Subscription Medicine: Concierge practices are a growing healthcare model
By April Morris
When the Affordable Care Act (ACA) is fully implemented, experts predict that between 25 and 30 million people will join the newly insured in the United States.
With aging physicians retiring and fewer entering general practice, experts also predict longer waits in the doctor’s office. In response, concierge medicine – also called boutique practices or direct primary care – has become a growing trend.
The treatment model involves patients paying a monthly or yearly fee for increased, no-wait access to their physician. Partner MD, a concierge-model employer of physicians operating six practices in three states, provides clinical, office, marketing and technology support to doctors. Physicians reported they formerly had roughly 5,000 patients each, Partner MD said; reducing the caseload to a few hundred allows for more “truly personal primary care.”
A gradual trend
Founded in 2003, PartnerMD has experienced 10 percent annual growth and recently expanded into the Upstate, says CEO Linda Nash.
She said the trend towards concierge medicine has grown over the last few years as the medical climate has become more challenging for doctors and for patients in terms of access.
Nash said she believes the ACA has generated more interest in the model and many people don’t consider it a luxury buy. The average household income for her company’s patients is $75,000, she said, adding, “I thought it would be quite a bit higher.”
Each physician in the PartnerMD practices has 10 scholarship patients who do not pay the $1,900 annual fee, she said.
Physicians have several reasons for going into boutique medicine, including difficulty affording the rent for a large office, caseload burnout or seeking a different way to practice, she said. Some patients are seeking this higher level of care because “they are people who haven’t been heard in the past.”
A matter of convenience
For Howard Einstein, concierge medicine is a matter of convenience and is worth the investment. Einstein’s physician switched to a concierge practice, and the patient followed. The convenience factor of no-wait or short-wait appointments and instant communication were important, Einstein said. He cites a recent trip for blood work that took only 10 minutes. “I don’t ever sit in the lobby.”
Einstein said a yearly physical where the doctor takes time to explain all of the results and issues a 10-page report is something he likes. “I feel like I have a connection with my doctor because he knows everything about me. It’s been nothing but a positive experience for me.”
Dr. Ron Phillips, a member of MDVIP, said he was already researching how to move to a concierge medicine model on his own because “it fits right in my medical ethic.” Phillips came from a private practice with five physicians and 35 staff members, he said. Before the switch, he was seeing up to 35 patients each day.
The concierge approach “combines old-fashioned time and availability with cutting-edge technology and prevention,” said Phillips. Now he sees about 15 patients each day and can spend 30 minutes to two hours with them during an appointment, he said.
Phillips said a benefit of concierge medicine is that he can offer tests that predict the risk of heart disease, memory loss and other issues for patients who “care about their health and want to go the extra mile for their health.”
“The bottom line is the premium dollar given to the insurance companies doesn’t fund primary care, it just covers catastrophic care,” he said. Phillips added that he was pleased that he made the switch. “This is the ideal practice.”
Not a cure-all solution
Concierge medicine is not a bad idea, but it’s not a solution for the entire healthcare system, said Dr. Angelo Sinopoli, vice president for clinical integration and chief medical officer of Greenville Health System. He sees it as one model of care that is emerging for patients and a good fit for those who “need more time to communicate, want that attention and want to feel like they’ve had all their questions answered by a physician.”
In the face of a physician shortage, Sinopoli anticipates patients will be seen by more nurse practitioners and physician’s assistants along with care managers and health coaches. Not using physicians for routine checks like those for blood pressure will also help patients be seen, he added.
Access to a physician is what concierge practices offer, and the Upstate is fortunate in that it has a medical school that is training additional physicians who will most likely stay in the area to practice, helping to relieve the shortage, said Sinopoli.
“It’s a really good mechanism for increasing the number of doctors in a community,” he said.
Sinopoli said it’s unlikely concierge practices will grow so much that they create a two-tiered healthcare system. “A couple of decades from now if we don’t manage things well, we could evolve to a two-tiered system, but I don’t see any evidence of that developing at this point.”
Clinics like MD360 and nighttime hours for offices offer patients more access to doctors, Sinopoli said. “That will give people more ability to get access to their doctors outside traditional work hours. I think that will satisfy a lot of the need that people have to see physicians at their convenience.”
In the future, Nash anticipates PartnerMD will continue to expand to keep up with the demand of patients seeking care when newly insured patients hit the insurance rolls. The company is seeking to establish new practices in the Northwest, Southwest and East Coast. As for seeing some of those newly insured patients in their practices, “I wouldn’t rule it out,” Nash said.
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