Health Insurance Buy your own doctor: Concierge medicine Written by Penny Gusner Penny Gusner Penny is an expert on insurance procedures, rates, policies and claims. She has extensive knowledge of all major insurance lines -- auto, homeowners, life and health insurance. She has been answering consumers’ questions as an analyst for more than 15 years and has been featured in numerous major media outlets, including the Washington Post and Kiplinger’s. Reviewed by Michelle Megna Michelle Megna Michelle, the former editorial director, insurance, at QuinStreet, is a writer, editor and expert on car insurance and personal finance. Prior to joining QuinStreet, she reported and edited articles on technology, lifestyle, education and government for magazines, websites and major newspapers, including the New York Daily News. Posted on: December 7, 2009 Why you can trust Insure.com Quality Verified At Insure.com, we are committed to providing the timely, accurate and expert information consumers need to make smart insurance decisions. All our content is written and reviewed by industry professionals and insurance experts. Our team carefully vets our rate data to ensure we only provide reliable and up-to-date insurance pricing. We follow the highest editorial standards. Our content is based solely on objective research and data gathering. We maintain strict editorial independence to ensure unbiased coverage of the insurance industry. Tired of hassles at the doctor’s office? Get treated like a king with concierge health care. How often have you waited for an hour to see your doctor, only to find that your appointment lasts all of 10 minutes? Have you been overcome by the uncomfortable feeling that something may have been overlooked due to the “mass production” nature of your doctor’s office? “Concierge” health care may be the answer. A membership at a “concierge” medical office allows you to opt out of the traditional health care system and wave good-bye to long waits, limited face time with your doctor and the sense that you’re no more than a medical chart and insurance claim number. A growing number of physicians, who are also fed up with fast-food medicine, are leaving managed care and traditional practices and giving patients the option of private membership. Concierge medicine is sometimes also called: Boutique medicine Direct care Retainer-based medicine Preventative care practice As the brainchild of Seattle physician Dr. Howard Maron, concierge medicine was first practiced in 1996. Today, there are about 5,000 concierge doctors in the U.S., according to the Society for Innovative Medical Practice Design, a concierge medicine trade group. Patients pay a fixed annual “membership” fee for personalized service from a primary care physician. This fee can range from $1,500 to $10,000 depending on the practice and the number of people seeking services. Compared to a traditional practice where physicians see 2,000 to 4,000 patients a year, a concierge doctor has a condensed workload of 500 to 600 patients. This allows more time for the doctor to concentrate on a patients needs without being rushed. There is normally no waiting time for an appointment and some concierge doctors take walk-in appointments. Rarely in a traditional practice do doctors still make house calls, but in a concierge practice this is common. Concierge doctors are on call 24/7. Examples of concierge medicine pricing (annual fees) Individual Family Corporate $1,800 $3,500 (2 people) $1,375 per person (5 to 10 people) $5,100 (3 people) $1,250 per person (11 to 25 people) $6,600 (4 people) More than 25 people: Negotiated Source: Choice Care, Dr. Marcy Zwelling There are two types of concierge business models: 1) An annual evaluation model, where a patient pays a fee for a complete physical with lab tests, and 2) a bundled fee-for-service model where the practice charges a yearly fee to cover a list of services. These services typically include: physical exams, blood work, unlimited office visits and other services (see list below). If you have health insurance, your concierge doctor will submit claims for treatments that are not covered under your membership. Common concierge medicine services On call 24/7House callsNo waitingUnlimited appointments for your membership fee“Executive physical exams” that include a full body scan, screening for 200 diseases, blood tests for rare conditions and time spent with a physician going over every aspect of your medical history. These comprehensive exams can cost well into the thousands through traditional channels.Lab testsX-raysCoordination of care if you become ill while travelingMental health servicesWell-baby checksAcute care visitsOnline access to medical recordsHome delivery of medicationsHospital visits from the doctorTransportation to appointmentsCoordinated care with specialists during travelHotel reservations for family during a medical crisisWellness, fitness and lifestyle screeningsWeight managementNutritionists Membership fees cover basic services that include preventive care, routine physicals, longer appointments, next-day appointments, 24-hour-a-day phone access and e-mail, house calls, coordination of care when you travel, and a CD with your medical records. Doctors defect from insurance Since the mid-‘90s, doctors have defected from health insurance systems by dropping contracts with managed care insurance companies and Medicare. They cited paperwork hassles, delays in reimbursements, battles for approvals, low reimbursements for their services and restrictions on patient care. With so many doctors departing for greener pastures, access to care has become a concern for legislators and consumer advocacy groups. A report from the Medicare Payment Advisory Commission said the number of Medicare patients in search of a primary care physician in 2007 was up by 24 percent from the previous year. HMOs have not been winning any fans either. The American Medical Association has vocalized dismay since 2005, alleging “health insurers are substituting corporate policy for clinical judgment, hurting