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 Could Medical Concierge Services Raise the Standard Of Your Family’s Health Care?
By Jennifer Maciejewski
Experts estimate that there are between 300 and 500 concierge practices in America, a number that is only expected to rise.
You’ve had a sore throat for days. When you call your doctor to make an appointment, you’re abruptly told that it will be three days until you can come in. You wait, you get worse. When it’s time for your appointment, you drag yourself out of bed, drive to the doctor’s office and wait. And wait.
All told, you’ll likely spend well over an hour waiting. When you finally see the doctor, she rushes through the exam, scribbling a prescription for an antibiotic, and hurrying out of the room to see the next patient before you’ve had a chance to process your diagnosis and ask a question. But what can you do? After all, that’s just how the health care system works, right? Wrong.
“I went into family medicine with the whole idea of a Norman Rockwell-style of medicine, and when I got out into the real world, I realized that’s not the way it was.”
Investing In Your Health
Frustrated by the system, some enterprising doctors chose to create a new way of practicing medicine — concierge service. Instead of handling more than 3,000 cases and seeing nearly 30 patients a day in order to pay the bills (a necessary practice given the skimpy reimbursements paid by insurance companies), concierge doctors limit their practices to roughly 250 to 600 patients. While there are no hard numbers, experts estimate that there are between 300 and 500 concierge practices in America, a number that is only expected to rise.
By carrying lighter and more realistic caseloads, doctors are able to devote more time to each patient, raising the standard of care. Appointments, which typically can be set up for the same or next day, start on time and last as long as is necessary for the doctor to conduct a thorough head-to-toe exam, explain the diagnosis, and answer any and all questions that the patient may have. Plus, many concierge doctors give patients their cell phone number and email address and even see them at home or on the weekend, assuring that patients have unlimited access.
“I wasn’t practicing my ideal way,” explained Laura Beaty, M.D., of Alliance Primary Care in Sandy Springs. “I went into family medicine with the whole idea of a Norman Rockwell-style of medicine, and when I got out into the real world, I realized that’s not the way it was. It was more of a numbers game: you have to see so many people, and you have this much time to do it. When you go home at the end of the day, you’re exhausted. I really just wanted to do it differently.”
In order to make carrying smaller caseloads financially viable, the doctors often charge their patients an annual membership fee, which ranges from one to several thousand dollars per patient, in addition to routine charges for lab work and other specialty procedures. Other concierge physicians prefer to charge their patients a flat rate per hour of service in lieu of a membership fee.
But concierge doctors don’t simply cater to the wealthy. In their own practices, they often find that everyone from teachers to busy professionals will make room in their budget for the membership fee. To help keep their style of medicine affordable for as many people as possible, many concierge doctors continue to work with major insurance companies, sometimes absorbing future co-pays and deductibles as part of the membership fee. Others allow their patients to pay the fee in monthly installments, making it easier to fit into the household budget.
“All in all, it’s a reasonably affordable amount to pay to have that sort of access, especially if your time is very valuable,” asserted Otis Plunk, M.D., of Private MD in Atlanta. “There are people who have all the access in the world, and they still elect not to take very good care of themselves. They are still reactive, and they wait until symptoms evolve or the problems have become acute before they seek treatment. If they had elected to do so, they certainly could have afforded to be more proactive, getting earlier testing and being more meticulous in their annual physicals and follow-up. It’s not always economic. Some of it is a mindset, the value you put on your health and the degree of responsibility you are willing and able to accept,” Plunk added.
Concierge doctors don’t simply cater to the wealthy. In their own practices, they often find that everyone from teachers to busy professionals will make room in their budget for the membership fee.
Worth Every Penny
People who turn to concierge doctors for their medical care often find that the benefits far outweigh the costs. “Most doctors are like factories,” lamented Barbara Gustin of Alpharetta, who is now one of Beaty’s patients. “Going to the doctor today is miserable. You wait forever, and they have no respect for your time. You get five minutes with them, and you are out the door. There’s no personal service. I have been going to my ob/gyn for 15 years, and every single time I go in there, they make me fill out the paperwork with my name and my address. It’s just the way that the medical practice has become, and I think the insurance companies have driven it to this awful place.”
“But I wanted personal service,” Gustin continued. “If something serious happened to any one of us and we needed to see a specialist, if we wanted, [Beaty] would go with us. Have you ever heard of such a thing? You’re lucky to get a decent recommendation from your doctor about where to go. And she researches things. I’ll ask her about something, and if she doesn’t know the exact answer, she’ll research it, and then give me all of the information on it. It’s just incredible.”
