Is Concierge Healthcare Right for You? Tips for Choosing a Boutique Doctor

My friend Fran and her husband were vacationing in a remote part of Canada when she swallowed a piece of chicken and it got stuck in her throat. She could breathe, but the chicken just wouldn’t go down.

As time passed, she got more and more concerned — verging on panicky. By 10 p.m., the chicken was still stuck, and she and her husband didn’t know what to do. So, she called her concierge doctor in Florida. He took her call — immediately. He asked a few questions, calmed her down, and then searched his databases for the closest and best emergency room. His knowledgeable advice and reassurance helped her relax — and the chicken slipped down her esophagus. Problem solved; no emergency medical care required.

For the retiree or empty nester, having a doctor who will take your after-hours phone call, respond to your emails, offer same- or next-day appointments, and spend as much time with you as you need to get all your questions answered is a luxury that most people don’t enjoy — and probably think they can’t afford. But this kind of concierge medicine is becoming more available all over the country, at prices that in some cases are fairly modest.

What Exactly is Concierge Medicine?

Concierge medicine, which may also be referred to as boutique medicine, is an arrangement between a patient and a physician for the direct provision of care. The patient pays an annual fee in exchange for more personalized health care services.

Concierge care is not a replacement for your health insurance. It is an addition to it. The cost for these concierge services will be on top of whatever you’re already paying — whether that’s for private health insurance, Medicare, Medicare Advantage, or a Medicare supplement plan. What you’re paying for is improved service in an industry that is often stretched.

Here are three reasons people choose to pay extra for the enhanced service that concierge doctors provide:

• Prompt responses.Almost all concierge physicians offer same or next-day appointments. This is especially attractive for patients with chronic conditions. It is also appealing to people who live in areas where there is great demand for health care services and where wait times for appointments are lengthy.
• Support for adult children who are caregivers. Jean Magruder, who cared for her mother until she died at 104, often listened to her mother’s complaints and was unsure of their seriousness. After her mother signed up with a concierge physician, Magruder was able to describe her mother’s issues to the doctor. In response, he would investigate the problem by calling her mother and, if necessary, make a house call. This greatly reassured Magruder, who was often providing long-distance care.
• Hospital visits. When a patient is hospitalized, many primary care physicians don’t visit their patients while they are there. Most concierge physicians see hospital visits as an important part of their commitment to patients. When Dave LeValley had back surgery, his concierge primary care physician made his appointments with a surgeon the doctor respected, ensured that the rest of the team was in LeValley’s insurance network, and visited daily to make sure things were going well.

How Much Does Concierge Medicine Cost?

There are a variety of medical groups around the country that specialize in managing concierge practices, or what the American Medical Association calls retainer-based practices. What exactly a concierge practice does and how it charges for those services will vary greatly, based on the exact services and where in the country the practice is located. Here is a sampling of three approaches to concierge medicine, along with the prices charged for these services.

MDVIP is one of the largest networks, including about 1,000 doctors nationwide. Its brand of personalized medicine costs about $140 per month ($1,680 a year) — higher in some locales. In return, participating doctors agree to limit their practices to no more than 600 patients. That is significantly fewer than the 2,300 patients under the care of a typical primary care physician, according to a study reported in the Annals of Family Medicine. Patients get quick access to their physician, a very complete annual physical and lots of time to consult with the doctor.

The American College of Private Physicians, a trade association, says it serves 10,000 concierge practices. Dr. Thomas W. Lagrelius, who runs Skypark Preferred Family Care, a concierge practice in Torrance, Calif., says his practice is limited to 400 patients — most of them age 70 and older. He charges $2,400 a year. For people younger than 35, the cost is $800 a year. For that, Skypark patients get doctor visits at home or in a nursing home or hospital. They can call their doctor — and expect an immediate return call — 24 hours a day. Once a year, they get a several-hours long “executive” exam. “We are able to keep our patients out of the hospital and out of the emergency room,” Lagrelius says. “We improve their health and lengthen their lifespans.”

Even large academic health systems like The University of Michigan are introducing concierge programs. Michigan Medicine, which attracts many patients with serious ailments who come from all over the region in search of expertise, is now offering Victors Care, which it says “personalizes and optimizes” care for people with chronic conditions. The fee is $3,600 a year.

Does a practice like this make sense for you? Here’s how to find one, plus some questions to ask before you sign up.

How Do You Find a Concierge Doctor?

If you have friends who see a concierge or retainer-based doctor, start by talking to them. If they like their doctor, you might, too.

Do a quality check. If you are a Medicare participant, start with Medicare.gov Physician Compare, which will give you information about payment, location, and some quality measures. If you are a Medicare Advantage participant, call your insurer and ask specifically about the doctors you are considering. It is also wise to make sure that the doctor you are considering is board certified.

Try searching these databases, each of which offers a multi-state selection of participating concierge doctors:

• American Academy of Private Physicians
• Concierge Choice Physicians
• MDVIP

Before You Sign Up, Ask These Questions

As with any change to your health care coverage, deciding to add a concierge doctor into the mix may raise some questions. Here are some issues to consider:

What kind of health care do you have now? If you currently like your doctor and their health care team and you have ready access, then why mess with success? You may not gain much by switching to a boutique practice.

Do you have a chronic condition? Providers of this kind of care emphasize its value for people who have conditions like diabetes or heart disease. Having a consistent caregiver, who monitors your problem closely and provides personalized treatment, can potentially make a big difference.

Do you like the concierge doctor? Before you sign up, make an appointment to talk to the doctor. If you don’t respect and feel compatible with the doctor, you probably don’t want to see that person exclusively.

What exactly is provided? Get a list in writing and make sure you understand what you are getting for your money. Remember that you’re probably not paying for better; you’re paying for better service. It is also important that your doctor have privileges at the local hospital of your choice. And, if you travel to another area frequently, you might find it helpful if your concierge doctor has contacts there and can facilitate care should you need it while traveling.

How will your concierge service coordinate with your insurance? As stated earlier, retainer-based practices are billed on top of your private health insurance, Medicare, Medicare Advantage, or Medicare supplement plan. Some concierge physicians don’t accept insurance, but many do. In either case, you’ll need health insurance to pay for tests, hospitalization, specialists, and other treatment beyond what your doctor provides. The doctor’s staff should be able to answer your questions in this regard, but if you need specifics from your insurer, call and ask. If your concierge physician and the specialists he or she prefers aren’t in your insurance network, this could be problematic.

What happens if you don’t like the doctor or the service? Many of these services want you to pay for a year up front. Before you do that, read the fine print and understand the cancellation policy. A prorated refund is probably the best you can hope for, if you decide to cancel.