Is 'concierge' medical care for you?

Greater interest in personalized medicine, an aging population and increased emphasis on preventive health care are fueling the rise of concierge medicine. In this health care model, patients pay extra for individualized care and attention.

The global concierge medicine market is expected to nearly double to $32 billion a year over the next 10 years. Frustrated with long wait times for appointments, waiting room delays and only brief conversations with their doctor, those who can afford it are shelling out hundreds of dollars each month — usually on top of health insurance premiums — for faster care and attention, 24-hour access and personalized health programs.

As a private patient advocate, I'm in the concierge business myself and I see its benefits. My clients pay me to be there when they need me. I anticipate their needs, cut through red tape and run interference with hospitals and insurance companies. The hoped-for result is a better health outcome.

Doctors get into concierge medicine for the same reason: to provide better care. Research indicates that concierge care patients receive more preventive medical care and experience fewer hospitalizations, ER visits and urgent care visits.

Doctors benefit, too. The typical primary care doctor has 1,200 to 1,500 patients, while a concierge practitioner might have 600 to 800. With the membership revenue, a doctor or practice has a guaranteed income stream, and they're compensated for responding to emails and electronic messages through patient portals. Providers are often inundated with patients' messages, frequently unable to keep up with the volume.

You might hear the terms “concierge medicine” and “direct primary care” used interchangeably, so before going any further, we should define terms.

In direct primary care, doctors don't accept insurance, relying solely on patient fees. They're more likely to charge monthly fees, which can run anywhere from $150 on the low end to $300 a month or more, to cover a certain number of office visits. Other services are paid for a la carte. Not accepting insurance lets a practice cut down on administrative costs.

In concierge medicine, doctors are more likely to bill your insurance on top of your membership fees, meaning you would still have costs such as copays. They're also more likely to charge an annual fee, which again is all over the board from $1,200 to $10,000 a year.

With either model, you still need to carry health insurance in case you need to go the emergency room or have to see specialists for conditions like heart disease or cancer. Concierge or direct primary care doctors typically offer coordination of care with your specialists.

Not all types of practices are suitable for concierge care. Besides primary care, these are the most common:

• Pediatrics

• Osteopathy

• Internal medicine

• Cardiology

• Psychiatry

• Endocrinology

You would likely have to sign a contract with a concierge or direct primary care practice, and there could be setup fees and also cancellation fees if you decide it's not working. Besides copays, there could be costs for additional office visits, wellness programs, advanced physicals and screenings.

Then there's the matter of location. Despite its fast growth, concierge medical practices still aren't on every street corner, so you may not be able to find one that's convenient to you.

Concierge care isn't new. It emerged as a luxury health care model in the 1990s, with practices charging as much as $30,000 a month for a membership. There was even a TV show in the 2010s, “Royal Pains,” about an ER doc who becomes a concierge doctor to the rich and famous in the Hamptons.

Although today's models cost a great deal less, one of the key concerns about concierge care is that it promotes inequity in health care. It remains true that people with more money have access to better care and, according to an NPR poll, half of those surveyed said that's unfair.

If concierge care becomes the model for U.S. health care, where will those patients go who can't afford a monthly subscription? And if concierge doctors are seeing fewer patients, how many more primary care doctors will we need to make up the difference?

Our health care system is cumbersome and difficult to navigate. If those frustrations are keeping you from getting the health care you need — and you can afford it — it might be worth giving concierge or direct primary care a try. Don't sign on the bottom line, though, until you've read the fine print.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates ( Meet Teri at the first Patient Advocacy conference, open to the public, to be held on June 16 at Abbington Distinctive Banquets in Glen Ellyn. Teri is offering a free phone consultation to Daily Herald readers at (847) 612-6684.

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