Hospitals are opening concierge physician practices

Concierge physician practices have been around for more than two decades, Galewitz reports. These practices started up in areas like Boca Raton, Florida and La Jolla, California, and catered to wealthy retirees who were willing to pay more money for better access to physicians.

NCH Healthcare System in Florida employs 12 concierge physicians who treat around 3,000 total patients. James Brinkert, regional administrator for the health system, said they "found a need in this community for those who wanted a more personalized health care experience."

Brinkert added that any NCH patients whose doctors have converted to concierge and don't want to pay the membership fee are either referred to other primary care practices or to urgent care.

Aaron Klein, who oversees the concierge practices at Baptist Health, said its program was initially intended to serve donors.

"High-end donors wanted to make sure they have doctors to care for them," Klein said.

Baptist's concierge program opened in 2019 and now has three practices throughout South Florida, where patients pay $2,500 a year.

The annual membership fees of concierge programs, which can exceed $4,000 a year in some cases, are paid in addition to copayments, deductibles, and other charges that aren't paid for by a patient's insurance plan.

Criticism of the model

Some concierge physicians argue that providing more attentive care means their patients are healthier. However, a study published last year by researchers at the University of California-Berkeley and the University of Pennsylvania found that concierge medicine had no impact on mortality rates.

But the researchers did find that concierge medicine corresponded to a 30% to 50% increase in total healthcare spending by patients.

Critics also argue that these models exacerbate primary care shortages. "Every time we see these models expand, we are contracting the availability of primary care doctors for the general population," said Jewel Mullen, associate dean for health equity at the University of Texas-Austin's Dell Medical School. Mullen added that concierge doctors partner with large hospital systems because of the systems' reputation, while hospitals sign up concierge physicians for referrals to specialists and inpatient care. "It helps hospitals secure a bigger piece of their market," Mullen said.

Advisory Board's Vidal Seegobin said, "physicians operating under this model will allocate more time and resources to meet the needs of the affluent patients paying for concierge services. And high-quality primary care offerings will expand in wealthier geographies, which may exacerbate existing geographic maldistribution for primary care."

This could also put even greater pressure on safety-net providers and limit the number of physicians participating in less generous payment arrangements, he added.

Who benefits?

Concierge fees provide new revenue to hospitals and serve to recruit and retain physicians. Those physicians then provide patient referrals to the hospitals that employ them.

"In a moment when health systems are finding it difficult to be profitable, it's a tempting option and understandable why they would pursue it," Seegobin said.

"Hospitals are attracted to physicians that offer concierge services because their patients do not come with bad debts or a need for charity care, and most of them have private insurance which pays the hospital very well," said Gerard Anderson, a hospital finance expert at Johns Hopkins University. "They are the ideal patients, from the hospitals' perspective."

Seegobin agreed, saying, "High-income, commercial patients are more financially desirable. They have the resources to manage their health and typically require more predictable, routine care that can be generously billed and remedied."

"For patients who can afford these concierge services, there is also a clear upside. Under this model, they'll be added to a smaller roster of patients, which will give them the opportunity to develop a longitudinal and trusting relationship with a physician, and get fast, high-quality care when they need it," he added.

In addition, Craig Cheifetz, a VP at Inova Health Care Services in Virginia, argues that concierge programs don't exacerbate primary care shortages, and that this model keeps doctors who were considering retiring early in the practice with a lighter caseload. He added that fees typically amount to no more than a few dollars a day, roughly what some people spend on coffee.

"Inova has an incredible primary care network for those who can't afford the concierge care," he said. "We are still providing all that is necessary in primary care for those who need it."

"My philosophy: It's better to give world-class care to a few hundred patients rather than provide inadequate care to a few thousand patients," Klein said. (Galewitz, KFF Health News, 4/1)

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