Concierge Medicine, Now for the Not-so-Rich

Developed in 1996, mainly for affluent folks, "concierge medicine" that offers a higher level of personal attention is morphing into a more affordable health care option for the masses, with lower yearly fees and more plan options. As a result, more patients are enjoying 24-hour access to doctors, longer office visits and even house calls.

"There's a wind in the sails of concierge doctor supply and demand," says Tom Blue, executive director of the American Academy of Private Physicians, a concierge care trade group. The business model is expanding, fueled by trends in health care. Primary care doctors are growing less satisfied as practices become overcrowded, he says, and patients are frustrated with the lack of face time.

There are now 4,400 concierge doctors in the U.S., and 1,000 practices were opened in the past year alone, says Blue, who adds that the number is expected to double for the next three years.

The growth is in response to rising demand, though not necessarily as a result of the health care reform law signed by President Barack Obama. Concierge practices are not likely to see a big bump as more people become insured under the Affordable Care Act, says Wayne Lipton, founder of Concierge Choice Physicians in Rockville Centre, N.Y.

"Most concierge patients already have insurance," he explains. "Concierge medicine is extra icing on the cake."

Now Serving the 1% -- and More

That extra icing is becoming more affordable. Yearly fees charged for concierge medical services have drifted down to $1,500 to $1,800, says Blue. That compares with the annual retainers of more than $10,000 charged by the first concierge practice in 1996, according to the American Academy of Private Physicians.

One Medical Group, based in San Francisco, follows the concierge model and charges yearly fees of less than $150. Concierge doctors see up to 16 patients per day, compared to the 25 patients physicians see on average.

One Medical Group patients have access to an iPhone and iPad app, get same-day visits, and can email their doctors. "What you say first to a doctor can't get to underlying health concerns, says Dr. Tom Lee, founder of One Medical Group. "This way, you can email doctors with follow-up questions."

Doctors with Florida-based MDVIP also encourage email and even texts because patients are given doctors' cellphone numbers. The company's 550 affiliated doctors typically spend half an hour with patients. "This improves communication between patient and doctor," says CEO Dan Hecht.

"In traditional health care, physicians and patients are on a conveyer line," he says. "So there's no clear follow-up." By contrast, he adds, MDVIP doctors focus on broad wellness exams more akin to executive physicals.

Even at the lower prices, is it worth it?

Lee and others in the industry say the moniker "concierge medicine" no longer fits, as the concept becomes more accessible and mainstream. As more patients sign up, Mark Pauly, a professor of health care management at the University of Pennsylvania's Wharton business school, questions whether the services provide value. "Some versions have lower prices, but you don't get as much," he says. "Plus, studies show that annual physicals aren't necessary for improving health."

But those in the business say the regular exams, additional testing and other preventive care offered by concierge-style medicine are its greatest assets. "There's an incredible array of very valuable services that aren't covered by traditional insurance," says Blue, citing certain tests for heart disease as one example.

Here are some other things to know when considering concierge care.

While some concierge doctors don't accept health insurance, preferring cash payments, others do take insurance because they have kept their regular practices while adding a layer of concierge services and fees. "Also, most concierge doctors accept Medicare," says Blue. However, insurers will not cover the yearly fees, which can add up.
Because concierge doctors can be reached by email and phone, travelers can benefit from this style of medicine, Blue says. "A lot of doctors are specializing in pre-trip medical planning, too," he adds.
Concierge care is suited to the chronically ill, particularly ailing seniors, says Blue. Some older people may want house calls or practices that can arrange three-way conference calls, he says.
Health savings accounts can help with the cost of concierge care. For most people, the yearly concierge medicine fees are out-of-pocket expenses, says Hecht. But a person with a health savings account could use money from the account to pay the fees.
The fees may be tax-deductible. If you have health care expenses that exceed 7.5% of your adjusted gross income, you may be able to deduct yearly concierge medicine service fees, says Lipton. The threshold will be increasing to 10%.