August 24th, 2009

Reports the Philadelphia Inquirer:

Faced with rising costs and patient loads, a small but growing number of primary-care doctors are sharply reducing their practice sizes and charging each patient annual fees of about $2,000 in exchange for personalized care.

At least 20 such “concierge” practices have sprung up in the Philadelphia area since 2002, mainly in affluent suburbs in Bucks County and the Main Line.

Nationwide, more than 800 doctors – the vast majority of them family practitioners and general internists – use some form of concierge practice, says health consultant Scott MacStravic, who has written about the topic. That number has more than doubled since 2005, he said.

A concierge doctor even stars in the television series Royal Pains, which ranked as the second-most-watched cable program last week.

…

A year of concierge care in the Delaware Valley runs from $1,000 to $2,800 for individuals, often with discounts if more than one family member joins. Nationwide, the range is wider – from $500 to $13,000 per person, according to a 2007 study in the journal Medicare Patient Management.

This charge – which neither insurance nor Medicare reimburses – typically covers such amenities as annual physicals lasting an hour or more, 24/7 access to the doctor via phone and e-mail, same-day or next-day appointments, a CD or flash drive containing personal medical records, little or no wait time, unlimited doctor visits, extensive preventive care, house calls, and hospital or nursing home visits.

Other more involved services – including prescription drugs, specialist visits, and hospital care – are not included with the annual fee. Most patients use insurance for this care and cover the deductibles and co-payments.

Many concierge doctors say they provide free or reduced-price care to “scholarship” cases, who may compose up to 15 percent of the patient load.

…

Concierge practices are wonderful for the doctors and patients in them, agreed George Rust, director of the National Center for Primary Care at the Morehouse School of Medicine in Atlanta. But, he said, they are not so great for everyone else.

“When concierge practices require high cash payments, they tend to exclude most patients I’ve seen,” said Rust, a family physician who practices in clinics. Given the shortage of primary care doctors, he said, he feels a moral obligation to care for anyone who needs it. And, he said, if some doctors cut their patient loads, it “shunts a very limited resource into a narrow segment of the population.”

That shortage results from a web of factors: a reimbursement system that often pays for procedures, not health outcomes; medical-school debts that routinely top a quarter-million dollars; ballooning paperwork; and fewer residency slots in family and internal medicine. Fewer doctors are choosing primary care over specialty fields, and those who do are overworked and underpaid, Rust said.

Read more at the Inquirer.