Concierge Medicine in General

There are about as many variants of concierge medicine as there are practices offering it. If you are considering joining a concierge practice for your medical care the information on these two pages may be helpful.

What is Concierge Medicine?

The term concierge medicine is thought to have come from a journalist and practioners bristle when they hear it partly because it sounds so frivolous and also because there are so many variations within concierge care. The common theme among all concierge practices is that the patient pays the physician directly and so the most accurate term is direct practice, but that is clumsy and hasn’t stuck. We call it concierge care.

What is Concierge Care?
Think of concierge medicine’s most common variant as a time share in a doctor. The physician agrees to keep his or her patient panel limited in size and in return, the patient pays a fee for membership in that group. The physician also generally agrees to provide other specific benefits for members. The fees are generally higher in smaller practices with more or better benefits and in practices with better reputations.

Most concierge practices have a membership contract which specifies their amenities and conditions so patients know precisely what they are buying. We advise people to only consider practices which require a membership contract.

By keeping their panels small, concierge physicians escape the assembly line model of insurance-driven healthcare and so should provide better service than other doctors. Most try hard to provide better quality of care also, but that is something nobody can simply assert. It has to be measured – but meaningful measures have eluded the medical profession so far.

A few years ago AllCare was asked to help create this educational video to explain concierge medicine in general terms. Dr. Garrison Bliss of QLiance in Seattle and Professor Regina Herzlinger of the Harvard Buiness School were kind enough to participate. Read Prof. Herzlinger’s wonderful book, Who Killed Healthcare, to understand why the US healthcare deliver system is so dysfunctional.

QLiance uses the principles of concierge medicine to provide excellent primary care very at a remarkably low price.

Specifics to consider when looking for concierge care

If you are considering concierge care…

Concierge practices vary enormously in what they do, how they do it, who they are, and what they charge. We receive many calls from people seeking concierge care and below are some of the things we advise.
After considering the specifics below, though, we suggest you trust your gut. Many doctors with unimpressive credentials are wonderful. Many doctors with world class credentials and testimonials are better at marketing than doctoring. Moreover, the doctor-patient relationship, like marriage, is all about fit. No doctor or practice is best or worst, right or wrong for every patient. You need to find the right match for you.

  • Cast a wide net, consider several physicians.
  • You are hiring a practice, not only a doctor. Office staff, hospital affiliations and so on are very important.
  • Seek trusted friends and colleagues with first-hand knowledge about each practice you are considering.
  • Visit the two or three practices which seem best.
    • Interview the doctor.
    • Meet the staff and get a feel for them.
    • Is this practice a good fit for you?
  • Physician questions
    • Training and board certifications?
    • Years in practice, years in concierge practice?
    • How often and for how long is the physician generally away from the office?
    • What happens if you have a medical problem while the physician is out of town?
    • What happens if you have a medical problem while you are out of town?
    • Which hospital does the physician use for inpatient care?
    • Does the physician make hospital rounds?
    • Does the physician provide hospital care directly or admit you to the care of a hospital physician (hospitalist)?
    • Expectations for scheduling non-urgent office appointments?
    • Expectations for urgent or emergency care?
    • Other amenities offered such as house calls, late or weekend hours, among others?
    • Who are typical patients for this practice?
    • For what reasons have patients left this practice?
    • Expectations for communication via telephone, email, text messaging, or Skype?
  • Contract questions
    • Is there a contract controlling membership in this practice?
    • Can you separate from the practice if it is a poor fit? How? How much notice?
    • If you leave the practice do you get a prorated refund of your annual fee?
  • Payment questions
    • What is the annual concierge membership fee?
    • Will your insurance pay the membership fee?
    • Are there other fees beyond the membership fee?
    • Is your insurance company billed for office visits and other medical care?
    • How about copays for office visits?

Concierge Medicine in general