Of the issues facing seniors today, healthcare is at the forefront of political, social and economic reform. It’s also front-and-center in the lives of individuals who must navigate a complicated system of insurance payments, doctor’s visits and prescription payments.
A simple doctor’s visit or annual wellness checkup can feel overwhelming.
Add to this increased wait-times in doctor’s offices, shortened appointment times and inability to be in touch with a primary care provider after business house, and many of us feel frustrated. We often leave appointments with more questions than answers.
For some Americans, concierge medicine is becoming a popular option for circumventing many of the frustrations faced by both doctors and patients in the attempt to meet patient needs and keep medical practices financially viable.
What is Concierge Medicine?
Concierge medicine is often described as a subscription-based medical service and is growing in popularity throughout the United States. According to research from Concierge Medicine Today, “Concierge Medicine Doctors and Membership Medicine programs have become more popular in the past five to ten years, particularly among the middle-class and upper-middle class.” Concierge medicine is associated with doctors who spend more time with patients, offer a greater variety of services and often offer greater access for patients to contact the doctor outside of office hours.
Rather than long wait times, short office visits and limited ability to ask questions or address concerns outside office visits, doctors who participate in concierge medicine want a better experience for both themselves and their patients. Rather than spending time billing insurance companies and adhering to the restrictions of what many view as a high quantity/low quality practice of medicine, doctors practicing concierge medicine offer screenings, services and (perhaps most valuable of all) time not traditionally covered by many insurance programs.
However, as appealing as this sounds for both doctor and patient, concierge medicine comes at a cost, and the price can climb as high as the services offered.
What is included in concierge medicine and specialty services?
There are three basic concierge medicine models, including low fee, medium to high fee and very high fee models. Each model provides a baseline level of service, and the cost of service increases with the level of service.
- Low Fee Models include services such as:
- same or next day appointments
- extended office visits (more than the typical 15-minute allotted with many insurance plans)
- physician email addresses for direct contact
- Medium to High Fee Models may include:
- wellness services
- 24/7 physician phone access
- advanced assessments
- Very High Fee Models (also known as Luxury Medicine or VIP Medicine) may include:
- Private rooms/wings at hospitals
- Fast track access to emergency doctors and/or specialists
- House calls
- Travel accompaniment
- Personal hospital physician (rather than floating between providers)
These are just some of the perks associated with concierge medicine. Everything from at-home IV fluids for dehydration to 60-minute office visits are on the table when it comes to concierge medicine.
What does concierge medicine cost and does insurance cover any of it?
There is no doubt: concierge medicine costs more than traditional medical care. Concierge physicians often work on a membership model, where the physician receives a monthly or annual fee to cover the cost of the amenities described above (longer office visits, focus on preventative care, greater physician access).
Yearly fees, according to Concierge Medicine Today (CMT), range from $1200 to $2700 annually to retain a concierge physician. These fees can be higher than $15,000 per annum for luxury concierge physicians, and these costs do not cover the costs of procedures, travel and other services.
Many concierge physicians do bill insurance, however, which often pays for the cost of covered services set up by the doctor (mammograms, medications, etc.). CMT reports 80% of concierge doctors accept insurance for both routine appointments and services. Though some services provided will not be covered by insurance, doctors discuss this with patients.
Specific costs of practitioners vary, but many list their prices online. On MDVIP, for example, a local internist charges $412.50 quarterly for subscription to her practice, making her annual subscription fee just over $1600. This comes out to roughly $135/mo.
What is the difference between Concierge Care and Direct Primary Care?
The terminology and definitions surrounding most of health care can often be confusing, and concierge care is no different. Many people believe concierge care is simply care paid for out-of-pocket. However, as noted above, many concierge doctors work with insurance companies and bill for services.
The concierge aspect of their practice comes in the form of an additional fee paid for by patients for the benefit of other perks including more time with the physician (who can work with a decreased patient load), house calls and access other services.
The key factor in concierge medicine is time. With fewer patients, concierge doctors spend more time and are arguably better able to focus on patients than those who must adhere to shorter office visits, larger patient loads and payment strictly from insurance companies. The supplemental income from patients (in the annual subscription fee) helps bridge the gap for concierge doctors who wish to see fewer patients for longer periods of time and give patients greater access during non-office hours.
Direct Primary Care is direct-pay care. Physicians who participate in direct primary care do not bill insurance companies for services.
This is common in the mental health field but is becoming increasingly popular in other healthcare professions. In direct primary care, a physician is paid by and works for the patient. If the patient wishes to bill an insurance agency on his own, that is entirely possible.
According to Fischer Clinic in Raleigh, NC, a patient may use his insurance for anything typically covered outside the office visit. For example, if a patient needs an MRI, Fischer Clinic “can submit that referral with the diagnosis codes needed for insurance purposes.” In this case, insurance is useful for specialty care, hospitalization or other procedures not included in routine healthcare. According to Fischer Clinic’s FAQ page, “You may save money because we are not bound by insurance contracts to charge a minimum rate and our wholesale prices are often lower than the price your insurance has negotiated with other providers.”
Often direct-pay care also provides same and next day appointments and longer appointments if needed (Fischer Clinic sets minimum 30-minute appointments).
What is the Hybrid Model?
Between the full-blown concierge model (where patients must pay the annual subscription fee or be booted from the practice) and direct-pay models lives the hybrid model. In the hybrid model, patients are given the choice of signing up for the concierge service, but physicians continue seeing non-member patients as well.
This works well for larger practices with patients of various age ranges. The younger patients may not feel the need for concierge services, while older patients may find the cost of subscription well worth it for longer appointments and more resources including communication options like physician email and cell phone numbers.
Most practices accommodate concierge patients on specific days, allowing doctors to see fewer patients that day. Also, separate phone numbers are often given for concierge patients vs. non-member patients. In this way, some physicians feel they can provide options for patients rather than a one-size-fits-all practice (concierge vs. non-concierge).
How do I find a Concierge Physician or Practice?
One of the most prominent resources is MDVIP. MDVIP is affiliated with over 1,000 concierge physicians/practices throughout the U.S. The process is fairly simple. Search through MDVIP’s group of affiliated physicians. Then, find a doctor near you and meet the physician. If you like the physician and the practice, you will sign a membership agreement. The doctor works directly with MDVIP. He or she shares a portion of the annual fee you pay with MDVIP for administrative management and support.
Concierge Choice Physicians (choice.md) also offers a doctor search and supports the hybrid model. For example, Raleigh, NC’s A. Leigh Ibach, M.D.’s Concierge Choice Physician page reads: I offer a concierge program for a limited number of patients who are interested in enhanced service and a more personalized approach to their health management.”
Or, simply call the American Academy of Private Physicians at 877-746-7301.
Get Our Newsletter
Navigating life after 50 can be complex for you and your loved ones. We're here to help with tips, advice, and answers to questions. When you sign up for our newsletter, we'll let you know by email when we publish new articles that can help you.