Stephanie Mitchell was tired of the usual annoyances when visiting the doctor, such as hours spent in the waiting room and rushed appointments with doctors too busy to give her their full attention.
“Navigating the health care system with its long waits for short appointments and depersonalized care can be a hassle,” says Mitchell, a working mom of two in Baton Rouge, Louisiana. “Sometimes it treats a patient more like a number than a person.”
“I was looking for a more personalized health care experience, and I wanted a doctor who really listens and takes the time,” she says.
In an effort to find a good doctor, Mitchell finally found Dr. Louis Minsky, a concierge medicine physician at Minsky & Carver Medical Center for Personal Wellness, an affiliate of MDVIP, a national primary care doctor network that provides concierge medicine services.
The word “concierge” conjures an image of a well-dressed employee at an expensive hotel who arranges restaurant reservations and caters to your every need. Concierge medicine isn’t exactly like that, but it does aim to be more attentive and patient-focused — and often comes at an expense.
“I like to think of myself as removing the hurdles of medical care,” Minsky says.
We asked our experts to explain how concierge medicine is structured, how it’s different from a regular doctor’s practice, and who stands to benefit the most from using a concierge practice.
[See: 12 Signs You Should Fire Your Doctor.]
What Is Concierge Medicine?
Concierge medicine is a health care model in which patients pay a monthly or annual membership fee for enhanced access to personalized care.
In concierge medicine, most providers are primary care physicians, also called general practitioners or family doctors.
Some may be pediatricians, which can benefit parents whose children seem to be always getting sick.
Enhanced medical services may include:
— Urgent care
— Minor procedures
— Lab and imaging tests
— House calls
“Concierge practices offer members the chance to avoid some of the typical hassles involved in seeking medical care,” says Hannah Neprash, an associate professor of health policy and management at the University of Minnesota School of Public Health. “Broadly speaking, the benefit is convenience and personalization.”
Patients who are tired of waiting days, weeks or months for hurried appointments are increasingly moving to this model of care, allowing health practitioners to spend more time with patients and be available more readily.
Direct primary care
A more affordable form of concierge medicine is direct primary care (DPC), which may cost as little as under $100 per month.
“Direct primary care is usually less expensive to the patient than concierge medicine, although both models fall under the general umbrella of direct-to-consumer care,” says Dane DeLozier, president of the DPC practice FreedomDoc Health, headquartered in Plainfield, Indiana.
DPC does not bill insurance at all and, therefore, has lower costs of operation and less administrative burden, which allows them to be more affordable.
“The direct care models systematically offer their services at lower costs because there are fewer transactional costs and fewer hands in the pot,” DeLozier says.
Although DPC might not offer all the bells and whistles of concierge medicine, such as additional labs and testing, the basic advantages are the same.
“The direct care model offers same- or next-day encounters, and you get to see the same physician every time. The more complex your health issues, the more beneficial it is to see the same doctor — just like the old days,” DeLozier says.
[READ: Health Questions to Ask Your Doctor]
How Does Concierge Medicine Work?
In a traditional doctor’s office, a patient pays per service, and the bill goes through the insurance company the doctor is contracted with before being sent to the patient.
But with concierge medicine, the monthly or yearly retainer fee encompasses the doctor’s fees and specified services.
Patients can see the doctor as many times as they need and can have more frequent and direct communication with the provider.
“For the patient, the benefit is having a doctor ‘at your beck and call,’ literally,” says Michael Seavers, an assistant professor and department chair of Healthcare Informatics at Harrisburg University of Science and Technology in Pennsylvania.
For concierge providers, spending more time helps them get to know patients better, understand their needs and form a preventive plan.
“The visit is more of a holistic approach focused on the specific patient and preventive medicine for the patient — more focused screening and tests can be performed versus a regular office visit to a typical family doctor,” Seavers says.
[READ Medical Gaslighting: What Should I Do If My Doctor Is Dismissing My Health Concerns?]
Concierge Medicine Pros
With concierge medicine, there are many benefits for the patient, including:
— Longer visits with their doctor: Concierge doctors see fewer patients and, therefore, can spend more time with patients at each visit. Minsky says he sees 5 to 10 per day versus 20 to 25 in a traditional practice.
— Little to no wait time in the office: In a traditional doctor’s office, once a physician gets behind schedule, wait times can snowball to an hour or more. With fewer patients, Minsky says his appointments start on time.
— Convenient, same-day office visits and consultations: Providers can schedule patients the same or next day, rather than having them wait weeks.
— Better communication: Doctors often offer their cell phone number, text messaging and email. “If patients have a medical concern after hours or over the weekend, they can reach us by phone 24/7, which provides peace of mind and can prevent unnecessary visits to the emergency room,” Minsky says.
