Concierge Medicine: So Many Questions

By: Jennifer Webster
Monday, May 27, 2013

Physicians explore their decision to practice concierge medicine.

Forbes reports that about 4,400 physicians now practice concierge-style medicine, a form of primary care characterized by a retainer-style fee in return for enhanced access to physician care. What makes physicians decide to become concierge doctors? Are the trade-offs — such as handing out one’s personal cell phone number — worth it? And are there ethical consequences?

Moving Out of a Flawed Model

Often, physicians move to concierge medicine when they become dissatisfied with their own practices. For instance, they may feel they are not able to provide quality care in short office visits, yet cannot afford to jam fewer visits into the day. This “cost crunch,” which drives some physicians to become employees of medical management groups or to retire, may also lead some to turn to concierge practice.

“There must be a better model,” says Floyd B. Russak, M.D., who is on the clinical faculties in medicine at Harvard Medical School and University of Colorado School of Medicine, President of the Arapahoe-Douglas-Elbert Medical Society, and the Medical Director of East-West Health Centers in Colorado. “There must be a better way to spend time with people.”

Like many physicians, Dr. Russak considered concierge care as a way to improve patient care and commit more fully to his patients. However, like others, he saw an important ethical question in transitioning from traditional to concierge medicine.

“Am I abandoning my patients?” he asked himself.

For Dr. Russak, the higher-quality care he could provide for his remaining patients (300 rather than 2,000) made up for having to let some go.

At his practice, which is affiliated with concierge medicine company SignatureMD, Dr. Russak and his physician colleagues made the decision to split the difference; some physicians took on concierge-style medicine, while others remained in traditional physician-patient relationships. Patients had the option to switch between providers. Relatively light churn occurred in both directions, and those providers with lighter patient loads were happy to pick up the business of the “overflow” when some of their partners went concierge.

In fact, various mixed models of concierge medicine are taking off across the country.

Hybrid Medicine

Steven A. Fisher, M.D., with the Fairfield County Medical Group in Connecticut, looked at concierge medicine, along with the rest of his practice, several years ago. The first concierge company his practice test-drove did not provide an optimal experience; for one thing, the concierge management company would have asked them to get rid of most of their patient base, Dr. Fisher explains.

“We weren’t ready to do that,” Dr. Fisher says. “Later, we heard of another management company we could go with, where each physician in our practice could have between 100 and 150 concierge patients, keeping other patients on a traditional basis.”

Dr. Fisher found his patients naturally selected concierge care or traditional care as they needed it.

“We have two groups, the elderly Medicare population, who want to be able to reach out to their physicians frequently, and a group of fairly wealthy patients,” Dr. Fisher explains. “Those patients want to work in physician visits around travel schedules.”

While telling patients you will be charging more, not accepting insurance or just plain dropping many of them may sound traumatic, Wayne Lipton, managing partner of Concierge Choice Physicians, argues that most concierge care is a “transitional product” in today’s market. In other words, physicians must become established traditionally before making the move to concierge care.

“It’s not ‘build it and they will come,’” says Lipton, citing lack of consumer awareness about concierge care. “[Physicians must] expand their practices to include subscription care, which is a sort of access fee for care.”

For the lack of general knowledge about bespoke medicine, new concierge physicians often contract with management companies who send marketers into the practice to educate patients about subscription care. However, Lipton says, consumer knowledge of concierge care is gradually expanding, making it easier to market.

The Ethics of One-on-One

For physicians who own single-doctor practices, manage larger medical groups, or work as employees on a commission basis, turning to concierge care presents as an ethical trade-off: care for fewer, wealthier patients, but do it more thoroughly. Mixed-style concierge medicine is one available trade-off. However, other physicians see concierge medicine as a completely different role, as a morally driven mission.

“You have to be open to 2 a.m. house calls,” says Ken Redcross, M.D., internal medicine and concierge physician whose business includes high-end concierge agreements such as traveling with patients and coming to their workplaces to treat them. “You have to establish that patient bond that has been lost over the past few years.”

Dr. Redcross goes the extra step, he says, severing relationships with patients who ask for inappropriate prescriptions, and generally taking a close, proactive role in his patients’ health and well-being.

“I am here to change lives,” he says, “and if anyone has a similar motto, there is nothing better than concierge medicine to do that.”

Concierge for the Masses

Erika Bliss, M.D., President and CEO of Qliance Medical Management, describes her business as “direct primary care.”

“We wanted to have a steady, recurring income, freed up from fee-for-service,” she says of herself and her brother, also a physician. “But he really felt strongly there shouldn’t be care just for the wealthy.”

The resulting medical group provides concierge-style care for patients who pay a monthly fee. To keep prices down, they negotiate group rates with employers and unions, Dr. Bliss says. Physician employees see 800 to 1,000 patients a day — more than a typical concierge workload but fewer than an average fee-for-service primary care physician.

However, says Dr. Bliss, “The only employers who offer just us are small employers who can’t afford full insurance. Most employers who purchase Qliance plans also offer high-deductible policies with us on the front end.”

The company is also working with insurance carriers to bundle with other insurance care, she notes.

Any form of concierge medicine — from a physician who travels with a patient, to an open-access primary care front end to a high-deductible insurance policy — may be limited in its reach and scalability. However, physicians are eagerly diving into direct care at diverse price points and with various portions of their patient loads.

There’s certainly more development on the way.