Concierge Medicine
Seniors making frequent visits to their primary care physician for chronic conditions associated with aging might want to consider the medical model called concierge medicine (also known as boutique medicine or retainer medicine). This is a system where patients pay a membership or annual or monthly fee in exchange for enhanced access and more personal attention from their doctor. This type of medical practice has been growing in popularity over the past twenty years. At one time it was only accessible to the wealthy, but today it is more widely available and affordable. According to AARP, people age 50+ are the biggest consumers of concierge medicine. Concierge Medicine Today reports that 77% of patients using such programs are 40-70 years old. States with higher numbers of seniors, such as Florida, have more concierge physicians.
Is concierge healthcare for seniors, quality care?
Just as in the hotel industry, “concierge” means personalized service. In a concierge medical practice, a patient pays an annual fee for personalized care and in return gets unlimited office visits, same day appointments, less waiting room time, longer exam visits, wellness visits, easy renewal of prescriptions, and greater 24/7 access to the doctor via phone, text, email. It could also include home visits.
Doctors in traditional practices are having to see a high number of patients each day (about one every 10-15 minutes) because insurance reimbursement rates are not enough to cover their expenses. Doctors as well as patients are getting frustrated by rushed appointments. When the concierge doctor charges a membership fee, the reliance on fee-for-service regulated by insurance companies is removed. Now the doctor can carry less of a patient load (1,000 or less as opposed to several thousand) and therefore have more time for their patients. Concierge doctors report seeing as few as 5-10 patients/day as opposed to 24-25.
The strong doctor-patient relationship that develops in concierge medicine results in greater patient satisfaction with their care and doctor. Concierge Medicine Today conducted a 2015 survey on concierge medicine practices. According to their data, 70% of concierge doctors spend between 30-60 minutes per office visit. Fifty percent report no wait time and 28% report waiting less than five minutes to see a doctor.
Practice Builders reports that 98% of patients say communication with their concierge care doctor is better than in a traditional practice, and 97% would recommend membership to a friend. Only 67% of patients were satisfied with their care in traditional health care. Concierge physicians report fewer hospital admissions and improved care to prevent chronic conditions such as hypertension, high cholesterol, and diabetes which are costly to treat.
What is concierge home care?
There is also a concierge style model of home care for seniors. This type of care requires a monthly or annual fee for a set list of services provided such as nursing and medical care, companion care, home based psychotherapy, and even yoga and physical therapy. Concierge style home care services often provide a case manager to oversee and coordinate all of the care a senior receives. The cost of concierge home care is quite expensive, however.
How much does concierge healthcare cost?
Concierge healthcare can be expensive so come concierge medical practices are out of reach for your average senior, but that is changing. According to Concierge Medicine Today, annual fees can run between $1,200 – $3,000 per year. Some concierge medical practices charge per month. Private health insurance typically will not cover the cost of concierge care.
Medicare does not cover membership fees for concierge care, however, plans like Medicare Advantage (a type of Part C plan) do provide a concierge style plan of coverage and care. According to medicare.gov, doctors who provide concierge care must still follow Medicare rules. They cannot charge you extra for Medicare covered services. AARP reports average monthly fees for concierge care ranging from $77 to $183 per month. Without a part C plan that will provide or cover concierge care costs, you will pay 100% of concierge care membership fees out of pocket. The membership fee will most likely cover office visits, routine bloodwork, and annual wellness exams. You will still need to carry health insurance for lab work, x-rays, specialized tests, hospitalizations, surgery, and specialists.
As the value-based model of medical care, for a variety of patients, has taken off, and concierge care embraces many of the same principles of value-based care. Value-based care involves the reimbursement of medical costs based on the quality of care provided to patients. In other words, reimbursements are tied to patient outcomes. With concierge care, outcomes are highly important as well. The idea is that there is less redundancy in care and better prevention, therefore lowering the cost of care for the practice and the patient. Some Medicare Part C plans in fact cover care and provide reimbursements according to patient outcomes and quality of care, similar to how the value-based model of care operates.