— Coordinating care with specialists: Your concierge doctor can arrange appointments and act as a mediator for your care with specialists who aren’t part of the concierge practice.
“Time is everything for these patients, so the ability to call a concierge provider and receive same-day service is a major bonus,” Seavers says.
Concierge Medicine Cons
If this sounds too good to be true, concierge medicine does have some drawbacks, including cost and ethical concerns.
Cost
Most concierge practices are expensive.
“The primary downside is expense; there isn’t great data on this, but it is not unusual for concierge membership fees to exceed $2,000 a year ($166 per month), and I have heard of fees going as high as $10,000 a year ($833 per month),” Naprash says.
However, patients may save money by avoiding going to urgent care clinics and emergency rooms, and their concierge doctor may include services in their retainer that patients would otherwise have to pay through their insurance, such as:
— Sick visits
— Lab tests
— Multiple wellness checkups
— Multiple appointments for chronic disease management
Ethical concerns
Because of its cost, only certain patients can afford concierge medicine. Patients under the U.S. poverty level, for example, would not be able to afford concierge medicine.
“Some experts are afraid that as concierge medicine increases in the U.S., the likelihood of a two-tiered health care system becomes more prevalent: one tier for the ‘haves’ and one tier for the ‘have nots,'” Seavers says.
Health often correlates with socioeconomic status and where patients live because this determines in large part how much money and access they have to health care.
“Social determinants of health (SDOH) have been discussed at length in the past few years — i.e., your zip code determines your health status,” Seavers says. “Concierge medicine will potentially add to the SDOH issues here in the U.S.”
Does Concierge Medicine Take Insurance?
The retainer fee for concierge practices isn’t covered by insurance, so you must pay out of pocket.
Private health insurance or Medicare may still cover medical services and treatments outside of that fee, especially if the concierge provider is in network, Seaver says.
Although patients will still need insurance for specialists, emergency or hospital care, they may be able to switch to a lower-cost, high deductible health insurance plan, with the goal that the concierge physician will handle the vast majority of their care.
Seeing a Specialist
If patients need a specialist, they will most likely see a different practitioner, who may or may not offer reduced fees for patients coming from a concierge doctor.
“A concierge provider usually has a robust network of expert specialists to refer patients to,” Seavers says.
Some concierge practitioners operate within a hospital or health care system, with specialists on hand.
Who Should Use Concierge Medicine?
The first consideration is monetary: Can you afford it?
“Good or bad, people with financial capabilities are the most likely to use concierge medicine,” Seavers says.
Other groups that might benefit:
— Older patients: Because patients often have more health concerns and multiple chronic conditions as they age, concierge medicine is a good choice for seniors.
— Higher-need patients: For those who are often sick, such as children or people managing a chronic disease, concierge medicine can be a way to get their money’s worth and avoid inconveniences when needing to come in frequently.
— Executives or frequent travelers: Although many traditional practices now offer telehealth, a provider’s availability is still key when you’re on the go. In addition, a concierge doctor may be able to arrange care with a local doctor or hospital if needed while you’re away.
— Patients focused on preventive health: Some people go to the doctor or urgent care center only when they’re in what Seavers calls “reactionary mode,” such as when they get sick. However, patients whose goal is to stay healthy can benefit from the preventive care and long-term health planning that concierge medicine offers — some practices even include nutrition, fitness and wellness services.
“The concierge provider can then help the patient stay with the plan over time,” Seavers says.
In Minsky’s practice, the annual fee covers preventive services, including comprehensive health screenings and diagnostic tests. His patients include people in their 30s and 40s who are health conscious and want to be more proactive.
“I go through the test results in detail and work with each patient to develop an individualized action plan,” he says. “Informed by the results, I provide ongoing coaching and tools to help patients make healthier lifestyle choices, prevent disease and achieve their specific goals.”
Bottom line
Concierge medicine — or its lower-cost cousin, direct primary care — could be the future of health care, as many patients prefer the convenience and access it gives them, and doctors like the lighter patient load.
“My patients reflect on the comfort of knowing I’m only a phone call away for answers that may negate a visit to the emergency room or urgent care,” Minsky says.
Whether it’s right for you will depend on how the cost compares to what you currently spend on health care and insurance, and if the security of having a doctor readily available for your health care needs is worth the price tag.
“Time is money, and I believe that if I’m going to spend time with my doctor, I’m also making sure I’m heard, which is hard when doctors seem to be on the clock and only spend four minutes with a patient,” Mitchell says.
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What Is Concierge Medicine? originally appeared on usnews.com
