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At Your Beck and Call

Concierge plans offer the kind of health care Michael Moore would love — if it were universal. But are they worth the out-of-pocket expense?

Tired of doctors’ visits that consist of waiting 45 minutes for a hurried 5-minute conversation? Try the boutique alternative. Also called concierge care or membership-based coverage, these services are becoming increasingly popular despite their high cost.

The idea is to charge consumers as much as $15,000 a year for better service than they can get through a conventional medical practice. Traditional primary-care physicians tend to serve 2,500 to 3,000 patients, and often the time they can spend with any one is limited by insurance as well as workload. Concierge doctors, in contrast, keep patient loads down to under 600. Most cut their ties to Medicaid and insurance plans. They promise their patients on-time appointments, 24/7 access, and medical tests that the physician, rather than the insurance company, deems necessary. It is medical care when, where, and from whom you want it.

“Most such practices are based on preventive care,” says John Marquis, a partner with Michigan-based law firm Warner Norcross & Judd LLP, and a concierge patient himself. “Where traditional primary-care doctors are usually reacting to the needs of the patients in their waiting room, concierge doctors have the time to be more proactive.” And by focusing on wellness, says Dr. Edward Goldman, co-founder of MDVIP Corp., a Boca Raton, Florida-based preventive-care network, such practices foster doctor/patient relationships that “identify and find disease.”

Why Doctors Like It

How many doctors are currently practicing concierge care is unclear. An August 2005 U.S. Government Accountability Office survey identified 146 such practices nationwide. But Michael L. Blau, a partner in the Boston office of law firm Foley & Lardner LLP and chair of its health-care venture effort, believes the number “is two to three times that now.” While the trend seems most active on the coasts, he believes that half the states have at least one concierge practice.

The practices are popular with physicians fed up with rushed patient interaction, mountains of paperwork, and lower reimbursement rates from insurers and Medicaid. The opportunity to increase their incomes doesn’t hurt either.

In the decade since the founding of the first concierge plan, Seattle-based MD2, several models have evolved. In addition to stand-alone practices, some doctors now offer two-tier arrangements — concierge service along with traditional care or specialty services. There are even some operational models. All of the more than 150 doctors in MDVIP’s network, for example, cap patient loads at 600. Their fees are among the lowest in the boutique field; each patient pays $1,500 to $1,800 per year for a guaranteed 1.5-hour physical, follow-up visit, personal wellness plan, and same-day appointments.

Doctors and patients familiar with concierge arrangements agree that a good doctor-patient relationship is essential, and that the provider should be qualified to treat any existing medical condition. Accordingly, before joining a concierge-care network, says Holly Isdale, managing director and head of Lehman Brothers’s Wealth Advisory Group, you should have a detailed conversation with the doctor assigned to you. Questions to ask include how many times a year your personal doctor will be available for in-person
appointments and how often to expect a substitute.

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