Doctors at Your Service: The Rise of Concierge Care

By: Elaine Gottlieb for Body1

Imagine having a doctor who’s available 24 hours a day and even makes house calls. It sounds like old-fashioned medical care but it’s available today – for a price. The cost for this type of medical practice – known as “concierge care” – averages $1,500 to $2,000 a year, and can run as high as $15,000, depending on the services offered and the age and health of the patient.

In addition to round-the-clock access and house calls, concierge services can include priority or same-day appointments, no waiting times, nicer reception areas, preventive and wellness services, spa amenities and frills like a wallet-size ID with your medical history. The greatest benefit is more time and contact with your doctor, who will closely monitor your healthcare, perhaps even accompanying you to specialist visits and handling health problems that occur anywhere in the world.

Take Action

Thinking about concierge care? Have you: Had conversations with your doctor about your healthcare and any difficulties you’re encountering Asked for referrals to find a primary care physician who meets your needs Consulted your insurance provider or HMO to find out about additional services or wellness programs Located concierge physicians at the Society for Innovative Medical Practice Design or MDVIP Looked at the services provided by concierge practices to determine which ones are most important to you Scrutinized concierge contracts carefully or retained legal counsel to do so for you

It’s a far cry from managed care, which has been one impetus behind concierge care. Faced with limits on time and reimbursement, higher malpractice rates and burdensome paperwork, doctors are seeing more patients and working longer hours to maintain their practices and income level. A typical primary care physician has a caseload of 2,500 patients while the added fees allow concierge doctors to see 600 patients or fewer. Since 1996, about 250 practices, mainly on the East and West coasts, have moved to concierge care, serving 100,000 patients.

This inequity concerns medical ethicists, physicians and politicians who feel it is fostering a two-tier system of healthcare. “Concierge care is like a new country club for the rich,” Representative Pete Stark, Democrat of California, remarked at a joint economic committee hearing in Congress in 2004.

That’s not the experience of Glenn Fleishman, a freelance writer in Seattle, Washington, who pays more than a thousand dollars a year for unlimited care from his doctor at Seattle Medical Associates. “Concierge care means getting your doctor on the phone when you call, getting in the same day for an appointment and spending 15-30 minutes with the doctor. That’s not what I’d call a luxury.”

Many patients turn to concierge care out of dissatisfaction with the constraints and bureaucracy of the healthcare system. “People who have been frustrated by a system where it’s difficult to even get a human being on the phone are delighted with our services,” said Garrison Bliss, M.D., a primary care physician in Seattle, Washington and president of the Society for Innovative Practice Design. His practice, Seattle Medical Associates, was the second in the nation to switch to a concierge practice, charging a monthly fee of $65 in 1997 which has risen to $95.

Bliss reports his patients aren’t richer, older, sicker or more anxious about their health than the norm; they just value the additional service. “We can provide friendly, consumer-oriented healthcare by divorcing ourselves from the medical system. If you’re not responsible for three times as many patients, you can actually take care of them. The bottom line is that everyone who called today got taken care of,” Bliss said.

With the additional income provided by patient fees, Bliss has had the resources to run his practice more efficiently and reduce costs. He believes that concierge care will become more affordable as business designs evolve and “we put more information in patients’ hands, not waste their time.”

Still, there is concern that concierge doctors are not fulfilling their professional obligation to serve any patients in need. The AMA’s guidelines for “contracted medical services” encourage physicians in retainer practices to find ways to fulfill this commitment. Some practices, like Dr. Bliss’, waive their fee for “scholarship patients.”

Most concierge doctors accept health insurance which forbids double billing for visits. So the concierge fees can only cover services that insurers don’t provide and must be defined in a legal contract entered into by the doctor and patient.

These contracts have not been closely regulated or monitored. So if you’d like more time with your doctor, greater convenience or wellness services, be sure to read the fine print.

Last updated: 09-Jan-06