Ten-minute physicals and health insurance paperwork aren't just frustrating for patients – they're a pain for doctors, too. One of every 10 Texas doctors say they are moving away from accepting insurance and toward a flat fee for coverage. They call it "concierge care," or direct medicine.
More than 4,000 U.S. doctors offer concierge services. That’s 30 percent more than last year. And Texas is a hot zone: at least a dozen doctors have gone concierge in Dallas-Fort Worth alone. Here’s a basic overview.
How Does It Work?
Every concierge practice is different -- but generally patients pay a yearly fee in return for an extensive physical and enhanced access to their doctor. Visits are typically longer, you don’t have to pay for services provided in the office, such as labs and check-ups, and you can call your doctor any time. Many concierge practices don’t accept health insurance, which doctors claim frees them from spending money and time on bookkeeping and documentation.
How Much Does It Cost?
The big sticking point with concierge care for many potential patients is cost.
While some doctors charge a standard fee for all patients, most charge a monthly or yearly fee determined by age.
Here's what Dr. Chris Ewin of Fort Worth charges:
- Ages 6-20: $90 a month.
- Ages 21-39: $130 a month.
- Ages 40-59: $195 a month.
- 60 and over: $295 a month.
Though there are practices that charge much more, Michael Tetreault of the magazine Concierge Medicine Today says more than 60 percent of concierge medical plans cost less than $135 a month.
Still, the cost is out of reach for many patients. Professor Sandra Carnahan of South Texas College of Law calls concierge care “an alternative for wealthy people," and says that unless doctors can prove they are providing better quality care and "not just some white-glove handling, I don’t think they’re going to be as successful as they like.”
Why Do People Want It?
Both patients and doctors say they’re turning to concierge care because they’ve become frustrated with the current health care system. Dr. Connie Casad , a gynecologist based in Dallas, recently transitioned from the traditional model to a hybrid system: She still sees old patients, but about 100 have opted to pay for concierge services. Casad says the switch was about the ability to spend more time with patients.
“I really did not have time in a conventional practice to spend with patients to really make a difference in their life,” Casad says. “A lot of women have sleep disorders, hormonal disorders, nutritional disorders, difficulty losing weight, and you cannot take care of those types of problems in a 15 minute pelvic exam type visit.”
For patients like Gus Bates, a Fort Worth resident who pays $1,700 a year for concierge care, it was also about securing access to a doctor in the future.
“My fear is that we’re not going to have enough physicians,” Bates says. “I doubt there’s going to be good quality internists, knowledgeable folks that don’t have 5,000 people as patients, and I want to have better care than that. I think we all want to have better care than that.”
There isn’t much research on whether concierge care keeps patients healthier, but one study from Tufts University shows these patients do receive better service and faster referrals to specialists.
How Does It Work With Insurance?
Concierge care is not a replacement for insurance. According to Michael Tetreault of Concierge Medicine Today, many patients combine a high deductible catastrophic health care plan with concierge care. This keeps them covered in case of a serious illness or accident, and they can go to their concierge doctor for the common cold, check ups and preventative care.
Check out this article from AARP for more on concierge care.