It’s Time To Redefine Concierge Medicine

A healthcare option once reserved for the wealthy may now be the middle class’ best chance to weather the vagaries of post-Obamacare medicine
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By Matt Jacobson

If you’re middle class and you think that your relationship with your family doctor is secure, think again.

Come January 1st when the Affordable Care Act takes effect, your doctor may not be around, or even if he or she is, you may be seeing a nurse practitioner or physician assistant during your next visit. The healthcare system is about to become a game of musical chairs, and when the music stops, there’s no guarantee you’ll have a seat.

Despite the partisan debate concerning the Affordable Care Act (a.k.a. Obamacare), both sides of the political spectrum endorse one aspect of it: Patients should no longer be denied coverage because of an existing medical condition. But the mechanism in the law that makes that possible – mandating that all 33 million previously uninsured Americans obtain health insurance – also will exacerbate the already dire doctor shortage in the US, which is projected to be 65,000 by the end of next year. To make matters worse, the doctor shortage is particularly acute among primary care physicians (internists, general practitioners, family doctors, and pediatricians).

The numbers simply don’t lie: You cannot add tens of millions of patients to an already strained healthcare system and assume nothing will change, especially in the face of the declining ranks of doctors.

However, there is a grassroots movement with an established track record of two decades that offers an answer to the uncertainty of your primary care. It’s called various things including retainer-based medicine, personalized care, and direct primary care, but it’s best known by the term “concierge medicine.” And that’s unfortunate, because what could be and should be viewed as a viable healthcare option for the middle class is often dismissed by the public and media because of its confusing moniker.

It’s time for concierge medicine to be redefined.

Concierge medicine is a primary-care system in which patients pay an annual retainer to gain enhanced availability and services from their primary care physician. “Enhanced care” means different things depending on the medical practice but generally it includes 24/7 access to the doctor’s email and cell phone (particularly helpful with families with either small children or with elderly relatives living with them), “no wait” doctor appointments (when you arrive, you see the doctor within 5 minutes) and perhaps most importantly, extended doctor’s visits. Today, the average doctor visit is 8 minutes and many insurance companies limit the discussion to a single topic. If you want to consult with your doctor about your flu symptoms and an on-going backache, that requires two separate appointments.

On the other hand, concierge medicine embraces preventive care. Because doctors offering concierge medicine limit their patient panels – typically to 600 patients rather than the industry average of 3,000, they have the time to truly get to know their patients. Concierge physicians partner with patients to achieve both short-term and long-term health goals. Industry studies have demonstrated that patients enrolled in concierge medicine programs have significantly lower hospitalization rates than do patients in conventional practices.

So, what’s not to like about concierge medicine? The answer depends on through what lens you’re viewing it. The liberal media tends to stop dead in their tracks when it comes to the name itself. Admittedly, concierge medicine sounds elitist – like the staff member at a snooty hotel who gets reservations at expensive restaurants. How could something that sounds like it’s for the wealthy possibly be a bona fide option for the middle class? The mere mention of a retainer adds another firewall. Surely, asking patients to pay an out-of-pocket fee is nothing more than a way for already wealthy doctors to get even wealthier, the argument goes.

The conservative media is at best indifferent and at worst, suspicious of anything that upsets the current balance of the healthcare system, which is weighed heavily in the interests of Big Insurance. Concierge medicine is lumped together with other “disruptive” healthcare delivery models and dismissed as an attack on the status quo.

As a result, the public is confused. But here’s the reality check. For many middle class families, concierge medicine is a viable option. Which families? That depends on their budget priorities. I am the CEO of a concierge medicine firm, SignatureMD, in which the average patient pays a retainer of about $1,600 a year or $133 per month. Many consumers pay about the same for their cable TV or smartphone bill. The typical retainer for a family of four is $3,000 or $250 per month.

Are enhanced care and service and guaranteed availability of a trusted physician worth it? It’s a matter of choice. For some patients, a latte a day is more important. The point is there are lots of ways to spend the money required for a concierge medicine retainer. But for those individuals and families who value preventive medicine and optimizing their health the choice is crystal clear.

The days are rapidly coming to close when the average American consumer can afford to be a passive participant in his or her healthcare delivery, dependent on their employer or the government to provide all the answers. A new healthcare system is on the horizon with lots of ambiguity and questions.

Concierge medicine also has changed since it first emerged in the 90s as the exclusive domain of the rich and famous. Today, it’s affordable for most of the middle class. So it’s time now to drop the pretense of concierge medicine being either a patient rip-off or a plaything of the 1%. Is it the only solution to what ails the healthcare system? Absolutely not, but for many Americans, it’s the practical solution.