Will suburbanites soon be paying doctors retainers?

Retainer fees are common practice when hiring an attorney, but could they soon find their way to your doctor's office?

Concierge medicine, as the business practice is called, is a small, but growing, trend in the medical field.

It had its start in the late 1990s in Seattle, and now it's spreading to the Chicago suburbs, with Highland Park serving as home to a prominent consulting company that helps doctors set up concierge practices.

Concierge medicine promises patients better access to their doctor in exchange for an annual fee of typically more than a thousand dollars a year.

For patients, the benefits are an invitation to call their doctors directly 24 hours a day, and longer, more in-depth office visits. But the upfront membership fees are not covered by medical insurance.

Dr. Steven Schubert transitioned his Vernon Hills practice to the concierge model just after the holidays, saying he could no longer keep up with the growing requirements of electronic record-keeping and other new administrative tasks with the large number of patients under his care.

Some of Schubert's patients, like Jon Lynn of Mundelein, have embraced the new model, despite some initial sticker shock.

“I really love the guy!” Lynn said, adding that Schubert's familiarity with his health is a major incentive for him to pay the additional fee. “He's always been so personable and so good about calling me three days later to ask how things are going. He always gives me the extra information and extra perspective I need to follow up on my own.”

Not always welcome

But there are critics of concierge medicine, too. One is community activist Rob Sherman of Buffalo Grove, a former Schubert patient who calls the concierge system “extortion.”

He's now trying to fight the business model through state legislation and a formal complaint to a regulatory agency. In his complaint filed with the Illinois Department of Professional and Financial Regulation, Sherman claims that Schubert effectively abandoned him by charging a retainer fee he has no intention of paying.

Sherman said his biggest concern is that the concierge model threatens to make health care unaffordable for some, particularly in less affluent areas.

“These are like a cancer,” Sherman said. “I'm trying to stop this cancer before it spreads throughout the industry and to other industries.”

Sherman asked state Rep. Elaine Nekritz, a Northbrook Democrat, to look into sponsoring legislation prohibiting concierge medicine in Illinois.

But Nekritz said her research of the issue turned up few opponents of concierge medicine, even among consumer advocate groups.

“I've decided not to pursue legislation banning these medical practices in Illinois,” Nekritz wrote to Sherman in late February. “We were not made aware of any data that suggest that these type of practices are a growing threat to access to health care. The business model has steadily built up a very small share of medical practices in the United States.”

The American Medical Association has no objections to concierge medicine, though it has created ethical guidelines for what it still considers a relatively rare business model, officials said.

Among these guidelines are a requirement to be honest in billing for reimbursement, and to help transfer nonparticipating patients to other physicians with no extra fee for the transmission of their medical records.

Schubert said he did everything he could to help Sherman connect with another nearby physician who does not use the concierge model. Sherman acknowledges this, but maintains there is no legitimate reason he should have to change doctors.

Industry changes

Michael Friedlander, principal of Specialdocs Consultants Inc. in Highland Park, said concierge medicine has faced and overcome legal challenges before, though not in Illinois specifically. His own company has doubled the number of practices it's transitioned to the concierge model over the past five years, but he doesn't foresee a time when it is a patient's only choice.

“I don't know if it will grow significantly, but it will grow,” Friedlander said.

Concierge medicine appeals most to doctors who passionately want to retain their autonomy at a time of increasing administrative responsibilities, Friedlander said. The typical formula for traditional practices has been one of declining reimbursement and increasing overhead, he added.

“It's forced physicians to see more patients in less time to stay in the same place,” Friedlander said. “The public doesn't understand what a physician goes through today, they really don't.”

Though the retainer fees for concierge practices vary, they can range from $60 to $80 per month on the low end, and well over $1,000 annually for some.

Practices that make the transition typically start with 1,600 to 2,500 patients or more, and narrow themselves down to somewhere between 250 and 750 patients.

The patients who stay with a doctor are those who recognize value in the care they're receiving, Friedlander said.

“It's not hamster-wheel medicine,” he added. “It allows you to spend adequate time with your patient.”

Physicians considering a switch should be in practice at least eight years — though the reality is that the ones who are transitioning have known their patients much longer than that, Friedlander said.

Lynn said he couldn't tell whether it was necessarily a benefit of the concierge model, but when he recently called Schubert with a health concern at 11:30 a.m., he was able to make an appointment for 1:15 p.m. the same day.

Schubert said he reached a point where he had only two options — to join a larger practice or go with the concierge model. He chose the latter because the autonomy he'd become accustomed to was important to him, he said.

“From my point of view, concierge is allowing me to continue to practice medicine the way I've always done — with emphasis on the patient — which you can't do with an increasingly administratively burdened practice,” Schubert said. “Concierge is growing because financially and administratively it would be difficult to keep seeing Medicare patients.”

Schubert said his decision is not meant as a criticism of larger practices with more people available to share the administrative tasks.

Model not for all

Dr. John Wilkerson, whose Elgin practice is part of the Alexian Brothers Medical Group, agrees that administrative tasks are growing — causing more private practitioners to join his group.

The new pressures Schubert talks about are real and caused even Alexian Brothers Medical Group to consider going concierge, he added. But it's not for everyone and definitely not the right fit for the Alexian Brothers philosophy, he said.

“We definitely decided not to go down that road,” said Wilkerson, who's been in practice for 25 years. “Part of our mission is to take care of the less fortunate.”

Dr. Robert Steinberg, a podiatrist practicing in Schaumburg, said the concierge model is not a good fit for a specialist like himself, whose patients are mainly fit athletes.

He said he believes it will never take over the health care industry.

“There's not that many people who want to do it, not many people who can afford to do it,” Steinberg said.

But he defends the right of any physician to make the change and argues that prohibiting the business model with legislation would be particularly un-American.

“If it passed, there'd be no doctors left. They'd all quit,” Steinberg said. “You can't make someone go into medicine, and you can't tell a doctor what to do in this way.”

What does a concierge fee buy?

A concierge fee can cost $1,000 or more every year. What can a patient expect in return? Here are five benefits a concierge doctor is likely to provide:

• Around-the-clock access

• Shorter waits for appointments

• Longer, more in-depth visits

• Stronger familiarity with your medical history and needs

• A more personal relationship with your doctor