NCPA - National Center for Policy Analysis


February 16, 2009

Steven D. Knope is a local primary-care doctor in Phoenix, Arizona, who treats a small group of patients in exchange for an annual fee. Known as "concierge medicine," this practice is gaining popularity, particularly among older Americans with complex medical needs. The concept started in Seattle in 1996 with mostly wealthy patients and has since spread to people of more modest means.

  • Annual fees range from $500 to $15,000.
  • Doctors limit the number of patients they see and give them highly personalized attention, including detailed annual physicals, preventive care, same-day appointments and a promise to return their calls quickly, 24/7.

Although there is no precise count, Thomas W. LaGrelius, a Torrance, Calif., geriatrician and president of the Society for Innovative Medical Practice Design, a professional society for concierge physicians, estimates that as many as 5,000 doctors and one million patients are involved in concierge care.

Concierge practices fall into two categories:

  • In the "fee for care" model, like Dr. Knope's, patients pay a relatively high fee; the doctor drops out of Medicare and private insurance and provides all the primary care the patient needs for no additional charge.
  • In the second model, known as "fee for non-covered services," patients pay a lower fee -- generally $1,500 to $1,800 a year -- and the doctor bills Medicare or other insurers as usual for most office visits. The fee covers services that Medicare doesn't, including exercise and nutrition counseling and the close attention of a personal physician.

The main criticism of concierge care comes from health-care experts and policy makers who say concierge medicine is elitist and worry that the trend is worsening the shortage of primary-care physicians.

Concierge doctors argue that they are helping to ease the burden on emergency rooms and reducing hospital admissions by keeping patients healthier. Medicare officials have determined that concierge care doesn't violate government guidelines. And the American Medical Association says it's one of many legitimate ways to deliver health care.

Scheduling only one or two patients an hour also gives doctors time to discuss personal issues like sleep problems and stress.

Source:  Melinda Beck, "Health Matters: Concierge Medicine," Wall Street Journal, February 14, 2009.

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