Wouldn't it be nice to have your doctor on speed dial? That ready accessibility is one of the principal draws of the growing healthcare trend of concierge (also called boutique, retainer, or more often now, direct practice) medicine.
According to Matt Jacobson, CEO and founder of SignatureMD, a leading provider of concierge medicine services, concierge medical practices typically charge their patients a monthly retainer (above the patient's health insurance premium), in exchange for enhanced services, including a personalized care program created by a primary care physician.
Like concierge medicine, Jacobson continues, the model of direct primary care practice also requires a monthly fee that typically covers all basic primary care; however, no service enhancements are available. Most primary care practices do not accept any insurance. (If the patient has health insurance, it's up to the patient to try to seek reimbursement of services from their insurer.)
"For patients, a concierge practice model offers a personal physician who knows them, their medical issues, as well as their personal life and values," says Alexa Faraday, M.D., who is board-certified in internal medicine and has an office at GBMC. "Having a doctor who is accessible and attentive, who can coordinate care among medical specialists, and who can be an advocate is a huge benefit for patients.
"People who are attracted to this model include those with chronic medical conditions, busy working people and parents who do not have time to spend waiting to be seen, seniors, and those who desire a higher level of service than is routinely provided in a traditional primary care setting," Faraday continues.
For physicians like Faraday, concierge medicine frees them to practice medicine the way it was meant to be practiced. "The SignatureMD approach improves service to their patients, boosts their own income, preserves their independence, increases their intellectual and emotional satisfaction, and restores their work-life balance," says Jacobson, a sentiment echoed by SignatureMD member Joel Meshulam, M.D., a primary care physician with his own private-practice at Mercy Medical Center. "I'm able to enjoy being a physician again," he says.
The number of concierge practices is growing nationally as well as locally, according to Faraday, saying that patients want a doctor whom they know and trust, and who will be available when they need care. "Patients want to be able to reach their doctor, get a timely appointment, be welcomed into a friendly and comfortable office, and be evaluated by a physician who gives them undivided attention in a caring, respectful manner," she says. "Concierge medicine offers an alternative to assembly line medicine."
That's what Marc Macks has found. The 54-year-old Odenton resident has been seeing the same physician for 20 years. Several years ago, his physician decided to go the concierge route; Macks decided to stay with him.
"Not only does the annual fee cover so many appointments a year, I also get a complete physical, my doctor will come to my house, hospital, or a specialist's office if need be, and he answers calls, e-mails, and texts, I can get an appointment usually within 24 hours, and he has the time to really talk to me and I don't feel that he's rushing off to the next patient," says Macks.
"Even more important," Macks continues, "he's an excellent physician, he knows my history (which probably will be increasingly important as Macks, 54, gets older), and he knows what I look like healthy."
Sarah and Edward Braun agree. The 61-year-old Locust Point residents had been long-time patients of Dr. Meshulam and when he decided to shift his practice toward the direct care model, the Brauns decided to make the change with him. "If I need him, he's always available," says Sarah Braun. "And the extra fee we pay doesn't interfere with our insurance, it just pays for extra services. It brings me peace of mind."
According to Jacobson, SignatureMD-affiliated physicians – such as Meshulam – focus their attention on 200-600 members who pay an annual fee, giving them personalized, unhurried service, same-day or next-business-day appointments that start on time, 24/7 availability, and other amenities. The typical office visit is 30 minutes long. That stands in stark contrast to their counterparts who see as many as 25 to 30 patients a day (upwards of 3,000 to 5,000 per year) with visits that last on average 15 minutes or less.
Another driver toward concierge medicine is the current doctor shortage in the United States (according to the American Medical Association, we need 50,000 more than we have), which is particularly acute among primary care physicians. Increasingly, patients are finding it difficult to find the primary care doctor they want or one at all, or having to wait a long time for an appointment.
Despite claims leveled against it, concierge medicine has not been shown to be elitist, illegal or unethical. The Federal government and insurance companies have investigated the practice after five U.S. senators wrote a complaint to the Department of Health and Human Services in 2002. After a formal investigation, then-Secretary Tommy G. Thompson determined that as long as retainer fees were for services not covered by Medicare, collecting the fees was not against the law. And in a report issued in August 2005, the Government Accountability Office concluded that the number of concierge physicians was still too small to cause Medicare patients limited access to health care, but that the government would continue to monitor the trend.
"Concierge medicine is neither elitist nor unethical," asserts Faraday, explaining that there is an annual fee for the physician's services, but this fee is within range of other common expenses – similar to the cost of monthly cable or a daily coffee. "People can decide for themselves how to spend their resources," she says.
Some critics have said that concierge doctors are abandoning their patients who can't afford to pay the annual fee. But many doctors like Meshulam have what they call a blended practice; some of Meshulam's patients have seen him for years and continue as they were, and others have signed on to his direct practice model at a cost of $1,650 a year. "I didn't want to kick my longstanding patients out," he says; a nurse practitioner now shares in the care so that everyone is covered.
Health care is not free no matter which way you look at it, say concierge or direct practice physicians. "Many people are forced into high-deductible insurance plans and have to spend $1,500 to $4,000 out of pocket before their insurance even begins to pick up medical costs," says Faraday. "For those people, a concierge practice may make perfect sense, by offering a higher level of service for the same out-of-pocket expense.
"For people with health savings accounts, they can use those pre-tax contributions toward the annual fee, making the choice of a concierge practice more cost effective," she continues.
"The United States health care system is the most expensive in the world," adds Jacobson, "but according to key measures of health like longevity, infant mortality rate and incidences of chronic disease, the U.S. ranks last among the 11 most developed countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States). One reason is that of every dollar spent on health care in the U.S., less than 4 cents is devoted to prevention."
For doctors like Faraday and Meshulam, direct practice medicine gives them the time to focus on patients who see their health as a priority.
"I take my role seriously," says Meshulam. "Everything we do is on behalf of the patient," adds Faraday.