When your client asks for guidance in switching from a traditional medical practice to concierge medicine, here’s what you need to know to help them make the transition.
Concierge or membership medicine offers upgraded services at a fee. Typical fees range from $135 to $150 a month, and can go up to about $2,000 annually. In some practices, fees can be paid quarterly, semi-annually or annually.
For that fee, services that patients receive can include 24/7 direct contact with their doctor via cell phone, email or text; same day or next day office visits that last as long as the patient needs; house calls and home delivery of medications; hospital and nursing home visits; social support; and a trusting relationship with a doctor who is not hurried or harried.
Also included are traditional primary care services, such as prevention screenings, wellness visits and diagnostic tests, and some urgent care. Surgery and emergency services require comprehensive health insurance plans available commercially or through the government.
Concierge medicine doctors have an average of between 150 and 600 patients. Their median patient age is 55 to 64, and their largest number of patients range in age from 65 to 74. They see between six and 12 patients daily. Traditional medicine doctors typically have more than 2,000 patients, and see between 22 and 30 patients daily.
“I think he went from 2,000 patients down to 500 patients and that made a tremendous difference in his practice. The biggest difference that we see is that his hands are no longer completely chapped and rough from seeing so many people. The wait time in his office is minimal, if at all now, in comparison to the 1½ hour-plus wait before concierge took place,’’ said Patricia M. Higgins, a concierge medicine patient in South Carolina.
The American College of Private Physicians (www.acpp.md), a concierge advocacy group, estimated that in 2019, there were about 10,000 concierge doctors nationwide serving about 1 million patients.
Nationwide, there are about 900,000 board certified doctors practicing in the United States, according to a 2018-19 report of the American Board of Medical Specialties.
The largest concentrations of concierge medical practices are in California, New York, New Jersey, Arizona, Texas, Massachusetts, Pennsylvania, Florida, Illinois and Georgia.
Patient frustration with the traditional medical practice partially explains the rise of concierge medicine, which had its informal beginning in 1996 when the Seattle Supersonics professional basketball team’s physicians founded a retainer-medicine practice.
“Since 1981, reimbursement for medical services has gone down and it’s become more difficult to get paid. The problem with that continuous slope downward for 40 years is that in order to maintain a practice, not even to grow it, the only way to do so is to see more and more patients. So traditional doctors started with seeing from 10 to 12 patients a day, then 14 to 16, and that is doable, but once you go to 20, 22, 26, that’s a problem. It became untenable,’’ said Terrence L. Bauer, CEO of SpecialDocs Consultants, LLC, a concierge management service based in Highland Park, Ill., and founded in 2002.
Concierge doctors are contracted with concierge networks like SpecialDocs to receive operational, marketing, legal, technological and membership support services, as well as training and tools. Physicians continue to perform traditional medical practice administrative functions, such as hiring and paying their staff.
Concierge Medicine Today, a trade journal for concierge medical practices, reports that the annual renewal rate among concierge patients has been 94.7%. It says the typical age of the concierge doctor is between 40 and 59. SpecialDocs reports a 96% renewal rate among its member patients, and a 100% renewal rate among its physicians.
Bauer of SpecialDocs says that a survey of the impact of COVID-19 on traditional medical practices conducted for the Physicians Foundation found that 16,000 of these practices closed permanently in 2020, and it is forecast that an additional 8,000 will close in 2021.
MDVIP, a concierge network with about 1,100 member doctors in 44 states, saw an increase in patient membership in 2020, despite—or perhaps because of—the pandemic. “We had the best patient member growth that we’ve ever had; we are now up to 350,000 patients,’’ said Bret Jorgensen, CEO of MDVIP, which was founded in 2000. “The new members came from referrals and online digital joiners, but the virtual model has been our model from the beginning. We are continuing to see the model be robust, especially with the 65-and-older patient who is squarely focused on their health care. They want to prioritize their health care by getting ahead of it and being proactive, and having a better, personalized relationship with their doctor is part of that,’’ Jorgensen said.
Despite COVID-19, MDVIP physician member concierge offices remain open and with heightened protective measures in place, Jorgensen said, because “the face to face relationship is a very important commitment.’’ However, its number of virtual visits rose to 1.5 million in 2020, due in part to the pandemic.
“Frankly, the great likelihood is that these patients didn’t want to go to an office, they wanted to talk to their doctor virtually, and avoid increased exposure,’’ he said. “Most of the support can be virtualized easily.’’
Chiefly, concierge medical doctors are in the practices of internal medicine, family practice, endocrinology, cardiology, gynecology, pulmonary and rheumatology medicine, in that order, Bauer said.
In membership concierge medical practices, a monthly membership fee is usually charged. Some of these groups do not take insurance, but others do. Insurance coverage can be similar to traditional medical practices: some concierge medical practices take assignment of benefits, bill on behalf of patients and accept payments through insurers.
Doctors who are members with concierge networks such as SpecialDocs and MDVIP are board certified in their specialty and must go through a vetting process.
Dr. Louise Aronson, a professor of medicine at the University of California at San Francisco and a geriatrician, suggests that concierge medicine physicians with patients over 65 be experienced in geriatrics because they will understand how medicines and medical procedures can affect an older body.
Consumer Reports says, “This type of care, which is also called retainer medicine or concierge care, works best as an add-on to your existing health plan. You pay a flat monthly or annual fee—no add-on charges—in exchange for the promise of nearly unfettered access to a primary care physician you choose, not one dictated by your insurance network.’’
Higgins, the South Carolina-based patient who sees a concierge doctor, says, “We will continue to use our CD even if it is a hardship for us because he gives us great care and has discovered serious problems early on because he checks us so carefully.’’