If a poll were conducted about the most frustrating things in life, waiting in a doctor’s office would undoubtedly be near the top, if not at the top of the list. On average, the wait time to see your doctor is about 18 minutes and possibly greater if a patient before you needs more than the 15- to 20-minute average visit at a traditional practice, which could have as many as 5,000 patients under one doctor’s care.1 In other words, a traditional medical practice could best be described as “assembly line” medical care, where a physician may see anywhere between 30 and 50 patients per day. No wonder physician burnout is a real phenomenon while patients are rightly concerned that their care is almost an afterthought.
A traditional medical practice, therefore, is not an optimal process to diagnose and treat every patient empathically given the little time a physician spends in the examining room. Undoubtedly, there are physicians in traditional practices that are excellent diagnosticians who treat their patients with respect and compassion. Nevertheless, the short time a patient has with a physician could mean an incorrect diagnosis and inappropriate treatment. This could be catastrophic for the patient. Employers thus have an obligation to their employees who receive their medical care benefits as part of their compensation package to provide them, given the financial constraints of every business, the least frustrating, highest quality medical coverage possible for obvious reasons.
An appealing patient-centered health care benefits package would tend to reduce absenteeism, increase morale, increase productivity, attract new talent, and, maybe most important, retain key employees who have helped make your business a success.2 In the last chapter we saw how Direct Primary Care (DPC), according to its advocates, fulfills the mission of creating an optimal doctor–patient relationship by charging a relatively a low-cost monthly fee to have a same day or a next day visit rather than the typical traditional medical practice where an appointment may not be available for days or sometimes a week or more in advance. Is there another alternative to DPC that employers could offer their employees to eliminate what seems like interminable delays in a physicians’ waiting room? Enter concierge medicine (CM), which is similar to DPC and is usually thought of as medical care for the “rich and famous.” Not anymore.
Brief History of Concierge Medicine
The genesis of concierge medicine began in 1996 when two doctors created MD2 (pronounced MD squared) in the Pacific Northwest. They charged an annual fee of $13,000 and $20,000 per family. In other words, this pricey new health care structure was out of the reach for most families except high-income individuals who wanted in effect to escape a traditional medical practice. These upper-income families wanted to get a more personalized health care experience.3
Insofar medical care is highly regulated at all levels of government, concierge medicine, although only a relatively small segment of healthcare, has grown markedly in the 25 years it was first offered to the public as an alternative to a traditional medical practice. Bioethicists as well as the American Medical Association (AMA) have weighed in on the ethics of concierge medicine with guidelines, given the perception of CM as an “elitist” practice that should not violate fundamental ethical principles that physicians should abide by to treat all their patients compassionately.
The Pros and Cons of Concierge Medicine
So what is concierge medicine? And could CM replace traditional medical insurance for employees? For employers, would having CM as a component of their benefits package set them apart from competitors as a more desirable business to work for?
A concierge medicine physician charges an annual fee or retainer, which could be paid quarterly or monthly depending on the practice’s billing options. The annual costs can vary from $1,500 to as much as $20,000 depending on the array of services offered.4 The former amount is atypical of most CM practices, which have gone “mainstream” to attract a greater pool of patients.
For the annual fee, a patient receives 24/7 access to a physician who usually has no more than a 500–600-patient panel. The CM doctor is virtually indistinguishable from a traditional primary care physician who conducts annual physicals, orders lab tests, provides diagnostic tests, treats both cuts with stitches, and minor skin conditions. Specialized treatments are referred to other doctors as well as surgeries that have to be performed in an outpatient center or hospital.
Concierge doctors have the same education and medical training—around 11 years after graduating from high school—to obtain a license to practice medicine.
A CM patient can expect shorter wait time to see a doctor in the office during normal business hours. And if a nonthreatening emergency occurs during the wee hours overnight, one doctor is typically available to treat the patient.
For example, one New York City CM patient with Parkinson’s disease fell backward at 3 a.m. in the bathroom and hit her head. Her husband who previously took his wife to the emergency room for medical treatment had to spend five hours to see a doctor and be discharged. This time the couple in their seventies who had contracted with a nearby CM practice called the office and were told to come in immediately where they were met by the medical team that performed a CT scan. The CT scan was negative. Only 40 minutes went by from the time of the call to the reading of the results. This couple had paid $10,000 annually for this CM service in Manhattan.5 A Manhattan CM practice is indeed expensive and out of the reach of most families.
