By Dena Braun | Your Health Magazine, June 2007
Imagine you’re at home curled up in bed with a 102-degree fever and a throat as scratchy as 80-grit sandpaper. You pick up the phone and call your doctor directly and she agrees to make a house call later that day. For most of us this type of health care is something from the history books, but today a growing group of people are literally buying back old-fashioned medical care.
Concierge medicine, also known as boutique or retainer-based medicine, is trying to return medicine to its roots, albeit for a price. What distinguishes concierge care from typical healthcare in America is that the patient pays some type of out-of-pocket retainer, ranging anywhere from $1,000 to $20,000 a year. In most concierge practices this fee is for personalized care and unfettered access to the doctor. In some practices that don’t take Medicare, the retainer is for actual medical care.
Regardless of the legal structure of the concierge practice, they all share similar philosophy and benefits. Concierge care is rooted in the doctor-patient relationship. Today a standard office visit is allocated right to 18 minutes as physicians rush through their days to accommodate the typical 2,500 to 4,000 patients they see per year. In a concierge practice, the number of patients is limited and office visits usually range from one to two hours. The additional time allows the doctor to focus on treating not only illness, but on preventative care.
“It’s sad that in our standard health care system you don’t have time to sit down and talk with your patients,” says Dr. Rick Kellerman, president of the American Academy of Family Physicians. “We’re taught in medical school that you get 80 to 90 percent of the information you need by talking and listening.”
According to Kellerman, concierge care is an outgrowth of the frustrations physicians and patients have with the current medical model. In addition to enough time to develop a doctor-patient relationship, people enrolled in concierge care typically enjoy 24/7 access to the doctor via phone or e-mail, same or next day appointments, no office wait times, house calls, a comprehensive annual exam, and facilitated appointments with other doctors and hospitals. In some practices, additional amenities like spa settings, travel medicine information and immunizations are included
“It really is like old-fashioned medicine and it’s a very enjoyable way to practice medicine,” says Dr. Connie Mariano, the former physician to Presidents George H. W. Bush, Bill Clinton and George W. Bush. Mariano now has a concierge practice in Scottsdale, Ariz. “You get to know the whole person, and you worry about them and care that’s going on in their life.”
Mariano created her Center for Executive Medicine in 2004 and capped her patient base at 300. Her youngest patient is 19 and the oldest is 90. Like most concierge practices her typical patient is a retired executive, aged 55 to 75.
Susan and Ford Schumann have been patients since the practice started and they emphatically state they’d never go back to traditional medical care.
“This is much more personal medicine,” Susan says. “Most doctors have so many patients that you’re a number, not a name.” Ford added that Mariano has made two house calls to treat his wife. “It really is 24/7 care,” he says.
“I treat my patients the same way I treated the President of the United States,” says Mariano. “I cater to my patients. It isn’t about my hours; it’s about their comfort and their convenience.”
While concierge practices began in the mid-1990s, it’s a small part of the medical community with only about 250 practices nationwide. A Florida-based firm, MDVIP, created a franchise of concierge practices in 16 states with 135 affiliated doctors and 45,000 patients. The MDVIP model focuses on preventative care with emphasis on a comprehensive annual exam, resulting in a personalized wellness program and an individual Web site designed to give the patient access to their own records and reliable health care information.
“Our practice model of preventative, proactive care is simply not possible in a traditional practice,” says Sherry Roth, senior marketing manager for MDVIP.
In most concierge practices, patients pay for office visits, medical testing and hospitalizations. For this reason, patients should still carry health insurance. While payment is required at the time of service under this system, some concierge doctors will file insurance or Medicare paperwork on behalf of their patients and any reimbursement is made directly to the patient. Depending on your situation, the annual retainer fee may be recouped through a health savings account.
Despite being a small player in the medical field, concierge practices receive big attention from critics who worry about the implications this type of practice has on the overall health care system. They argue that retainer-based medicine creates a class-system in health care and if these practices thrive, eventually there will be no care for the less affluent.
“I call that argument the ‘parade of horribles,’” says Jack Marquis, a lawyer on the board of the Society for Innovative Medical Practice Design (SIMPD). “Does anyone seriously believe that all general practitioners are going to do this?”
According to Dr. Helene Wechsler, owner of Scottsdale Private Physicians, concierge care is destined to remain a small, niche component of health care.
“It’s never going to overrun the medical system,” she says. “There is a small segment of the population that has multiple medical problems, and needs and wants this type of care.”
Princeton economist Dr. Uwe Reinhardt, an expert on the economic implications of retainer medicine, says concierge medicine is so small it has no significant economic impact, and furthermore, certain conditions are needed for these practices to succeed.
“I don’t think boutique medicine will thrive in, say, Minnesota because the economic distribution in the Midwest is flat,” says Reinhardt. “This model works in places where there is great disparity in economic distribution.”
The American Medical Association has traditionally set the ethical standards in medicine and its official position on retainer-based medicine is that it “is consistent with pluralism in the delivery and financing of health care.” The AMA does state that these practices can raise concerns and establishes guidelines for doctors to follow when setting up a concierge practice.
