The Concierge Catch: Better Access for a Few Patients Disrupts Care for Many – KFF Health News

“You have to pay the fees, otherwise the doctor will not come to see you.”

That was a telling point for Terri Marroquin, of Midland, Texas, when her longtime therapist began charging a membership fee in 2019. She learned of the change when someone pointed out a posted notice at the therapist’s front desk.

At first, she stuck to that practice; she said it’s now difficult to find a primary care doctor in her area who doesn’t charge an annual membership fee of $350 to $500.

But last year, Marroquin finally joined a no-fee practice, where she sees a physician assistant instead of a doctor. “I had enough. The concierge fees kept going up, and the doctor’s office kept getting nicer,” she said, referring to the decor.

With a national shortage of primary care physicians projected to reach 17,637 in 2023 and get worse, most Americans are paying for the privilege of seeing a doctor — on top of insurance premiums that cover most of the services a doctor provides or orders. Many people looking for a new doctor are calling a long list of primary care practices, only to be told they aren’t taking new patients.

“Concierge medicine potentially disproportionately enables wealthy people to pay for the scarce resource of a physician’s time and excludes people who have lower incomes and who are sicker,” said Adam Leive, the book’s lead author. 2023 Study on Concierge Medicine and researcher at the Goldman School of Public Policy at the University of California-Berkeley.

Leive’s research found that concierge patients had no reduction in mortality rates compared with patients who visited non-concierge physicians, suggesting that concierge care may not significantly improve some health outcomes.

A 2005 study found Concierge physicians had a lower proportion of patients with diabetes than their non-concierge counterparts and cared for fewer black and Hispanic patients.

There is little reliable data available on the size of the concierge medicine market. But a Market Research Firm Projects Concierge medicine revenue will grow 10.4% annually through 2030. There are approximately 5,000 to 7,000 physicians and practices offering concierge care in the United States, most of whom are primary care providers, According to Concierge Medicine Today(Yes, this emerging field already has a trade publication.)

The concierge pitch is simple: more time with your doctor, in person or remotely, quickly and at your convenience. While combining care with multiple primary care physicians Thousands of patients With each appointment lasting 15 minutes or less, some who can afford the fee say they feel compelled to pay the fee to maintain adequate access to their doctor.

As primary care providers continue to transition to concierge medicine, many patients may face the financial and health consequences of a potentially lengthy search for a new provider. With fewer physicians in non-concierge practices, the pool available for those who can’t or don’t want to pay is smaller. For them, finding a doctor is harder.

Concierge care models vary widely, but all involve paying a periodic fee to become a patient of the practice.

These fees are generally not covered by insurance nor payable with a tax-advantaged flexible spending account or health savings account. Annual fees range from $199 for Amazon One Medical (discounts available for Prime members) to the low four digits for companies like MDVIP And SignatureMD $10,000 or more for top branded practices, such as those that partner with physicians Massachusetts General Hospital,

Many patients are daunted by the prospect of paying for primary care. For one thing, the Affordable Care Act requires insurers to cover a wide range of preventive services without the patient having to pay out of pocket. “Your annual physical should be free,” said Caitlin Donovan, a spokeswoman. National Patient Advocate Foundation“Why are you paying $2,000 for this?”

Liz Glatzer felt her doctor in Providence, Rhode Island, was competent, but didn’t have the time to get her full health history. “I had a double mastectomy 25 years ago,” she said. “At my first physical exam, the doctor went over my medications and everything else, and he said, ‘Oh, you haven’t had a mammogram.’ I said, ‘I don’t have breasts to have a mammogram.'”

In 2023, after repeating the same exchange during her next two physical exams, Glatzer signed up to pay $1,900 a year for MDVIP, a concierge staffing service that contracts with her new doctor, who is also the husband of a friend. In their first two visits, Glatzer’s new physician took hours to get to know her, she said.

For the growing number of Americans who can’t or don’t want to pay when their doctor goes to concierge care, finding a new primary care can mean frustration, delayed tests or missed treatments, and fragmented health care.

“I’ve met many patients who couldn’t afford concierge services and had to find a new primary care physician,” said Yalda Jabbarpour, MD, director of the Robert Graham Center and a practicing family physician. Separating from a doctor who transitions to concierge care “breaks the continuity with the provider that we know is so important for good health outcomes,” she said.

This disruption has consequences. “People don’t get the preventive services they should, and they use more expensive and inefficient ways to get care that could otherwise be provided by their doctor,” said Abby Leibowitz, chief medical officer at MIT. Health AdvocateA company that helps patients find care and resolve insurance issues.

What happens to patients who feel helpless when a physician shifts to a concierge practice?

Patients whose doctors leave often give up maintaining a continuing relationship with a primary care physician. They may end up relying entirely on a pharmacy-based clinic or urgent care center or even a hospital emergency department for primary care.

Some concierge providers say they are responding to concerns about access and equity by allowing patients to opt out of concierge care but remain with a practice group at a lower level of service. For example, this can lead to longer waits for short appointments, fewer visits to the physician, and more visits to mid-level providers.

Deb Gordon, of Cambridge, Massachusetts, said she is looking for a new primary care physician because her physician has embraced concierge medicine — a challenge that involves finding someone in her network who has admitting privileges at her preferred hospitals and who is accepting new patients.

Gordon, who is co-director Coalition of Occupational Health Advocateswho provides support services to patient advocates, said the practice her doctor left hasn’t assigned her a new provider, and her health plan said it was okay if she went without one. “I was shocked that they literally said, ‘You can go to urgent care,'” she said.

Some patients find themselves turning to physician assistants and other mid-level providers. But those practitioners have much less training than physicians with board certification in family medicine or internal medicine and therefore may not be fully qualified to treat patients with complex health problems. “The expertise of physician assistants and nurse practitioners can really vary widely,” said Russell Phillips, director Harvard Medical School Center for Primary Care,