Since this story was published in 2018, the CM practice in the article changed its name to Sollis Health (see https://sollishealth.com). Employers can access the page devoted to them and see if this medical care benefit would make a good fit for their employers. Sollis locations are limited to a few communities in California, New York, the Hamptons, and Florida. In other words, Sollis Health is to health care what high-end luxury cars are to the public. If you have to ask for the price, you probably cannot afford it. But the pricing structure is not out of reach for many upper middle-income families who would be willingly to pay up to $9,000 for a family of three, which would include a child under 18.
The founder of Sollis Health, Dr. Bernard Kruger, who is a board-certified physician in oncology and internal medicine, realized that a hospital emergency room leaves much to be desired for non-life-threatening care. Kruger brought a patient who fell off a horse to the emergency room at a local hospital and was met by the head of the department there. Nevertheless, Kruger’s patient still had to wait five hours for a CAT scan. He realized there had to be a better alternative. He and his partners created Priority Private Care, now Sollis Health. In other words, there was—and still is—a problem in treating ER patients in a timely manner. Dr. Kruger’s medical entrepreneurship took a problem and turned it into a thriving CM practice.6
We already remarked about the shorter wait time to see a CM doctor. Telemedicine visits can be handled almost immediately as well as phone and text messages. Office visits tend to be covered with the annual fee, but the CM practice may bill the patient’s insurance company as an in or out of network provider. Unlimited visits for patients are particularly beneficial for anyone with chronic medical conditions such as diabetes, hypertension, or heart disease, to name a few.
One of the most attractive aspects of CM is the time a doctor spends with patients. This allows the doctor–patient relationship to grow so the physician has a much better grasp of the patient’s overall health concerns and lifestyle to assist him or her with the necessary information, protocols, and treatments for optimal health.
For employees who have health savings accounts or flexible savings accounts, the cost of a CM membership may be paid out of these accounts. If these accounts can defray the out-of-pocket costs of the annual CM fee, then a concierge benefit may be even more attractive to employees, especially those whose income would allow them to purchase this service.
Despite the obvious benefits outlined above of having employees enrolled in a concierge medicine practice, there are drawbacks that both employers and employees should beware of when deciding if concierge medicine makes sense.
The cost of enrolling in a concierge medicine practice may not be considered a good value for employees if the only CM in their community is pricey and bills insurance companies for office visits. That means the employer would have to provide a traditional insurance policy for employees. If an employer does not pick up all or most of the cost of CM, then the employees may have an out-of-pocket expense they may not wish to incur and thus forgo all the benefits, which makes CM an attractive health care benefit.
On the other hand, if an employer could structure a health care benefits package that includes CM as the foundation and employer-paid insurance package that included hospitalization and emergency care, assuming such a package would meet the Affordable Care Act requirements, then the premium savings to the employer would be substantial.
A CM practice in an employer’s community may not have physicians that employees necessarily want to have as their primary care doctors. This could be an insurmountable obstacle in offering a CM option to employees. Assuming employees have already chosen a primary care doctor, an employer could ask physicians in their community if they would consider moving from a traditional medical practice to becoming a CM practice. This may be too much of a burden for an employer to consider, in effect becoming a catalyst for doctors to restructure their medical practices. However, for some physicians, the possibility of having a CM practice may be “just what the doctor ordered”—in this case a company’s HR manager—given the burnout of primary care physicians who have to see at least 40 patients per day to maintain a viable traditional medical practice.
The bottom line for employers is obvious. If a CM option is the only health care benefit a business would offer to employees, they would have to be willing to embrace concierge medicine as in their best interests—no waiting to see a doctor, 24/7 access to a doctor, virtual meetings available as well as immediate or almost immediate medical test results, and consultation with a doctor. This may be a lift too heavy for an HR manager to consider, namely changing the “culture” and expectation what a health care benefit should be. Nevertheless, employees in the COVID era may be amenable to having a CM practice as a health care option or the foundation of their health care benefits.
How would an employer approach employees regarding a CM practice health care benefits option? The short answer is with educating them after the HR manager performs the necessary due diligence with one of several CM consultants or any one of concierge medicine practices in your area.
American medical care is being transformed for a variety of reasons—the cost of traditional insurance premiums, accessibility to physicians in a timely manner, quality of care, and the insufferable amount of time spent waiting the see your doctor in the office. According to proponents of concierge medicine, CM addresses all these issues; therefore, it should be a win–win for employees, employers, and doctors. Concierge medicine has increased in popularity for the reasons patients give about the flaws in the current system. Whether it makes sense for your workforce can only be determined by providing employees with the pros and cons of CM for them to make an informed decision, assuming management has concluded that as a health care package.