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Thursday, May 17, 2012
Special Report: February 2007
Special Treatment
Is concierge medicine the end of healthcare hell — or the beginning of greater inequity?
Story by Michael P. Scott
Bob Dawson knew he was in trouble when a severe spider bite to his leg required multiple visits to a physician. He could barely walk after a week of care and found himself hobbling around in a Rocklin parking lot after a medical procedure. “It was so frustrating because my leg didn’t appear to be getting any better,” says Dawson. “And on top of it, this series of visits cost me around $1,100.”
As Dawson continued to limp his way around the lot, he noticed a sign that captured his attention: Boutique Family Medicine. Curious, he decided to walk in and see what this business was all about. As fate would have it, Monty Peterson, his former physician at Kaiser, of whom he had always been a real fan, was there to greet him.
“After getting past our mutual shock at being reacquainted in such an unusual way, Monty shared with me what his new concierge medicine practice was all about,” says Dawson. “From that point on I was hooked.”
Dawson is among a growing number of area business professionals who have embraced the many benefits of concierge medicine. Also known as retainer, boutique or personalized medicine, it represents a trend gaining steam throughout the Capital Region.
The beginnings of concierge medicine can be traced back to the mid-1990s, when Dr. Howard Maron, former team doctor and medical director for the NBA’s Seattle Supersonics, began offering to the public the type of personalized healthcare received by professional basketball players. According to the Society for Innovative Medical Practice Design, an association created to assist physicians who want to convert their practices to this new model, there are approximately 250 concierge physicians across the country — a figure that, according to some projections, will triple in the next five years.
Advocates for this innovative form of medical delivery say it is the wave of the future. Here’s how it works: Patients pay a monthly or annual fee in exchange for highly personalized care from their doctor. Depending on the type of practice, this fee covers services ranging from same-day appointments to house calls to executive physicals.
Physicians are typically available 24/7 for any urgent-care needs that may arise, and while most concierge practices don’t accept Medicare or traditional insurance, they recommend that their patients, at a minimum, carry catastrophic insurance coverage for inpatient hospitalization, emergency room visits, prescriptions and radiological and laboratory services.
Healthcare-delivery experts say declining reimbursement rates for physicians along with society’s growing interest in consumer-driven care are largely behind the concierge medicine movement.
Take, for example, the issue of physician reimbursement. In 1996 it was routine for physicians to bill $100 per patient visit and receive $95 back from the insurance company.
By the late ’90s, that same $100 netted only $40 in reimbursement. To compensate for these losses and stay even with their office overhead, physicians typically had to cram more patients into their schedules and see them for shorter visits.
Peterson is one of a handful of area concierge physicians determined to turn today’s traditional healthcare model on its head. Outspoken and irreverent about his experiences at Kaiser Roseville, Peterson says the time has come for a new way of delivering cost-effective, high-quality care to patients.
“Prior to starting my concierge practice, I felt enormous pressure to rush patients through the door,” says Peterson. “I was often prohibited from ordering important diagnostic tests and constrained from sending patients to specialists when warranted. This made for a very frustrating experience.”
“The concierge model further aggravates a very serious problem:
medical access for patients who have no financial means.”
— Maurice Penner, University of San Francisco
Dr. Michael Arca, who left Kaiser to join Peterson, concurs. “I kept asking myself, ‘How can I practice the true art of medicine when I’m seeing a new patient every 10 minutes?’” says Arca. “The time is now for patients to begin getting full value for what they paid for, and the concierge model is ideal for ensuring this.”
The Rocklin doctors charge $60 per month for adults and $40 for kids. There are no co-payments, and the services do not cover major surgeries or catastrophic care. On their first visit, all patients receive a comprehensive two-hour physical exam, complete with a full battery of lab results and a lengthy written health summary.
Dawson, who is the managing partner for the Business Group Inc., says he was shocked when Peterson provided him his personal contact numbers for any after-hours medical needs.
“How many physicians give you their home and cell phone numbers in case you need to reach them?” says Dawson. “He tells me that I can call him anytime at home and even on the weekends for urgent health matters that come up. I shared my appreciation and then told him that I’m probably not going to be trying to reach him late at night or in the wee hours of the morning unless I’m dying.”
According to a study in the American Journal of Managed Care, nearly half of all patients wait more than 30 minutes, on average, to see a doctor in a clinical setting. Dawson says he has never had to wait when visiting Peterson’s office.
“I’m always seen immediately upon arriving,” says Dawson. “It’s rather refreshing when I consider all the medical appointments I’ve gone on where I have been left in a sitting area with kids running around, shuffled from waiting room to waiting room.”
Healthcare experts say convenience is the main contributor to the rising interest in concierge plans. They also argue that, as patients manage more of their own healthcare dollars, they have the freedom to choose care that is more convenient, less costly and of a higher quality.
