowing them to see on average 6-8 patients per day. This as opposed to a health insurance based doctor who has an average patient load of 2000-3000, where that doctor sees on average 20-24 patients per day (now you can see why they triple booked your time slot).

Between 2005 and 2010 as the concept of concierge based medicine caught on, the increase across the United States was 5 fold, to as many as 750 doctors. In 2013, that number increased to 5,500. In 2014, that number is expected to surpass 12,000 (Source, Concierge Medicine Today as written Medscape, 2014) ! Why? The red tape and hassle of dealing with health insurance companies can just be overwhelming. As well, many doctors are tired of providing reactive medical care as opposed to proactive care. In addition, with the implementation of the Affordable Care Act (ACA) and the mandate that all Americans be insured with at least minimum coverage, there are a huge number of newly insured patients. This has caused a massive increase in the number of potential patients (potentially making your primary care doctor even more inaccessible) and the reimbursement rates provided by the government are often prohibitive. More work, less pay and an even further reduced quality of care for patients.

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The ACA minimum coverage requirement arguably makes pure concierge medicine non-compliant. This is because the concierge membership fee or premium is not considered “insurance” according to the ACA. However, most concierge patients pay for both their health insurance policy (thereby being in compliance) and the concierge service in addition. The ACA allows concierge medicine to be in compliance as long as the patient also possesses a “wraparound” catastrophic medical policy. This allows the premium paid to the concierge doctor to be offset by a less expensive, higher deductible health plan.

In addition, many of the individual health plans available today already carry very high deductibles. Often times over the course of a year a patient will not even meet their stated deductible. That being the case, why not use that same deductible money to buy membership into a concierge service?

What is the down side to concierge medicine? Well, first, the “premiums” or membership fees you pay for the concierge service is not tax deductible. Costs for medical care over 10% of your adjusted gross income are deductible, but premiums or membership fees to your concierge doctor do not count towards that 10%. That tax law may change in the future, but for now it could be a financial drawback.

Second, what if your concierge doctor does not possess the skill or equipment you need for your health issue? In that case the concierge doctor could refer you to a specialist – a doctor with whom you do not have a financial relationship and that can mean more money out of pocket. Often times, though, that specialist will have a negotiated agreement with the concierge doctor to charge far less than normal rates.

Third, some argue that concierge medicine discriminates against the poor, allowing access to better health care for wealthier Americans. Others, though, argue that society accepts that some live in a nicer, safer neighborhood or drive a nicer car than others, or send their kids to private school over public school (they still pay their taxes that provide for the public school, but choose to pay in addition for a private education). Why should the same societal acceptance not apply to personal health care?

If the goal of healthcare for all is to make America healthier and keep skyrocketing healthcare costs down, then keep in mind that a recent American Journal of Managed Care study (Dec. 2012), which analyzed concierge practices over 5 states between 2006 and 2010, demonstrated that members of concierge type practices were about 52% less likely to be hospitalized relative to nonmembers. In addition,” elective, non-elective, emergent, urgent, avoidable, and unavoidable admissions were all lower” for the concierge members as opposed to nonmembers.  The study concluded that the concierge type model “of personalized preventive care allows the physician to take a more proactive, rather than reactive, approach; we believe this increased physician interaction is the reason for the lower hospital utilization and ultimately lower healthcare costs seen here.”

The world of individual health care is changing. Insurance based primary care doctors are still the norm, but the ever increasing trend is for doctors to abandon the insurance based model of declining reimbursements and increasing patient loads, and seek what is for them a more acceptable alternative. One such alternative is the concierge model. Many patients find this model to be a good fit as well.

SOURCE: http://sacfirm.com/blog/membership-has-its-privileges/

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