Medical Practices With Concierge Service
Frustrated by rising costs, managed care demands and overwhelming patient loads, a growing number of physicians are converting their traditional practices into retainer-based or "concierge" practices. Under this evolving model, physicians cut back the number of patients they see, spend more time on personalized care and charge each participant an annual fee ranging from $1,500 to $20,000. In short, these doctors receive more money for seeing fewer patients and gain more control over the way they practice medicine.
Two "Concierge" Models
1. MDVIP is one of the best known of the "concierge" medical practice designs. It was founded by two physicians in Boca Raton, Fla.. They incorporated elements of both a monthly fee practice and an insurance-financed practice. Medical practices who join MDVIP accept insurance money for covered services and charge an annual fee of up to $1,500 for non-covered services (such as 24/7 availability to their own physician, an annual executive physical exam and others). On its website, MDVIP lists approximately 55 affiliated providers.
2. The concierge or retainer-based health care model was created in 1996 by two Seattle internists who set up MD². One of the physicians served as the team doctor for an NBA team and wanted to provide the high level of care reserved for professional athletes to other patients. MD² describes its services as "custom-tailored" medical care for patients "who wish to obtain superior standards of quality and attention." Its annual ration is $20,000 for a married couple.
In return, patients receive special services such as longer office appointments, house calls, same day appointments, extensive annual physicals and more.
Concierge practices are controversial for several reasons including:
Insurance. Patients typically maintain health insurance for items such as hospitalization, specialty services, catastrophic care, laboratory tests and diagnostic studies. Practices that charge a retainer fee have been accused of violating commercial and government health plan agreements, especially Medicare. Contracts with these parties prohibit providers from charging a patient any amount for covered services in excess of the applicable co-payment, co-insurance or deductible. In addition, health plans say they already require physicians to provide many of the extra services.
Elitism. Critics argue that physicians with concierge practices are only treating affluent patients while eliminating those who are unable to pay the retainer fees. This leaves other doctors to pick up a disproportionate number of patients who cannot pay.
The American Medical Association position: Retainer contracts are consistent with the AMA's belief that there should be "pluralism in the delivery and financing of health care." However, the association says these practices "also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care." For more information, click here to read the AMA policy statement on retainer practices, adopted by its Council on Ethical and Judicial Affairs.)
In its guidance, the AMA tells physicians it is imperative not to abandon patients when setting up a retainer-based or concierge practice:
"The conversion of a traditional practice to a retainer practice can place a burden upon patients who must seek another physician and establish a new relationship. Therefore, physicians converting their practices must facilitate the transfer of their patients, particularly those with medical conditions that require ongoing attention. This should include identifying practitioners in the community who are willing to accept patients, and personally communicating the clinical information appropriate to a smooth transition of care. It is inappropriate to charge patients an extra fee for transmission of their medical records."
In addition to patient abandonment concerns, physicians interested in converting to retainer-based practices must be sure to structure their fees to remain in compliance with insurance contracts, as well as state and federal laws.