Peterson says most of his patients have combined health savings accounts with low-cost catastrophic health plans. Peterson estimates that for about 20 percent of his patients, money will never be an issue. Forty percent of those enrolled in his services are uninsured, he says.
Health savings and health reimbursement accounts have been widely touted in some circles as effective ways for patients to fund concierge care. The former is a tax-exempt trust or custodial account created to pay for qualified medical expenses of the account holder/employee and his or her spouse and dependents.
With an HSA, either the employer can provide funding for the employee, or an individual, such as a business owner, can establish one on his or her own. Health reimbursement accounts differ slightly in that they are exclusively employer-funded accounts that reimburse employees for qualified medical expenses. In other words, these plans can only be established by an employer for an employee.
Don McGrew and Jim Maher of McGrew & Maher Insurance Services Inc. say an individual must be enrolled in a qualified, high-deductible health plan in order for contributions to be made to a health savings or health reimbursement account. Account holders then use these funds to pay for eligible out-of-pocket medical expenses such as those associated with concierge care, or they can save the money in their account for future needs.
“A concierge medicine plan provides patients with choices
and puts money back into their pocket.”
— Jim Maher, McGraw & Maher Insurance Services
“We’re big believers in these types of accounts and believe that they offer enormous value to the consumer when combined with a membership in a concierge medicine plan,” says Maher. “We have discovered that they allow patients to gain a much better appreciation for how their money is being spent, therefore making them better consumers. In the end, it provides them with greater healthcare choices and puts money back into their pocket.”
Though supporters say the consumer-driven healthcare model gives patients greater control over their healthcare dollars, critics say too much stratification already exists in our nation’s healthcare system between the haves and have-nots, and that concierge medicine amounts to special dispensation for the well-heeled, who can afford out-of-pocket costs.
The American Medical Association’s Council on Ethical and Judicial Affairs points to concerns about the potential decline in the number of physicians delivering charity care. They note that concierge medicine exacerbates existing healthcare inequities based on rationing by ability to pay.
Maurice Penner, a national authority on healthcare-delivery models and chair of the health services administration program at the University of San Francisco, believes the consumer-driven movement toward concierge medicine will only intensify the disparities between the poor and the well-off in terms of access to care.
“While I can accept the fact that there are a number of valid reasons for physicians to switch to the concierge model,” says Penner, “the fact remains that it further aggravates a very serious problem in our country: namely, medical access for patients who have little or no financial means to pay.”
Even a $60-per-month enrollment fee for concierge services, he says, would exclude a lot of people. “While there are a few do-gooder physicians that might keep their rates low, the vast majority under this new arrangement will charge what they think the market will bear, thereby excluding a large segment of the patient population.”
Penner believes an even larger ethical question is the fact that, under Medicare, the federal government provides huge amounts of subsidy money to train medical students. He says that should this concierge medicine movement become popular, these funds would essentially be used to support unequal access to medical care.
One additional concern Penner raises is that a growing number of patients will be abandoned as physicians convert from traditional to fee-based retainer practices. “It definitely begs the question as to where all of the people with traditional insurance will go for their care if this concept becomes mainstream.”
Dr. Bob Nelson, founder of Concierge Physicians of California, believes the larger conversation should be about the quality of care a patient receives in return for the money he or she is spending. His clients pay an annual fee in return for the convenience of 24/7 physician access, house calls, same-day appointments and executive physicals.
Like many concierge practices, Concierge Physicians of California does not accept Medicare or traditional insurance, but recommends that patients have catastrophic coverage. Nelson says his practice is limited to a set number of patients, which allows him to give each individual his undivided attention and time.
“In settings that I’ve worked for in the past, I felt unable to offer the very best care to patients because of the constraints of that medical system,” says Nelson. “Now I enjoy being able to ask my patients, ‘Do you have any additional concerns you’d like me to address?’ without having to rush them out the door.”
Nelson says concierge medicine works particularly well with men, who can be notoriously stubborn about important health issues.
“It’s so true that men are often in denial regarding their health and offer all sorts of justifications as to why they don’t need preventative care,” says Nelson. “My practice now allows me the freedom to take a proactive approach to medicine, one where I am able to see patients when they are healthy and help them stay that way.”
With respect to the future, Nelson believes there is a bright road ahead for the concierge medicine concept. “This model is going to be the norm in 10 years. There is no doubt in my mind about that.”
Perks offered by concierge physicians
Same- or next-day appointments for non-urgent care: 99%
24-hour telephone access: 99%
Extended office visits: 96%
Access to physician via e-mail, cell phone or pager: 94%
Coordination of medical needs during travel: 82%
Home consultations: 78%
Private waiting room: 63%
Mental health counseling: 60%
Online or electronic access to medical records: 42%
Accompaniment to specialist appointments or medical procedures: 38%
Home delivery of medication: 1%
