Article on Concierge Medicine - is this the future

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Finding Middle Ground: Doctors Craft New Business Model to Offer Better Care Without Hefty Charges

The medical care market is increasingly becoming like the real estate market: you get what you pay for. The top complaints from patients regarding doctor visits typically include long waits for just a few minutes of doctor face time, impersonal care, lack of appointments and slack follow up.

“Concierge” care has recently entered the medical scene offering more personalized, around-the-clock treatment, but it comes at a hefty price tag: up to $2,000 a year, and many concierge docs don’t accept insurance. With a growing number of patients in need of more attention from doctors and an easier experience getting the care they need, clinics nationwide are aiming to bridge the gap between expensive concierge care and lost-in-the-shuffle treatment.

At One Medical in San Francisco and GreenField Health in Portland, Ore., patients are charged an annual membership fee and are cared for by doctors with an average of 800 to 1,000 patients on their roster. That’s less than one-third the number of patients seen by doctors at most mainstream clinics today. By limiting the number of patients served, the doctors are able to offer more benefits such as longer one-on-one visits, and e-mail and phone appointments.

At One Medical, owner and founder Dr. Tom Lee offers his patients office visits without waiting-room time, 24-hour a day online and telephone access to doctors and the ability to book appointments and request prescription refills online. Membership costs $200 a year, and he accepts most major health insurance plans. To help reduce overhead costs, Lee’s office has fully embraced the virtual world. Instead of patients having to make a trek into the office every time they get a sniffle, they can speak to their doctor via e-mail, instant message, or Skype, and have a prescription sent directly to their pharmacy.

Lee says the model is a win-win for doctors and patients: membership fees keep the doctors’ offices profitable despite the limited patient load, and patients receive more personalized care.

“The membership fee allows us to do things not typically covered by health insurance, like virtual visits and phone calls,” says Lee.

The model has been successful for One Medical, and the company now operates six facilities in San Francisco, five in New York City and has plans for expansion later this year in Silicon Valley and Boston.

The "problem" that clinics like One Medical are trying to solve is that medicine has become purely a volume business for doctors who want to make a living, says Dr. Steven Fisher, owner of Fairfield County Medical Group in Trumbull, Conn.

“Doctors have to run people through as quickly as they can in order to fit in more patients in order to make more money, and what ends up happening is that doctors do not have the time they should to spend with their patients," he says.

Lee agrees with this diagnosis, adding that physicians should never be paid based on the quantity of patients they see. “Doctors should be paid based on the quality of the service they provide, not the number of patients they can squeeze in in an hour. We wanted to build a practice that would enable a better experience for both the doctors and the patients.”

Lee says the doctors at One Medical enjoy more hours in their day without having to run people through, and the patients enjoy a longer appointment time and better access to their doctors. He encourages patients to think of the clinic as “member supported” but not “members only,” and stresses that if someone wanted to join One Medical and was unable to pay, the membership fee would be waived without hesitation.

“It’s not an access fee, and in a perfect world, we would hope that this level of care would be available to everyone."

That's the sentiment echoed at GreenField Health in Portland, Ore., where administrator Steve Rallison says members enjoy better care due the annual fee they pay, which ranges from $120 per year to $756 per year depending on age. GreenField uses the logic that the older you get, the more specialized care you need; patients in their 30s would pay $396 per year, while someone in their 60s would pay $612 a year.

"When the physician is not harried, all kinds of wonderful things happen,” says Rallison. “The membership fees enable a better doctor-patient relationship simply because of the additional time they provide."

Virtual visits help GreenField save both time and money. Patients have the ability to call or e-mail doctors personally 24 hours a day, and book appointments online at any time. The clinic also assures its patients of little to no wait time, and same-day or next-day appointments.

But even with all these perks, neither One Medical or GreenField can be considered true “concierge” medicine, says Fisher.

"True concierge doctors will only have around 400 patients, and many of them won’t take any type of health insurance. On top of that, in most major cities like Miami or New York, the fees are 10 times what One Medical is charging,” says Fisher.

Fisher says that in states including New York, California and Florida, concierge fees currently stand at around $2,000 per year. He adds that for people considering investing in concierge services, the prices aren't likely to go up anytime soon, as in the last few years the cost seems to have plateaued.

"Honestly, some people spend $2,000 a year for their maid to go on vacation with them," says Fisher. "It's all about what you find valuable. If you find value in having your doctor's number and the cost isn't going to be a burden to you, then I would absolutely recommend it. It's like going to a hotel and paying extra money for the ocean views. If you are happier with that view and you can afford that view, then get it. If you're happy looking at the garden, then do that. The good thing is that for the people who want the ocean views, they now have the option."

