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Concierge medicine:

special treatment for an extra fee

Created date

April 23rd, 2013
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Would you like 24-hour access to your doctor? Longer office visits? How about house calls?

What if you had to pay extra for these services? Turns out, some people are willing to do just that. The concept is called concierge medicine, and it was developed in the late 1990s primarily for wealthy people. Since then, the concept has caught on and doctors across the U.S. are turning to this practice model, also known as direct primary care, boutique medicine, or retainer-based medicine. There are different versions of this type of service. Some doctors accept insurance and offer non-covered services for extra fees, and some don’t take insurance at all.

The Medicare Payment Advisory Commission (MedPAC), a government body that advises Congress on Medicare and monitors potential problems with access to Medicare, asked consultants to look into this trend. The resulting 2010 investigation revealed there are about 756 retainer-based doctors in the U.S.—a significant increase from the 146 found by the Government Accountability Office five years earlier. That 756 is only an estimate, because no designated body keeps track of concierge doctors. Today, the number may be anywhere from 2,000 to 4,000.

Most doctors who have switched to concierge medicine are primary care physicians. Many have made the switch because of decreasing payments (despite rising health care costs) by insurance companies, including Medicare. But doctors of many specialties besides primary care have switched to this practice model or plan to. One survey by a physician staffing company found that almost 10% planned to switch over and about 6% would stop taking insurance, including Medicare. This means many Medicare beneficiaries could find themselves with fewer choices and limited access to doctors.

Getting concierge services free

Some experts say that concierge medical practices are the best place for people with a number of chronic health conditions. They, more than anyone, need long, in-depth appointments, quick access to doctors, and, oftentimes, home visits because of a disability.

According to the American Academy of Private Physicians, concierge medical practices are becoming more affordable. Fees have come down from a high of over $10,000 per year to around $1,500 annually. Nevertheless, should you have to pay for any of these personal services?

Geriatricians, such as those found at Erickson Living communities, don’t think so. “Our on-site medical centers use a team approach to provide the best possible care,” says Cheryl Ziemba, M.D., medical director at Cedar Crest, an Erickson Living community in Pompton Plains, N.J. “This allows us to have longer office visits with each resident in which we can address all relevant health issues. And we have plenty of time to talk about prevention and wellness, and to look beyond the main problem to how an illness is affecting someone’s daily functioning.”

Some concierge practices offer an in-depth annual physical exam as an extra benefit, but Erickson Living doctors already do this as a routine part of their practice. They look beyond the exam results to what they mean to residents. “The Annual Wellness Visit helps residents establish what their health care goals are for the coming year—whether they want to be more active, lose a few pounds, improve their cholesterol numbers, and so on,” Ziemba says. “We talk about how to realistically achieve those goals.”

Getting in touch with your doctor in the middle of the night shouldn’t be a special privilege. “Our residents always have after-hours access to a doctor. Practically all calls are answered within 15 minutes and, in many cases, it takes less than that,” Ziemba says.

Erickson Living doctors coordinate all residents’ medical care, which means communicating with all specialists, pharmacies, rehab professionals, nurses, and anyone else involved—even family. “If a resident requests it, we regularly keep in contact with their designated health care representative, whether that’s a family member or someone else,” Ziemba says.

House calls, same-day appointments, and little to no time spent in waiting rooms are all part of the package. “We do not charge a premium for accessibility or personal attention,” Ziemba says. “All seniors deserve this kind of care.”

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