high-quality medical care, [and] causing physicians to turn away from a managed care delivery system.” In New York, there has been an annual doctor dropout rate of 10 percent from the state’s largest HMO, the Health Insurance Plan of New York (HIP), since 2005, according to the Center For Studying Health System Change. The state’s second-largest HMO, New York Health Net, has been seeing dropout rates of 14 percent in the last four years. Often, patients decide to use money from a health spending account to pay the membership fee. Some concierge practices require patients to carry a catastrophic health plan, at a minimum, when they become members. A catastrophic health plan is generally used for emergency medical care such as hospital stays and surgery. MDVIP, a preventative care practice based in West Palm Beach, Fla., opened its doors in 2000 to address the growing frustration of patients and doctors over mismanagement of health care. “A traditional doctor’s practice involved trying to provide medical care to 2,500 patients, who could only be seen by a doctor for eight to 10 minutes,” explains Darin Engelhardt, president of MDVIP. “It should not be typical for a patient to expect to finish a copy of War and Peace while they wait to be seen by a doctor.” MDVIP provides services that are generally not covered by private health insurance or Medicare such as alternative care (acupuncture, chiropractor), executive physicals and care outside the U.S. They take all types of insurance plans. Engelhardt notes that MDVIP takes patients who don’t have health insurance, and having insurance is not a prerequisite to care. Patients with chronic conditions often find the concierge model appealing. “They come to us looking to get prevention and wellness that is beyond the scope of what traditional insurance products offer,” says Engelhardt. “A smaller setting allows the physician to be far more engaged as a manager of chronic conditions.” David Rothman, a retired FBI agent from California, and his wife Mary Lou have been going to a concierge doctor for 15 years. “If you can afford it, it’s worth it, especially if you have medical problems,” says Rothman, who is a patient of Dr. Marcy Zwelling-Aamot, a concierge doctor in Los Alamitos, Calif. “There is nothing better than being able to pick up the phone and speak to your doctor directly. Since my doctor no longer has 4,000 patients, I’m able to reach her when I need her. If I go to the emergency room, she will meet me there if it’s local and talk to any attending physician about my medical care. I like that comfort.” Rothman adds that another advantage is being able to deduct his concierge doctor’s fees off his taxes. If medical expenses exceed 7.5 percent of your adjusted gross income, you can deduct medical expenses from your taxes. MDVIP says patients generally fall into three main categories: those who are over age 55 who require disease management, middle-aged patients concerned with preventive care and traveling executives. The physician benefits as well. According to the Society for Innovative Practice Design, if a concierge membership costs $1,000 annually and the doctor sees 600 patients, the practice brings in $600,000 per year. If 53 percent of that goes toward operational costs, the physician makes an annual income of $318,000. The nationwide average yearly income of a primary care physician (who is on the lowest salary tier for physicians) is $100,000 to $200,000. If you value your time and like the security of knowing your doctor is just a phone call away, concierge medicine may be your ticket out of the crowded doctor’s office. How to find a concierge doctor Visit the Society for Innovative Practice Design’s physician database.Use MDVIP’s nationwide referral service.Check the phone book for physicians advertising concierge health care.Word of mouth from friends, family, co-workers. Maryland takes issue with “concierge” practices Are concierge medical practices selling a form of insurance — and doing so without being licensed? The Maryland Insurance Administration has determined that the “annual evaluation model” of pricing is not insurance if the fee falls in line with the market value of the services provided. Therefore, a concierge practice using an annual fee would not be regulated by the insurance commission. In order to prevent a “bundled fee-for-service model” from being regulated, concierge practices would have to outline the services provided in their patient contracts and then implement an annual fee that does not surpass the market value of an executive physical, in addition to limiting the other services provided in the fee. Physicians can provide an annual physical exam but they must reduce their other services to one follow-up visit and limit the number of office visits. Services provided must also be clearly spelled out in contracts with patients. Concierge contracts in Maryland must state that both the patient and the physician have the option to terminate the contract at any time. When the contract is terminated, the physician must refund the patient their retainer fee on a pro-rated basis. The Maryland Insurance Administration also asked new and current concierge physicians to contact them so they can go over their written agreements to make sure doctors are not inadvertently selling insurance without a license. Source: Maryland Insurance Administration report on “Retainer” or “Boutique” or “Concierge” Medical Practices and the Business of Insurance, January 2009 Related Articles Tips for buying individual health coverageMore health insurance stories Penny GusnerContributor . .Penny is an expert on insurance procedures, rates, policies and claims. She has extensive knowledge of all major insurance lines -- auto, homeowners, life and health insurance. She has been answering consumers’ questions as an analyst for more than 15 years and has been featured in numerous major media outlets, including the Washington Post and Kiplinger’s. Related Articles How much does COBRA insurance cost? 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