- In an industry facing constant evolution, healthcare has proven competent at healthcare delivery innovation. Among retail clinics, microhospitals, and other alternative care sites comes concierge medicine, a form of healthcare delivery marked by higher patient financial responsibility in exchange for more quality time with the doctor.
Concierge medicine was born out of the growing role of the consumer patient in healthcare. As patients began bearing more financial responsibility, they also began demanding a better healthcare experience. Patients are looking for shorter wait times, high-quality healthcare, and a better patient-provider relationship, three things concierge medicine ideally delivers.
Concierge medicine, otherwise known as retainer-based medicine or direct primary care, requires patients to pay a monthly fee for their doctor. This capitated patient payment includes all of the primary care and preventive care services that individual doctor offers and is the same regardless of how frequently the patient visits the doctor.
According to the American Association of Retired Persons (AARP), this monthly fee does not replace health insurance. Concierge medicine payments do not include emergency department visits, out-of-network care, or specialist visits.
Additionally, health insurance does not reimburse for concierge medicine payments, but some patients are able to use money from health savings accounts to cover the cost.
Concierge medicine arrangements can cost anywhere from $1,200 to $3,000 annually, according to industry trade group Concierge Medicine Today. These payments are usually split into monthly fees.
Per a separate analysis published in the Journal of the American Board for Family Medicine, the average monthly cost for concierge medicine is $93.26, although there are some arrangements targeted at low income patients that only cost about $30 monthly.
Interestingly, the JABFM article found that the terminology used to describe a concierge medicine arrangement impacts the cost of care for patients. Providers who offer “concierge medicine” versus “direct primary care” or “retainer-based medicine” charge more per month, an average of about $182.
As of 2016, there were 141 concierge medicine practices with 273 locations in 39 states, according to the JABFM article. Most of these practices had four or fewer providers and lower patient panels than traditional practices.
These cost and patient panel arrangements are what distinguish concierge medicine from traditional practices. As such, they have the largest impact on patient care in concierge medicine and are important factors to consider when a patient is choosing concierge medicine.
How does concierge medicine impact patient care?
As noted above, concierge medicine emerged from a desire to meet patient experience needs. Long wait times and administrative burden often bog down patient care access, but with concierge medicine those issues are less pronounced.
Patients are able to quickly access their doctors and spend more time with them, thus increasing patient satisfaction, according to Jim Williams, MD, a primary care provider who delivers concierge medicine.
“The benefits for the patient are that they find their doctor is far more accessible in person because the office visits last much longer – as long as the patient needs, in fact. The shortest visit is 30 minutes,” Williams said in a previous interview with RevCycleIntelligence.com.
“There’s no sense of being rushed,” he added. “Furthermore, the practice is much smaller so the doctor and his/her staff gets to know each patient far more intimately. Far more time is available on the telephone – not just with the doctor, but with staff, the business manager and the nurse as well.”
Those benefits are attractive for doctors transitioning to concierge medicine, too. Doctors will experience more job satisfaction and less burnout because they do not have to answer to as many administrative requirements and they can spend more time with patients.
However, critics of concierge medicine say that the arrangement could also have consequences on patient care access and health equity.
“Critics of concierge medicine say they're concerned that if many doctors choose this type of medical practice, the result will be fewer doctors to go around, leaving it increasingly difficult for patients, especially lower-income ones, to find a doctor,” according to AARP.
This issue is especially salient for pediatric populations, according to the American Academy of Pediatrics.
“The ethical concept that all children should have access to pediatric care is an important consideration for those choosing practices that have the potential of being discriminatory against underserved populations,” the organization says.
“Practice models that, by design, exclude certain categories of patients should be understood to create a greater potential of being discriminatory against underserved populations. Additionally, practices that downsize their patient panels also must be aware of ethical and legal considerations relating to patient abandonment.”
Considerations for selecting concierge medicine
Concierge medicine may not be the best solution for all patients. Just as when selecting any other type of medical provider, patients must consider their specific needs when opting into concierge medicine.
AARP suggests patients think about their current medical care when considering concierge medicine. If a patient is able to access timely appointments, have a positive rapport with their current providers, and are satisfied with their current care quality, it’d be beneficial to stick with that provider.
Patients should also assess their health needs. Patients who are fairly healthy and only utilize some preventive care and an annual physical will not reap return on investment with concierge medicine. Likewise, long travel time just to access concierge medicine may not factor positively into the decision.
However, patients should weigh the benefits of concierge medicine. If patients find a clinician with whom they click and will build a beneficial relationship, the arrangement may be suitable.
Concierge medicine does have both its critics and supporters. While the patient-centered benefits of quicker care access and better relationships abound, some stakeholders say the model does not promote health equity.
Ultimately, it will be important for patients to consider whether the model is beneficial for them to receive better treatment access.