In concierge medicine, patients pay their primary care physicians a retainer in return for basic services and augmented care. These flat fees are sometimes the physician's sole source of income; in other cases, doctors continue to take insurance and use their concierge patients' retainers as supplementary fees. For patients, the perquisites vary from practice to practice, but can include more personal attention, house calls and even the doctor's cell phone number for 24-hour access.
Concierge Doctors: They're Not Just for the Super-Rich Anymore
reprinted courtesy AOL News 04/07/12
By Eamon Murphy
Posted 1:00PM 04/06/12 Posted under: Health Care
Reading certain media reports, one might think that concierge medical care is a
service solely for the super-rich, an exclusive realm of $1 million in-home
emergency rooms and $30,000 annual fees for round-the-clock access to
physicians. But the concierge model actually encompasses a range of services,
often costing significantly less than the stratospheric figures cited in
stories about health care providers who cater to the 1%.
"An increasing number of physicians have turned to concierge
medicine," explains Physicians News Digest, "also known as
retainer or boutique medicine, to retain their individual practices."
In concierge medicine, patients pay their primary care physicians a retainer in
return for basic services and augmented care. These flat fees are sometimes the
physician's sole source of income; in other cases, doctors continue to take
insurance and use their concierge patients' retainers as supplementary fees.
For patients, the perquisites vary from practice to practice, but can include
more personal attention, house calls and even the doctor's cell phone number
for 24-hour access.
For David Woolfe, 57, whose primary care physician is a concierge doctor, one
key perk is the comprehensive annual physical. "It's just a broader
spectrum kind of assessment. They do a mental acuity thing, which had never
been part of my physical previously, vision and hearing in a more determined
sense, that sort of thing."
The enhanced exam is a two-step process: "You do the physical and the lab
work, then come in to discuss." Woolfe also receives "a nice little
CD" explaining his results.
For services like this, along with the ability to contact his doctor on her
cell phone -- which he has done only once -- Woolfe pays $1,500 a year; his
insurance covers regular visits. "It's costlier," Woolfe concedes,
"and I don't know quite frankly if it's worth the additional expense. The
physical is good, though, in the sense that it creates a real baseline: This is
what things were when you were healthy, so you know when things start to
change."
Woolfe didn't exactly come to concierge medicine of his own choosing. "I
didn't switch so much as my doctor switched to a concierge model within her
practice," he says. "So, in order to stay with her -- and I like her
very much -- that was my primary motivation." And he's hardly a
high-flying member of the wealthy elite: A resident of Long Island, he works as
a religious educator and freelance writer.
"In terms of bang for the buck," Woolfe concludes, "other than
having access to the doctor I want treating me on a regular basis, it's not
worth it to me."
"But," he adds, "I don't really have any issues that require
that kind of attention. Frankly, I don't think many people do. That's why it's
called 'concierge.' It's just nice, it's not really necessary."
Jumping Off the Conveyor Belt
David Katzman is an internist in St. Louis who used to see five or six patients
an hour -- 25 or 30 a day. "It was difficult to do," he says,
"and really difficult to do well." But even churning through patients
that fast, Katzman was finding it hard to make ends meet: "Expenses go up,
whether it's postage, or malpractice insurance or rent, and you really don't
have control over what you get for patient visits, what you can charge or what
you receive. The only way you can make up your cost is taking on more
patients." Other revenue-enhancing options -- doing lab tests, dispensing
drugs, selling supplements, or opening a weight loss clinic in his office (or speaking
for drug companies) -- didn't appeal to him.
"I couldn't take care of patients the way I wanted to," Katzman says.
"I had to have a panel of 3,000 to 4,000 patients. It wasn't very personally
rewarding to me."
His solution was to switch the concierge model. He made the transition in 2003.
Now, Katzman's patients are given an hour for every physical examination. They
can call his office, request an appointment, and see him on the same day. They
can text, email, or call him on his cell phone. And they can be confident that
"their doctor knows them, and knows their medical history," Katzman
explains, "because I don't have nearly as many patients."
His office has the time to schedule consults with specialists, and calls
patients with lab results quickly. Katzman and his partner will visit their
patients in the hospital, which many primary care doctors no longer do, and
they can cover for each other relatively seamlessly, since they know many of
each other's patients.
This deeper engagement has given Katzman the sense of professional satisfaction
he lacked when he was engaged in what has been called "conveyer belt
medicine."
Concierge medicine, he says, is "sort of like turning the clock back 40 or
50 years to a relationship between the doctor and the patient which is in many
ways like a family relationship." Katzman even makes house calls a couple
of times a month -- he did one just two days before speaking with DailyFinance.
Affordable, If You Make It a
Priority
Katzman's practice is far from an exclusive haven for the most affluent.
"I certainly have super-rich patients," he says, "but the
majority of people are middle class or upper-middle class."
About 10% of Katzman's patients see him on scholarship, meaning he doesn't
charge them at all. "These are patients who could obviously never afford
this," he says. Many were in his practice before he became a concierge
doctor, but some have been added since the switch. "Sometimes you're on
call in the ER and patients get admitted that way," Katzman explains.
"Usually, if I start with a patient I'll continue with them. Sometimes
it's employees of people who are patients, like the housekeeper of a patient.
Or there's somebody who knows someone who's having a problem and needs
help."
For patients not on scholarship, Katzman charges an annual retainer of $1,800
for those over 50, and $1,200 for those younger. "The fee is relatively
modest," he says, "compared to other fees in life. If somebody values
being in a practice like this, they can do it in place of going out to dinner
twice a month, or instead of the extended package on cable TV, or whatever.
It's about picking and choosing what's important."
Ultimately, Woolfe agrees about the price, even if he sounds ambivalent about
the value. "One would never say to someone who doesn't have $1500 that
it's nothing -- it's a nice chunk of change. But in and of itself, it's not a
reason to say you've got to be wealthy to do this."
reprinted courtesy AOL News 04/07/12, original link http:// www dailyfinance.com/2012/04/06/concierge-doctors-theyre-not-just-for-the-super-rich-anymore/
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