Concierge medicine a mere blip on Medicare radar

Fewer than 800 physicians nationwide have retainer-based systems, so researchers can't measure how these practices might affect care for beneficiaries.

By — Posted Sept. 30, 2010

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The number of doctors charging patients a retainer fee for extra services has grown, but it's difficult to measure the impact on Medicare beneficiaries because so few physicians operate concierge practices, according to a study presented to the Medicare Payment Advisory Commission.

Researchers at the National Opinion Research Center at the University of Chicago and Georgetown University identified 756 physicians across the U.S. who have entered into what they termed retainer-based arrangements, commonly called "boutique" or "concierge" medicine. That is up from 146 retainer-based physicians identified in a Government Accountability Office report in 2005. Under these arrangements, patients pay a monthly or annual fee to have greater access to a physician through methods such as after-hour or home visits, same-day or next-day appointments, and access to the doctor's cell phone number.

MedPAC asked for the study to find out if more doctors moving toward a retainer-based practice might have an impact on Medicare beneficiaries' care. NORC's Elizabeth Hargrave, who presented the study's findings to MedPAC during a Sept. 13 briefing in Washington, D.C., reported that this was difficult to determine. So few physicians use the arrangement, few Medicare beneficiaries are affected, she said.

"It's like searching for a needle in a haystack," said Hargrave, senior research scientist at NORC. "But some physicians stated that they feel like they have more preventive care, better continuity of care, more services in general."

Overwhelmingly, physicians using a retainer-based system are in primary care, Hargrave said. But the research team identified a few specialists who adopted it, including endocrinologists and cardiologists. The study also found the majority of physicians are in solo or two-person practices and operate in mostly large metropolitan areas such as Los Angeles, Miami and Washington, D.C.

Medicare-participating physicians can charge beneficiaries extra for items and services that are not covered under the program. However, there are potential liabilities posed by billing patients for services that are already covered.

Researchers identified three practice models:

  • Model one: The retainer fee covers some extra services; the physician continues to bill for separate visits, and some accept insurance. Fees ranged from $600 to $4,200 annually.
  • Model two: Fee covers all the patient's costs, and the physician doesn't bill insurance or Medicare; most doctors have completely dropped out of Medicare. This is less common than model one, but its popularity is growing. Fees ranged from $1,500 to $5,400 annually.
  • Model three: Physicians offer a retainer option in their practice.

Hargrave said most of the physicians the researchers interviewed enjoyed the transition to a retainer-style practice.

"They thought they had a lot more time to spend with patients," she said. "A lot of folks said that they had been really burnt out before they made the transition, and that this was something that kept them in medical practice."

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