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Trend Report: The Return of the House Call

Many doctors now offer concierge medical services—for a fee. Here’s what to think about before signing up.

A VISIT TO THE DOCTOR'S OFFICE can sometimes feel about as personal as renewing your license at the DMV. First, there's that long wait in the waiting room—assuming you're lucky enough to be able to schedule an appointment when you need one. Then there's the 10-minute wait in the examination room. And after all that, you may have just eight minutes with your doctor to discuss what ails you.

Increased demand for medical care and a growing doctor shortage in the U.S are creating overcrowding in many doctors' offices, and doctors aren't any happier about the situation than you are. The Association of American Medical Colleges estimates that by 2025, the country will have between 48,000 and 90,000 fewer physicians than it needs.

As a result, a growing number of Americans are signing up with physicians who offer what's known as "concierge" medical care. In this type of arrangement, patients who pay a monthly or annual fee to their primary care physician receive more personalized access.

In response to rising demand, an estimated 12,000 physicians across the country (about 5% of all primary care doctors in the U.S.) have started practicing concierge medicine, also known as boutique, retainer or VIP medicine, and that number is growing, according to data from trade publication Concierge Medicine Today.

The magazine reports that concierge physicians tend to limit their practices, serving 300 to 7501 patients compared with 2,500 or more patients for doctors with typical practices. The retainer or annual fee they charge allows them to cut back dramatically on their patient load, giving them more time to spend with the patients who pay for their concierge services.

As popularity rises, prices are falling

Once considered a service solely for the super-rich, concierge medicine is becoming more affordable. Prices have declined to a point where it may make sense for busy working families—or those caring for family members who have chronic illnesses or are recuperating from an illness—to investigate this option.

How much does it cost? More than half of concierge practices charge $1,600 a year or less per person, according to a study by Concierge Medicine Today. That's down dramatically from the $15,000 to $20,000 that patients often paid for this service 15 years ago.

An important point to remember, however, is that this fee is in addition to the health insurance coverage you pay for through your employer or on the open market.

What exactly do you get for your money?

The concierge fee usually covers all of the care that a primary physician offers, such as visits for treatment of colds and flus, aches and pains, and preventive and non-specialized care. Diagnostic tests and more specialized care typically cost extra and are billed to your insurance carrier, as is treatment for serious injury or illness.

For most people, the appeal of concierge medicine lies in the personalized care and attention offered. The average time spent with a doctor at a traditional primary care office lasts six to 15 minutes. At a concierge doctor's office, the time you spend with your doctor averages 45 to 90 minutes, according to the Concierge Medicine Today study.

More than half of concierge practices charge $1,600 a year or less—down dramatically from the $15,000 to $20,000 that patients often paid 15 years ago.

Many concierge practitioners also offer 24/7 access via phone and email, which means that in addition to your annual physical, your doctor will have the time to check in with you periodically to see how you're doing on, say, lifestyle modifications. Your retainer also buys conveniences such as same-day appointments, no waiting, faster access to specialists, hospital visits from your doctor and, in some cases, even house calls.

The concierge doctor's package may include lab tests and X-rays, or offer discounts on tests such as MRIs and on prescription drugs. "Some develop relationships with labs and contract lower rates than an insurance company would," says Michael Tetreault, editor in chief.

Some issues to consider

Physicians claim that the reduced patient load and the extra time they can spend with each patient lets them focus more on preventive care, but critics argue that there's no evidence that patients are healthier for the added fees. "Many of these doctors are taking care of the 'worried well,'" says Robert Berenson, M.D., Institute Fellow at the Urban Institute. Still, for young families, for older people as they age, and for those helping to care for aging parents or relatives, the increased access can make dealing with medical issues that much more convenient.

Before signing up for a concierge service, there are a few things to consider. First, it's important to get clarity on what the fee covers. The range of services varies among physicians and should be spelled out in a contract. You should also ask whether there's a waiting list for the doctor whose service interests you. Visit the practice and talk to the staff and the doctor in person, and ask to see testimonials from satisfied patients.

Medicine is much like other consumer services, after all. You have to do your research and determine whether this purchase makes sense for you.

3 Questions to Ask Your Advisor

  1. Is the added expense of concierge medical service worth it for my family, given our needs?
  2. Are there ways to get more out of my existing health care coverage?
  3. How can I see to it that I'm budgeting enough for health care?

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1 Concierge Today 2014

This material should be regarded as educational information on Healthcare considerations and is not intended to provide specific healthcare advice. If you have questions regarding your particular situation, please contact your legal or tax advisor.


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