Fisher's clinic recently tested out a "hybrid" concierge model, where patients were given the option to purchase concierge care for $2,000 per year. Perks include longer appointments, hospital care from your physician and 24 hour phone access to your doctor.

"It's working," Fisher says. "I have more time for appointments with my concierge patients, but my regular patients also benefit from seeing a doctor who is a little less stressed, a little less burned out and a little less tired. I am not constantly going through my day saying 'I gotta see another patient, I gotta make another dollar.' I have the cushion that saves me from having to take on so many new patients."

Fisher says that while he is a proponent of concierge care, he only recommends it to patients who can afford it. However he says the need for more personalized and 24-hour access increases with age.

"I carry my phone everywhere, and my patients can call me anytime. For some people, just having that peace of mind is worth it."

Concierge medicine is not without its critics, Fisher says, because unfortunately the type of care given to the people who pay the concierge fees is the type of care that everyone in the country should be receiving.

"Unfortunately, the business model followed by most of today's doctors requires us to churn out patients. Concierge medicine allows us to be the doctors we planned to be when we graduated medical school. I hope one day this is the type of care we can give the population at large, but right now, the system is broken."



Read more: www.foxbusiness.com/personal-finance/2012/07/26/finding-middle-ground-doctors-craft-new-business-model-to-offer-better-care/#ixzz23j5XzZKL

[Deleted]

Lots of people pay AT&T more than two grand a year.

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Aug 16, 2012 11:21:24 GMT -5 @spenjamins said:

Lots of people pay AT&T more than two grand a year.

LOL.

I'd pay it if I had some sort of sickness that requires regular care. (Well other than being crazy but I pay enough for that already.)

[Deleted]

I think it can be a reasonable choice. Seeing a physician that is required to carry a case load of patients that is unmanageable is horrible for the doc and the patient.

[mrs.spunky]

I'd pay $400-500/year for DH and I together to have access to such a practice, but not $2k. I'd probably pay $1k when we have kids so I wouldn't have as much of a worry regarding timing sick visits, emails/calls after hours, etc. However, we have a plan with a relatively low OON deductible and decent coinsurance. Someone who has an HMO wouldn't want to see a doctor who doesn't take their insurance.

[DarcyLongfellow]

That hybred concierge service sounds like the best of both worlds. You get more personalized care, but your office visits are still covered by insurance. I would absolutely pay $200 a year to be able to call my doctor on the phone, get appointments easily, not spend forever in the waiting room, etc.

Honestly, I'm super lucky because DD's pediatrician is basically like that, only we don't pay any sort of membership fee. He is young (early 40's), but he seems to practice on an old school model. He keeps his patient load very small on purpose (only accepts newborns), I can always get her a same day appointment, and I have called him after hours many, many times. He's amazing.

[hulley]

I would absolutely pay for that level of service. Hell, I'd pay $2000 a year just to have the ability to do an e-visit or phone call with my doc. I'm sorry, but I don't need to go to the office and pay $600 towards my deductible just for you to say "Yup, it's still a UTI".

I had no idea doctor's had such a high patient load. 2400 sounds like so many people! I'm grateful my doctor still kinda knows who I am.

[AJL]

I don't see this as a bad thing. Though I wonder how my physicians' office does it. We all see doctors who belong to one "clinic." They have twenty clinic locations in the city and surrounding area and are a multispecialty group.

I have a family physician, OB/GYN, pediatrician, and allergist through them. Every doctor has access to my records because it's centralized and digital. The employ hundreds of doctors and work with dozens of insurance companies. They have a huge business office that handles all the financial issues and for a patient, they're really easy to work with.

They're been around for 30 years and I think their business model is working. Almost every person who is a patient of a doctor in this group has overwhelmingly positive things to say.

[RBL]

H was seeing a pain management doctor who switched to this. He opted to find a new doctor who accepted our insurance.

My understanding from what we got from his doctor was that the yearly fee was to see the doctor. So any additional testing would be out of pocket, for H that would consist of MRIs and drug tests. Both of which are pricey.

[dirtyred]

I have a friend that has a concierge doctor. She loves it. Anytime you have a question, you call and you get the doc, not messages relayed through a nurse. Need to come in the day you call, or early in the am or later in the evening, or maybe on a Saturday? No problem. Appointments are typically 30-60 minutes, so everything gets a thorough going-over.