Not long ago, the term concierge medicine meant you could see your doctor whenever you wanted – if you were rich. These days, the concept, in which you typically pay an annual fee for quick access to your healthcare provider, is more mainstream and accessible.
Concierge doctors – sometimes known as private physicians or direct care doctors – offer patients more personalized care. You can typically call or email your doctor at any time and schedule same-day appointments. Sometimes you can chat with your doctor by video, or the doctor may come to your home.
The concept started in 1996, when two doctors, Howard Maron and Scott Hall, decided to ask their patients to pay a flat fee, like an attorney’s retainer, in exchange for direct care. It works as a private (direct) financial relationship between you and your doctor, with a commitment to restoring the doctor-patient relationship, eliminating long wait times, and reducing the need for an insurance company to make decisions about your healthcare. Instead of the typical 15-minute visit you might get with your normal primary care doctor, concierge doctors may see you for 30 to 45 minutes.
Such practices also eliminate fee-for-service healthcare regulated by insurance companies that reimburse a portion of what a doctor would normally charge for a service. Without basing their financial dependence on insurance and Medicare, doctors can eliminate overhead (like billing and medical coding staff) and focus more on their patients.
You’ll typically pay an annual fee to one of these estimated 10,000 U.S. doctors. The average ranges between $135 and $150 a month, with many doctors charging less than $100 a month, according to the American Academy of Private Physicians, an industry advocate that offers a tool to find concierge doctors.
While most preventive procedures and tests are covered by typical health insurance, according to federal law, a concierge practice may include additional services, such as screening for Alzheimer’s disease or expanded blood tests for other conditions.
You’re still required to have health insurance even if you see a concierge doctor – unless you want to pay a tax penalty. Because concierge medicine is private, out-of-pocket care, it may work well with a high-deductible health insurance plan and a health savings account (HSA), because you’ll still have to pay for some tests or procedures you might need outside of your concierge plan. Your doctor will work with your insurance company to try to get you some coverage.
Be careful, however, if you do you use your HSA account to pay for concierge services. Your annual physical with your concierge doctor may be an applicable HSA healthcare expense, but your monthly retainer won’t.
Some hospitals offer concierge medicine, but don’t confuse the concept with the name for a staff member called a concierge, which some hospitals employ like the guest services staff of a hotel to elevate your experience in the hospital by, say, fetching you a gourmet meal or a robe.
The trend isn’t going away; more doctors are abandoning health insurance as the current healthcare system forces them to see many patients, often 2,500 a year, as quickly as possible to make ends meet.
As an alternative, the growth of concierge medicine may even offset the decline of the primary care doctor, with estimates expecting a shortage of 91,500 primary care doctors by 2020.
And with the rise of mobile health (mHealth) technology, concierge medicine can be a model for healthcare for all. For instance, PlushCare, a San Francisco start up, charges you $45 to get diagnosed, treated, and prescriptions via a phone call or video chat with a doctor.
While many people these days like to “shop” for healthcare, they still want to develop a trusting relationship with their doctor. Quicker access to physicians, and longer appointment times, give you time to really talk to your doctor. mHealth companies like PlushCare are betting you’ll transcend from being a “consumer” to developing a close doctor-patient relationship, and come back for their version of concierge care the next time you have a minor health issue.
March 03, 2015
Christopher Nystuen, MD, MBA