Like Gustin, Bill Green of Alpharetta noticed a significant difference in the standard of medical care received from Plunk, his concierge doctor. “The differences have been night and day. It’s almost like you have your own private doctor. Your appointments are always on time. The doctor is there to spend as much time with you as you need, so you can ask all the questions; you don’t feel like you are being rushed. He has many different types [of equipment] to evaluate your health at his office, which I haven’t found typical at other doctor’s [offices] — they’ll send you to three or four different places to have tests done. The result? My blood work results came to me the very next day in a secured Internet format, which I have never received before, with complete explanation and a call from the doctor.”
 An Ethical Practice?
While critics of doctors who offer concierge services often raise ethical questions about the preferential treatment, the doctors themselves find the criticism to be unjustified. “There’s no doubt that I’m practicing medicine far more ethically now than I had in the traditional world,” asserted David Albenberg, M.D., a board member of the Society for Innovative Medical Practice Design, a professional organization for concierge doctors. “Nobody has ever raised issue with the traditional family practitioner who sees 35 patients a day, spends five minutes with them, cuts them short, and routinely keeps them waiting an hour-and-a-half. That is thought to be ethically sound. But as soon as somebody puts a dollar of their own onto the table and says, ‘This has value for me; I want more time, I want your availability, I want your attention, I want you not to be frazzled,’ suddenly, there are ethical questions that come into the mix. If you actually sit back and look at what we are doing, it’s very difficult to point an ethical finger in this direction,” he said.
Since they juggle fewer patients, con-cierge doctors have the time to push for tests that they feel are medically necessary, even if they meet resistance from the specialists or the insurance company. “It allows me to practice medicine more freely,” explained Jay Kulkin, M.D., of the Women’s Institute for Health in Atlanta. “It allows me to do what I think the medical literature dictates is in the best interest of the patient. I don’t have to ask permission to do a test. It really changes the way we do business.”
And Jim Rhoden of Marietta credits that change with saving his life. At 65, Rhoden was overweight and diabetic. After failing to convince his regular doctor to offer him concierge services, he joined Beaty’s practice. She examined him, reviewed his medical records, and ordered a catheterization on his heart, even though none of his heart tests indicated a problem. When the cardiologist said that Rhoden didn’t need the test, Beaty insisted.
“They catheterized me on a Thursday morning at St. Joseph’s Hospital,” recalled Rhoden, president of the Futren Corporation. “On Friday morning, they did a heart bypass because I was 60-percent blocked in the main aorta. My surgeon called it the widow-maker blockage, the one that causes people to keel over on the golf course or at the dinner table. He said I was very fortunate in that, with that type of blockage, it doesn’t show up on any of the testing, other than a catheterization, in most folks. They just end up in the morgue.”
A Broken System
Whether they choose to work with insurance companies or not, most doctors agree that the current system is broken. Insurance companies will only reimburse doctors a set fee for their services, regardless of how sick the person is or how long the exam takes. Further complicating the situation is that the reimbursement amount is constantly shrinking, forcing doctors to increase the number of patients that they see in a day in an attempt to break even.
“Every time I am seeing a patient under a regular insurance plan, I am losing money,” noted Maria Schiaffino, M.D., of South Gwinnett Primary Care. For instance, the insurance company may pay Schiaffino $120 for an exam, but the actual cost of treating that patient is closer to $200, once you factor in everything from the cost of the office’s rent and utilities to the salaries of the nurses and clerical staff. As a result, more and more primary care physicians are retiring or closing their practices and fewer current medical students are specializing in the field, exacerbating a nationwide primary care physician shortage.
“There are a lot of frustrated doctors and a lot of frustrated patients out there, so, of course, this is the niche that’s coming out of that,” Beaty reflected. “Trying to access healthcare is quite frustrating, and a huge part of why the system has to be that way right now is because of insurance reimbursement. What you make on the dollar is pretty small, so you have to see more and more people. You just can’t take ideal care of that many people. You can take good care, but not completely ideal or optimal care, which is what I wanted to deliver. In regular medicine, you have to scare people into doing what often they need to be doing, rather than taking the time and exploring other options and figuring out what’s best for each individual person. Medicine doesn’t have to be black and white.”
Needless to say, you can rest easy knowing that someone out there is waiting on you, not the other way around.
For more info
Alliance Primary Care
755 Mount Vernon Hwy NE
Atlanta, GA 30328
404-851-0029
Private MD
www.privatemd.net
Society for Innovative Medical Practice Design
www.simpd.org
South Gwinnett Primary Care
1800 Tree Lane
Snellville, GA 30078
770-972-2663
Women’s Institute for Health in Atlanta
975 Johnson Ferry Road NE
Atlanta, GA 30342
404-832-0300
3400-C Old Milton Pkwy.
Suite 190
Alpharetta, GA 30005
404-832-0300
www.wifh.com
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