The medical care market is increasingly becoming like the real estate market: you get what you pay for. The top complaints from patients regarding doctor visits typically include long waits for just a few minutes of doctor face time, impersonal care, lack of appointments and slack follow up.
“Concierge” care has recently entered the medical scene offering more personalized, around-the-clock treatment, but it comes at a hefty price tag: up to $2,000 a year, and many concierge docs don’t accept insurance. With a growing number of patients in need of more attention from doctors and an easier experience getting the care they need, clinics nationwide are aiming to bridge the gap between expensive concierge care and lost-in-the-shuffle treatment.
At One Medical in San Francisco and GreenField Health in Portland, Ore., patients are charged an annual membership fee and are cared for by doctors with an average of 800 to 1,000 patients on their roster. That’s less than one-third the number of patients seen by doctors at most mainstream clinics today. By limiting the number of patients served, the doctors are able to offer more benefits such as longer one-on-one visits, and e-mail and phone appointments.
At One Medical, owner and founder Dr. Tom Lee offers his patients office visits without waiting-room time, 24-hour a day online and telephone access to doctors and the ability to book appointments and request prescription refills online. Membership costs $200 a year, and he accepts most major health insurance plans. To help reduce overhead costs, Lee’s office has fully embraced the virtual world. Instead of patients having to make a trek into the office every time they get a sniffle, they can speak to their doctor via e-mail, instant message, or Skype, and have a prescription sent directly to their pharmacy.
Lee says the model is a win-win for doctors and patients: membership fees keep the doctors’ offices profitable despite the limited patient load, and patients receive more personalized care.
“The membership fee allows us to do things not typically covered by health insurance, like virtual visits and phone calls,” says Lee.
The model has been successful for One Medical, and the company now operates six facilities in San Francisco, five in New York City and has plans for expansion later this year in Silicon Valley and Boston.
The "problem" that clinics like One Medical are trying to solve is that medicine has become purely a volume business for doctors who want to make a living, says Dr. Steven Fisher, owner of Fairfield County Medical Group in Trumbull, Conn.
“Doctors have to run people through as quickly as they can in order to fit in more patients in order to make more money, and what ends up happening is that doctors do not have the time they should to spend with their patients," he says.
Lee agrees with this diagnosis, adding that physicians should never be paid based on the quantity of patients they see. “Doctors should be paid based on the quality of the service they provide, not the number of patients they can squeeze in in an hour. We wanted to build a practice that would enable a better experience for both the doctors and the patients.”
Lee says the doctors at One Medical enjoy more hours in their day without having to run people through, and the patients enjoy a longer appointment time and better access to their doctors. He encourages patients to think of the clinic as “member supported” but not “members only,” and stresses that if someone wanted to join One Medical and was unable to pay, the membership fee would be waived without hesitation.
“It’s not an access fee, and in a perfect world, we would hope that this level of care would be available to everyone."
That's the sentiment echoed at GreenField Health in Portland, Ore., where administrator Steve Rallison says members enjoy better care due the annual fee they pay, which ranges from $120 per year to $756 per year depending on age. GreenField uses the logic that the older you get, the more specialized care you need; patients in their 30s would pay $396 per year, while someone in their 60s would pay $612 a year.
"When the physician is not harried, all kinds of wonderful things happen,” says Rallison. “The membership fees enable a better doctor-patient relationship simply because of the additional time they provide."
Virtual visits help GreenField save both time and money. Patients have the ability to call or e-mail doctors personally 24 hours a day, and book appointments online at any time. The clinic also assures its patients of little to no wait time, and same-day or next-day appointments.
But even with all these perks, neither One Medical or GreenField can be considered true “concierge” medicine, says Fisher.
"True concierge doctors will only have around 400 patients, and many of them won’t take any type of health insurance. On top of that, in most major cities like Miami or New York, the fees are 10 times what One Medical is charging,” says Fisher.
Fisher says that in states including New York, California and Florida, concierge fees currently stand at around $2,000 per year. He adds that for people considering investing in concierge services, the prices aren't likely to go up anytime soon, as in the last few years the cost seems to have plateaued.
"Honestly, some people spend $2,000 a year for their maid to go on vacation with them," says Fisher. "It's all about what you find valuable. If you find value in having your doctor's number and the cost isn't going to be a burden to you, then I would absolutely recommend it. It's like going to a hotel and paying extra money for the ocean views. If you are happier with that view and you can afford that view, then get it. If you're happy looking at the garden, then do that. The good thing is that for the people who want the ocean views, they now have the option."
Fisher's clinic recently tested out a "hybrid" concierge model, where patients were given the option to purchase concierge care for $2,000 per year. Perks include longer appointments, hospital care from your physician and 24 hour phone access to your doctor.
"It's working," Fisher says. "I have more time for appointments with my concierge patients, but my regular patients also benefit from seeing a doctor who is a little less stressed, a little less burned out and a little less tired. I am not constantly going through my day saying 'I gotta see another patient, I gotta make another dollar.' I have the cushion that saves me from having to take on so many new patients."
Fisher says that while he is a proponent of concierge care, he only recommends it to patients who can afford it. However he says the need for more personalized and 24-hour access increases with age.
"I carry my phone everywhere, and my patients can call me anytime. For some people, just having that peace of mind is worth it."
Concierge medicine is not without its critics, Fisher says, because unfortunately the type of care given to the people who pay the concierge fees is the type of care that everyone in the country should be receiving.
"Unfortunately, the business model followed by most of today's doctors requires us to churn out patients. Concierge medicine allows us to be the doctors we planned to be when we graduated medical school. I hope one day this is the type of care we can give the population at large, but right now, the system is broken."