(MintPress) – While the debate over healthcare reform rolls on in America, a handful of healthcare professionals are taking matters into their own hands, offering medical care for patients who don’t have insurance and make too much money to qualify for state-sponsored programs.
Some clinics are now charging patients a flat monthly fee, rather than accepting insurance for medical care. These clinics are hoping to provide basic healthcare coverage for a growing segment of the American population without access to insurance coverage. However, critics are quick to point out that if the model takes off, it could compound problems within the health care system.
Concierge medicine gains popularity
The growing trend, called concierge medicine, executive, retainer or VIP health care isn’t only for the very wealthy, despite the sound of it. The clinics are also known in the medical industry as retained medical practices.
The way it works depends on who is providing the care, but generally someone seeking to enlist in this type of coverage pays for a yearly membership fee, which can range in price depending on the provider.
National Public Radio (NPR) recently profiled an Oregon doctor, Dr. Steven Butdorf, offering this type of service at his clinic called Exceptional Health Care. Butdorf charges patients $39 to $79 per month, depending on their age.
A new Oregon law allows clinics like Butdorf’s Exceptional Health Care to operate after registering with the state, which allows it to operate exempt from insurance regulations.
Butdorf told NPR that he was motivated to start the business after noting at his previous practice that many patients complained about the cost of medical care. “You know, we’d end up sitting in the room having discussions about macro economics of health care instead of their medical issues. And as I learned about this model and came to understand it better, it just had a strong appeal to me as a better way to practice medicine,” Butdorf said.
Not having to deal with insurance companies and having the opportunity to spend more time with patients are reasons he says he is confident he made the right choice in opening up the clinic.
Butdorf currently has 200 patients, many of whom have jobs, and make too much money to qualify for state sponsored health insurance, but don’t receive health care through their employers. He used his savings to open the clinic in February, and while he has not yet received a paycheck, he’s calculated that once he has 300 more patients, he’ll break even.
A history of the movement
The model is said to have originated in Seattle in the 1990s. Typically, concierge physicians care for fewer patients than in a conventional practices, ranging from an estimated 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year, according to the Medical Group Management Association (MGMA).
In addition to Oregon, New York, California, Washington and about a dozen other states allow such clinics.
Mostly concentrated on the East and West Coasts, in 2005 the Government Accountability Office (GAO) counted 146 such practices. The American Medical Association does not track the number of concierge practices because the concept is still so new, but it does seem to growing.
The GAO’s survey reported annual patient membership fees ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500 to $1,999. The most often reported features of concierge clinics included same- or next-day appointments for non-urgent care, 24-hour telephone access and periodic preventive care examinations.
However, some experts caution that this type of coverage is not always an adequate substitute for medical insurance, as it generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers.
Another study, published in 2010 by the National Opinion Research Center at the University of Chicago and Georgetown University, tallied 756 physicians across the U.S. who have entered into retainer-based arrangements. It identified retainer practices in all but 11 states, but said they tend to be concentrated in urban areas. It also listed the most retainer practices in the metropolitan areas of Los Angeles, Miami, Washington, D.C. and Naples, Fla.
The vast majority of retainer physicians are in primary care, the study said. Among those it looked at, all had at least seven years of experience, but had been in a retainer practice for fewer years. About three‐fifths are in solo practices, and the largest retainer practices found by the study included seven physicians.
The authors of that study concluded “Because the field of retainer medicine is so new, there have not been extensive studies to compare patient outcomes between retainer care and standard care. Several of the people we interviewed gave examples of cases where they believed the extra attention patients received in a retainer practice resulted in better outcomes or more continuity of care. Some also believed they were providing care in a lower‐cost way, by keeping patients out of the emergency room, making fewer specialist referrals, or duplicating fewer labs. One said he prefers to practice retainer medicine, but does not think the patients in his retainer practice are better off medically than they were in his former practice. This is a question that could benefit from further research.”
Controversy surrounds emerging concierge models
Advocates of these types of practices say they will help people who have no insurance. The model also saves money by eliminating insurance billing and reimbursement, and by enabling primary-care providers to spend more time with patients doing preventative care and managing chronic conditions, so patients don’t end up in the emergency rooms or hospitals with more severe medical issues.
However, critics of the set-up have charged that its elitist and may contribute to a shortage of primary care physicians.
Michael Stillman, an internist at the Boston University School of Medicine, was quoted in an article from the Chicago Tribune as saying the practice was a “blatant money grab” and also said it raised the specter of reduced access to care. “Imagine a country in which every physician took on only a few hundred retainer fee-paying patients,” Stillman said, “Where would people of modest and even average incomes receive their care?”
Critics say it promotes a two-tiered health system that favors the wealthy, limits the number of physicians to care for those who cannot afford it and burdens the middle and lower class with a higher cost of insurance.
Various legal issues have emerged as part of the debate over concierge care. In 2003, the New Jersey Department of Health and Senior Services asserted that concierge care agreements are inconsistent with the state requirement that network healthcare providers not discriminate against any person.
In 2004, the New York State Department of Health issued an official statement condemning concierge medicine among enrollees in health maintenance organizations (HMOs).
There have also been arguments from critics alleging concierge care may violate Medicare and state insurance regulations.