How concierge medicine works - paying doctors extra for better care

by | Nov 23, 2009 03:00 PM ET

A definition of concierge medicine can be found on this page:

Concierge medicine (also known as "Direct Care") is a term used to describe a relationship with a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care.

Concierge medicine can also mean paid-by-patient medicine, as opposed to paid-by-insurance medicine. In other words, a patient pays a higher price for a service, and pays by cash/check/credit card so that the doctor does not have to deal with insurance companies. In return, the patient gets a much higher level of service. The practice is vividly described in this article:

Clinic with two doors, a symbol of two-tier care

In New York City, heard of doctors locating their practices on corners, so they can have one door where they take insurance and another door offering services for patients who pay cash up front for each procedure.
We visited one of these clinics with two doors, to see how it works. The result is a glimpse into a two-tiered system of health care, a system that could be coming to a street corner near you.

As described in the article, the level of care on the concierge side is very different from that on the insurance side. For example:

- Quick appointment (two days on the concierge side rather than 15 days on the insurance side)

- No waiting in waiting room on cocierge side (lots of waiting on the insurance side)

- Spa robe on conceirge side instead of thin hospital gown on insurance side

- Doctor reads mammogram immediately on concierge side rather than waiting 9 days for result on insurance side.

- Ability to talk to doctor directly on concierge side. Not an option on the insurance side.

For concierge service, a customer pays $350 in cash/check/credit card. Health insurance reimbursement (which is the responsibility of the patient) might lower that cost to $210. A person on the insurance side pays nothing or a co-pay. Health insurance reimburses the doctor $140.

The article points out that many are not pleased with the development of two-tier concierge care:

Bioethicist Art Caplan, an contributor, said that even the relatively subtle differences in the experiences of the two patients are unsettling.
While boutique and concierge care have been sold to patients for their benefits to those who pay extra, Caplan said, they have eroded the care that other patients receive, particularly the ability to get the doctor's ear for a few minutes.
“I was bitterly disappointed and disturbed by what you found,” said Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Other descriptions of concierge medicine are available here:

Doctors are giving concierge service a closer look, as seen in these articles:

- How to set up a concierge practice

- The State of Pediatric Concierge Medicine

The second article describes why doctors are headed in this direction:

The practice of “concierge medicine” (boutique medicine, direct care, whatever you want to call it) has grown substantially in the last few years. Unsupportable patient volume, managed care payment and administrative challenges, and clinical dissatisfaction have led to literally thousands of physicians getting out of the insurance-dependency loop and into smaller, slower practices. With physician satisfaction at an all-time low, especially in primary care, is it any wonder that pediatricians are looking for better ways to work with their patients? Perhaps the most telling sign of the arrival of concierge medicine is that there are more than a dozen national organizations that exist solely to help doctors through the process of changing practice models (,,, etc).

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