The Wall Street Journal • 3.23.12
A small but growing number of primary-care physicians are changing over to what are often called "concierge" or "retainer" practices, treating a limited number of patients who pay from a few hundred to thousands of dollars a year for more-personalized services.
"On a very basic level, you're paying for improved access and ease of accessibility," says Alwyn Cassil,public-affairs director at the Center for Studying Health System Change, a health-policy research firm in Washington.
Hard numbers aren't available. But the American Academy of Private Physicians, a trade group, estimates that 4,400 doctors now run such boutique practices, with about 1,000 doctors changing their practice in the last year, says Tom Blue, the group's executive director.
The practice originated in the 1990s, when Howard Maron, a former team doctor for the Seattle Sonics, founded MD2 International, a personalized physician service based in Bellevue, Wash., with multiple locations, where patients pay as much as $25,000 a year.
The trend has picked up steam as stingy insurance reimbursements have squeezed primary-care doctors to the point where many take on a roster of 2,000 to 3,000 patients, seeing upward of 30 a day.
By restricting their practices and charging fees for additional services, they can maintain or improve their incomes with a less-frenzied schedule. Some physicians affiliate with networks or specific companies, while others go it alone.
Health-care consumers can choose whether to pay out of pocket for services, like short office-waiting times, that once were an expected part of the doctor-patient relationship. The most typical cost is about $1,500 a year, or roughly the equivalent of a family cellphone bill, and includes a thorough annual checkup as well as easier access to your physician. Hospitalizations, specialist care and other out-of-office services will cost extra.
If you are considering such a move, here are some questions you should ask.
Is this right for me? One part of the service might be a thorough annual exam that goes beyond a typical checkup and might include an ongoing fitness and wellness plan that keeps you in touch with your doctor.
If you don't want a lot of attention and mostly want a quicker response when you have an occasional sinus infection, concierge care costs a lot more than it is worth.
However, if you have a chronic illness or are prone to emergencies, the doctor is available to talk directly with specialists or admit you to the emergency room, coordinating your care. That has made the practices attractive to some retirees with more serious health issues.
Clark M. Blackman II of Alpha Wealth Strategies, a Houston-area wealth-management firm, sees the service as something like a frequent-flier program that offers upgrades to better customers. "It makes sense if $1,500 isn't really going to make a dent in what you're leaving to your kids," he says.
Will you take my insurance? MDVIP, a Boca Raton, Fla.-based unit of Procter & Gamble, has a network of more than 500 doctors, with more than 180,000 patients, who each pay $1,500 to $1,800 a year for "noncovered services." Their doctors agree to limit their practice to 600 patients. They will bill insurance companies for covered services; people without insurance generally pay out of pocket for those services.
By contrast, MD2 International offices each have two physicians, who restrict their practices to 50 families each and don't take insurance. The firm has five offices and is opening others in Dallas and New York this year.
All tests and services in the doctors' office are covered by the payments, as are house calls to your home or office. But patients still need insurance for hospitalizations and specialists.
What happens if I get sick while I'm out of town, or while you're on vacation?Ideally, your doctor's office will help you find a referral, either through its own network or the doctor's other connections—but that isn't guaranteed. Some doctors promise to be available all the time by phone or email, even if they are traveling themselves.
Do you make house calls? One of the real perks is the possibility that a doctor will come to see you if you are very sick—or even if you aren't. You want to ask whether your doctor will do this and under what circumstances.
How will you handle my medical records? A more thorough medical exam might include advanced testing for cardiac problems or screening for depression, potentially turning up health issues that wouldn't show up in a basic checkup, which could affect your future insurability. You want to know how much information from these additional tests might be shared, and with whom they might be shared.
What if I change my mind or don't like the service? You should be able to drop the service at any time. Whether you get a refund, and how much, might depend on whether you already have had an annual physical exam that year.