Concierge medicine

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Concierge medicine (also known as "Direct Care") is a term used to describe a relationship with 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. Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design.

Concierge medicine has had somewhat of a "brand/identity" issue in the media and health care marketplace. It's also referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; direct primary care and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S., according to SIMPD. However, there is only one organization tracking the specific number of concierge/direct primary care practices in the U.S. today, Concierge Medicine Today, an online news agency dedicated to educating traditional practice physicians and patients about the cost effectiveness and value these types of practices can provide to both physicians and patients.

Concierge physicians care for fewer patients than in a conventional practice, ranging from 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year.[1] All generally claim to be accessible via cell phone or email at any time of day or night or offer some other "special" service above and beyond the "normal" care provided. The annual fees vary widely, from $60 to $2,400 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services. Some concierge practices do not accept insurance of any kind. These also can be referred to as "cash-only" practices. By refusing to deal with insurance companies these cash-only practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients.[2] They become "concierge" only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for "additional" services exclusive of what is covered by insurance plans.[3] It should be noted that this annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers.

Mostly concentrated on the East and West Coasts, in 2004 the Government Accountability Office counted 146 such practices. The American Medical Association does not track the number of concierge practices because the concept is still so new.[4]

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[edit] History

Dr. Howard Maron, the founder of MD2 International ("MD Squared") and pioneer of concierge medicine, has said of the term: "...I only came up with the concept—not the term 'concierge medicine.' I know what a concierge is, but to describe what I do as simply opening doors and directing people.... I prefer 'highly attentive medicine.'"[5]

The origins of concierge medicine are often traced to MD2, which was launched in 1996 in Seattle by Dr. Howard Maron. Others include SignatureMD, EliteHealth, MDVIP, and numerous individual concierge physician practices across the United States.

Since 2003 there has existed a professional society of concierge and other direct practice doctors known as the Society for Innovative Medical Practice Design or SIMPD. As of mid 2008 this organization had about 200 members and by late 2008 was growing at the rate of a member a day. In 2009, SIMPD estimates that there are over 5000 physicians nationwide, most of which are not SIMPD members. SIMPD offers many member benefits including national care networks, discounts for direct practice doctors on mal practice insurance, annual meetings and many more. Patients looking for concierge doctors and other direct practice doctors can visit the "find a physician" link on the SIMPD web site at http://www.simpd.org to find such a physician in their community.

Another such group is The American Society of Concierge Physicians.[1]

[edit] Controversy

The concept of concierge medicine has been accused of promoting a two-tiered health system that favors the wealthy,[6] limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. Detractors contend that while this approach is more lucrative for some physicians and makes care more convenient for their patients, it makes care less accessible for other patients who cannot afford (or choose not) to pay the required membership fees.[7]

One physician in a CNN.com article noted that he might not be treating patients at all if he hadn’t made the switch to concierge medicine: "…many doctors are becoming so disillusioned with primary care that they are quitting altogether." Others physicians feel like they can't abandon patients unwilling to pay the additional fee. This was where physician Brent Cohen[8]ended up after considering the model, for example.

Proponents of concierge claim that it meets consumer demand, allows physicians to provide the treatment they deem necessary, and improves quality of care by increasing the amount of time that can be spent on preventative medicine.[9] Preventative care such as lifestyle advice, and follow-up phone calls and emails are not usually reimbursed by insurance. Physicians significantly reduce the number of patients they see in a day, which allows them to spend extra time and attention with each patient. It has also been noted that while some concierge medicine practices do not accept insurance, all of their patients are encouraged to carry health insurance for services utilized outside of the practice.

Some say that concierge medicine is not the solution to the healthcare system’s woes, but is a symptom of "too much emphasis being placed on cost control and too little emphasis on the patient."[6]

In early 2008 it was reported that one health insurer was dropping from their provider networks, some physicians who charge an annual fee . Another insurer also expressed opposition to annual fees. Other insurers do not oppose concierge medicine as long as patients are clearly informed that the fees will not be reimbursed by their health plan.[10]

[edit] Concierge medicine in popular culture

The USA Network television series Royal Pains focuses on such a doctor's introduction to the practice of concierge medicine.

NO LINK? Beginning October 1st, 2009, a new, online physician publication began providing credible information designed to help educate physicians (primary care, family practice, specialty, etc.) about a growing market…concierge medicine. Concierge Medicine Today is an online news resource targeting primary care and family physicians, patients, legislators and physicians of all backgrounds and specialties interested in learning more about ‘concierge medicine.’

[edit] See also

[edit] References

  1. ^ "On Panel Size" Physicians Practice journal, June 2005
  2. ^ "Cash-Only Healthcare Still Works" Physicians Practice journal, July 2008
  3. ^ United States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.
  4. ^ "Boutique Medicine: When wealth buys health," CNN.com, October 19th, 2006.
  5. ^ "The Highly Attentive Approach", Worth magazine, July 2005.
  6. ^ a b "Your Own Private Doctor," by Mary Duenwald, Departures magazine, November/December 2004.
  7. ^ United States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.
  8. ^ "Concierge Medicine" Physicians Practice journal, Feb 2004
  9. ^ John Abramson, Overdosed America, MD, pgs. 169–194.
  10. ^ Lynn Cook, "Insurers, doctors at odds over `concierge' care", Houston Chronicle, March 13, 2008.

[edit] External links

Retrieved from "http://en.wikipedia.org/wiki/Concierge_medicine"