If you remember the time when physicians made house calls it was a period in American healthcare where the relationship between doctor and patient was both medical and economic. During the era of house-calls you received your services directly from your doctor and you paid for those services directly to your doctor. Along came the presidency of Lyndon B. Johnson and his “Great Society”.
This aspirational vision began the disconnect on payments for physician services t patient and doctor. In this new emerging aspirational society, everyone was going to have comparable healthcare and both the government and private insurance would be the payment intermediary between patient and doctor. The patients purchased health insurance or if they were senior citizens they purchased Medicare insurance to cover the costs of their healthcare needs. As this phenomenon emerged and expanded, a total disconnect occurred between the patient and the physician. The patient no longer understood the cost or the value of the service being received.
As we fast-forward decades from the Great Society to today, we have a new emerging unique relationship being developed between physicians who provide primary care services such as internists or family doctors and their patients. This new relationship is occurring within the more affluent socio-demographic who seek to have preferred status with their primary care doctor to ensure immediate access and physician availability. We are in a time of increasing physician scarcity and access to a doctor can be weeks or more away from the time the services are sought. These physicians are experiencing a reduction in the reimbursements provided by the third-party payer (insurance companies) for the services they have historically provided. As a result, the physicians have begun to look for alternatives to seeing more patients and reducing the amount of time available to each patient.
The alternative that is emerging is that increasing numbers of well-trained primary care physicians are adopting a concierge medicine model. In this model, the physician caps the number of patients in his/her practice and receives an additional direct payment, in addition to the insurance reimbursement, from the patient. The norm for the average full-time primary care provider is to see between 1500-2200 patients annually. In concierge medicine, the number of patients seen by the physician is a sliding scale tied to the concierge payment made directly by the patient to the doctor. So what does concierge medicine cost? There are significant national groups that charge an additional patient payment, approximating $1800 annually, and the physician agrees to limit the number of patients in the practice to 600 patients. From this benchmark, there are practices that limit the number of patients to 50 patients annually and they are paid an additional $20,000 per year to have this very exclusive limited practice. Between these two extremes, there are a number of price points and patient numbered caps all along the continuum of concierge medicine.
In a unique way, you can think of concierge medicine as a throwback to the doctors who made house calls.
The doctor provides much more hands-on direct access and the patient remunerates the doctor with an additional annual direct payment to have this accessibility. Do you really get good medical access with concierge medicine? The limiting factors that occur in this emerging concierge medicine model result from the fact that healthcare delivery has become much more complicated and specialized over the last five decades. Many of the illnesses that the traditional primary care doctor handled previously are now referred to specialist and sub-specialists. In this scenario, the exclusive access that exists with the PCP dissolves when the patient moves on to the specialists. The specialists, not being tied to a patient cap, has a full waiting room and the patient is again thrown in with the masses seeking, this time, a specialized physician. Further, the PCP develops a referral pattern that may result in the specialists recommended not being uniquely qualified for the specific medical issue or event, but more, a result of familiarity or network connections. Further, the complications of the billing processes in medicine and the document known as Explanation of Benefits (EOB) still remain within the purview of the patient as most concierge physicians continued to bill their patient’s insurance company. When you decide that you are in the market for a concierge doctor, you need to focus on the doctor’s skill sets, referral patterns, and ability to navigate with you through the complex healthcare system we have. Just purchasing access for primary care in the complex healthcare world may not satisfy the experience your parents and grandparents had with their doctor who made house calls.
There is a difference between concierge healthcare and concierge medicine. Which one are you really wondering about?