This article has been reviewed and edited by Dr. Martin Duggan in 2021
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Concierge Medicine
Some seniors who make frequent visits to their primary care physician have been frustrated by having to wait before seeing their doctor. Because there is a serious shortage of primary care doctors, and because of the way doctors are paid in America, most family doctors have to care for a very large number of patients in order for their offices to remain independent.
For a worrying patient, hearing the person in charge of scheduling tell you that your medical problem can wait a few days is an anxiety-provoking experience. Even when someone is willing to trust that their problem isn’t serious, having to wait in order to be evaluated by a doctor is very irritating for some people. The chronic conditions associated with aging often require reviewing lab results or brief doctor visits to confirm medication adjustments are going smoothly. These require frequent visits to the doctor’s office. When their primary care provider is busy, some people feel strongly that they aren’t getting enough attention.
The community at large recognizes that things need to change. We need more doctors, we need to help patients avoid chronic conditions (such as obesity) that require large numbers of visits, we need to ensure that people undergo screening evaluations so that small problems are caught before they become bigger problems.
However, change hasn’t happened. Wait times are still long. For some doctors and patients, there is a medical model that has become appealing. This model is called concierge medicine (also known as boutique medicine or retainer medicine). This is a system where patients pay a yearly or monthly fee in exchange for increased access and more personal attention from their doctor. These fees can be very expensive but there are some people who believe it is worth the price.
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, better care?
No. We could find no quality evidence to suggest that concierge-style medical practices provide patients with superior health outcomes. Let’s take a look at some of the reported evidence regarding satisfaction scores.
However, there is some evidence to suggest that patients in concierge-type practices are more satisfied. 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 often see a high number of patients each day. Many patients are frustrated by appointments that seem rushed. Some doctors in a concierge practice have the ability to schedule longer visits with their patients than doctors in a traditional office. 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 reported 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.
A closer look at satisfaction scores.
This all sounds well and good. But is it true that concierge practices are better? Once again, we have to make an important clarification here. The above results are from sources that are not peer-reviewed. These sources actively promote concierge medicine and so their results may be biased. There is no quality evidence to suggest that patients in a concierge practice live longer, healthier, or better lives than patients who see doctors in a traditional practice.
In these polls, there are other potential biases. People who have just paid a large sum of money for a product are far more likely to report high satisfaction with the product. Confirmation bias impacts satisfaction scores: when we have paid a significant sum for a service, we don’t want to feel like we wasted our money. Without this context, many of these statistics are misleading. It makes you wonder if people who are paying more for concierge medical services are more satisfied because they had to pay more for it.
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 incredibly expensive, and we could find no evidence that it provides superior health outcomes.
How much does concierge healthcare cost?
Concierge healthcare can be expensive so some 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, some more expensive supplemental insurance plans like Medicare Advantage (a type of Part C plan) may cover some expenses related to concierge-style primary care visits. It is safer to assume that your plan will not cover concierge fees until you have been assured by your insurance company that they will cover these services. 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. Even these membership fees will not cover all of your care. You will still need to carry health insurance for lab work, x-rays, specialized tests, hospitalizations, surgery, and specialists. And if your insurance company determines that it would be less expensive for you to have testing or other services outside of the concierge-style practice, they may refuse to cover those services for you until you switch providers.
What types of practices or doctors provide concierge care?
Almost all doctors who provide concierge-style medical services work in three fields: family medicine, internal medicine, and emergency medicine.
Is concierge care best for me?
For most people, the answer to the question above is no. From an ethical perspective, doctors don’t usually recommend more expensive options unless there is significant evidence that said option offers patients a better health outcome.
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
- American College of Physicians Position Paper on “Concierge” Medical Practices https://www.acpjournals.org/doi/full/10.7326/M15-0366?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
- Concierge Care, Medicare.gov, https://www.medicare.gov/coverage/concierge-care
- What to Know About Concierge Medicine, AARP, https://www.aarp.org/health/conditions-treatments/info-2019/what-to-know-about-concierge-medicine.html