There is great promise that concierge healthcare will evolve into a model that saves the lowest-income patients money for their care. For example, low-to middle income Americans who lack quality health insurance or have no health insurance, and who risk going into catastrophic debt by using emergency room services or for the care of a chronic condition, may fare better through a concierge care model. The better preventive care, the medical home model of caring for chronic conditions, and the more personalized relationship between patients and doctors, promises to greatly improve care and save Americans with modest incomes a great deal of money and frustration.
What types of practices or doctors provide concierge care?
Most concierge care physicians are primary care doctors or internists. Some specialists have switched to the concierge model and we may see more specialized concierge medicine in the future. Many excellent doctors have switched to concierge medicine because they grew weary of having to see a set number of patients each day, week, month, or year due to reimbursement issues. They desired to work in a practice where they could get to know their patients better and spend more time per visit with them.
An increasing number of urban hospitals are developing primary care concierge style care plans for patients. The idea is that they will keep private paying customers within the hospital system, and revenues will be invested in hospital services for low-income patients or specialized services or programs such as substance use counseling, for example. Call your local hospital and ask if they offer a concierge style primary medical care option.
Is concierge care best for me?
It depends on whether you are willing to spend more on healthcare for the extra attention. If you are able to find one of the rare concierge care practices that cater to patients with modest or low incomes, and you do not quality for Medicare yet, concierge care is probably something worth looking into If you are over age 65, finding a concierge doctor that has experience with geriatrics would be beneficial. For those patients with chronic health problems, having unlimited access to their doctor can feel very comforting. On the other hand, if you need to see a specialist frequently, concierge medicine may not be best for you.
Find out what your Plan C insurance covers, if they have a concierge style plan or cover concierge care, if you have Medicare. Calculate how much concierge care could save you in the long run based on how much you typically spend on out-of-pocket and emergency care.
How do I find a concierge care practice and what questions should I ask?
When selecting a concierge practice, be sure that they take Medicare and/or insurance for expenses not covered by the annual fee. Be prepared to still be charged the co-pay. Get detailed information on what is included in the annual fee. Some concierge practices’ membership fee covers most of the services they offer, but others charge an additional fee for things like lab work. Speak with other patients to get a sense of how their experience has been with a particular practice.
Some questions you will want to ask include: Is the doctor board certified? Will you always see the same doctor in the practice? What does the monthly or annual fee cover? What out-of-pocket costs may there be for your someone with your level of health or a chronic condition?
There is no national database or registry of concierge doctors for seniors. To find a concierge doctor in your neighborhood use the Concierge Medicine Today Doc Finder. https://conciergemedicinetoday.org/concierge-doctors-directory/ Or access the Concierge Choice Physicians website and select “find a doctor” on the navigation bar at https://www.choice.md/
Sources:
- Before You Pay Extra to Join a Concierge Medical Practice, Consider These Questions, The Washington Post, https://www.washingtonpost.com/lifestyle/home/before-you-pay-extra-to-join-a-concierge-medical-practice-consider-these-questions/2019/10/21/90d8206a-ef8b-11e9-b648-76bcf86eb67e_story.html
- Boom or Bust: How COVID-19 Impacted the Concierge Home Care Business, Home Healthcare News, https://homehealthcarenews.com/2020/06/boom-or-bust-how-covid-19-impacted-the-concierge-home-care-business/
- Concierge Care Taking Hold at Some Large, Urban Hospitals, Modern Healthcare, https://www.modernhealthcare.com/article/20171021/NEWS/171019863/concierge-care-taking-hold-at-some-large-urban-hospitals
- Concierge Care, Medicare.gov, https://www.medicare.gov/coverage/concierge-care
- How Concierge Care for Low-Income Seniors Can Improve Outcomes and Reduce Costs, The American Journal of Managed Care, https://www.ajmc.com/view/how-concierge-care-for-low-income-seniors-can-improve-outcomes-and-reduce-costs
- Is Concierge Practice the Right Decision for You and Your Patients?, Practice Builders, https://www.practicebuilders.com/blog/is-concierge-practice-the-right-decision-for-you-and-your-patients/
- The Pros & Cons of Concierge Medicine, Health Journal, https://www.thehealthjournals.com/concierge-medicine/
- What to Know About Concierge Medicine, AARP, https://www.aarp.org/health/conditions-treatments/info-2019/what-to-know-about-concierge-medicine.html
