The rising costs of health care is one of the biggest issues faced by Americans today, as health insurance becomes a costly benefit many employers don’t feel they can afford to offer. Doctors equally feel dissatisfied with large managed-care systems that allow them little time per patient and require them to treat as many as 2000 people per year.
Concierge medicine–also known as insurance-free, direct pay or boutique medicine–offers an alternative to large-scale hospital systems. Typically, these practices do not take insurance, and patients pay an annual or monthly fee. This allows doctors to cut down on the overhead associated with accepting insurance while seeing fewer patients. Patients, in turn, receive more personalized care and services, such as same-day appointments and the ability to call their doctor directly to ask questions.
“As part of being a concierge patient, you’re going to get unrestricted access to your primary care physician,” says Dr. David G. Edelson, MD, FACP, who is the director of HealthBridge, 4-doctor primary care internal medicine group in Great Neck, New York. “I’m only going to keep 250 patients under concierge, and that allows me to spend much more time with patients.” Having fewer patients also means that doctors are simply more available to answer questions. “They get a private number to me, so they don’t go through the voice mail system,” says Dr. Edelson.
As the name “concierge” implies, many of these practices offer a suite of high-end services, such as house-calls, gym facilities, prescription services, private waiting rooms and nutrition counseling. Clients of these high-end services typically have additional insurance, which covers prescriptions, major surgeries, or any other specialized procedures. One of the criticisms of this kind of healthcare model is that it creates a two-tiered system, where doctors and patients who opt out of the managed-care system to care only for those who can afford the additional retainer fee.
Yet not all concierge practices are aimed at the wealthy. Atlas MD, concierge medial practice in Wichita, doesn’t accept insurance yet keeps virtually all costs of care low. “For better or for worse, one of the things we struggle with is that people assume it’s too expensive,” says Dr. Josh Umbehr, one of the founders of Atlas MD, which only costs $10 to $100 dollars per month, depending on the patient’s age. “In a good way, I think one of our marketing struggles is to convince people that concierge can be a very high quality and affordable service.” The retainer fee charged by Atlas MD not only covers the doctors visits, but also includes a whole range of diagnostic services and any procedures that can be done in house, in addition to getting patients access to considerable discounts on prescriptions.
“Paying a low monthly membership for medical care seemed low risk,” says Lacy Hansen, who is a member of Atlas MD. “I had no idea how wonderful the care we received would be.” Hansen and her husband are both self-employed, and had decided to forgo the high costs of purchasing a health insurance policy. “When Atlas MD became an option, we jumped on it,” she says.
“I think uninsured people need concierge medicine more than anyone,” say Dr. Umbehr. “They need our discounts more than anything. It’s a considerable paradigm shift: concierge for the uninsured.”
When asked the ways that the concierge care differed from traditional hospital care, Hansen has no shortage of examples. Not only is she on a first-name basis with her doctor, she feels confidant emailing him with even small questions, knowing that she will get a prompt response. “Instead of making an appointment when my son’s skin rashes flare up, wait forever in the office, only to have them be less noticeable as they were the day I called, Josh has us send pictures. He is able to see exactly what we’re talking about and often made diagnosis via email.”
Follow-up care, something that not all health insurance policies reimburse doctors for, is another area where concierge medicine can excel. At HealthBridge, patents get access to a team of health specialist, from chiropractors to personal trainers. “Once we do an annual evaluation and identify somebody with an area of concern, we can immediately direct them to professionals within the center who can help them with these issues on and on-going basis,” says Dr. Edelson.
Hansen explains that the Dr. Umbehr always follows up after an appointment, and also makes sure that she’s keeping up with his recommendations. “He sends me messages just to see how things are going or to check on an issue from weeks prior.”
“People are kind of trained to not want to go back for follow-ups,” says Dr. Umbehr, due to the wait, the hassle and the additional cost. “But we know that the more time I spend with you, the better that message is going to be heard and received.”