Concierge Medical Practice - A Doctor's Letter to His Patients

Concierge Medical Practice - A doctor's letter to his patients about changing to a retainer practice. Comstock/Getty Images

Concierge Medical Practice

Faced with the burdens of an aging population and low reimbursement for their services, many PCPs are leaving primary care or changing the way they practice. Some PCPs are switching to concierge practices, a growing trend, also known as retainer, boutique, or direct medical practices. They are controversial and many in the healthcare system think they will make the shortage of PCPs worse, especially in 2014 when many more Americans will have access to affordable health insurance.

The concierge practice model, allowing PCPs to offer more personalized care by decreasing the number of patients they care for from about 2000 to less than 1000, first appeared in the 1990’s. In return for these enhanced services, PCPs charge patients a retainer fee, which can range from about $1500 a year to as much as $15,000 per year depending on location and the type and extent of new services.

A Physician’s Letter to His Patients

The following letter (slightly edited for length) was recently sent to more than 1500 patients who belong to an internal medicine practice in a northeastern state. The majority of the patients who received this letter are on Medicare and live in a community that has limited access to primary care physicians.

The letter provides a good example of the issues surrounding concierge medical practices. Several patients have agreed to pay the retainer fee because they feel that they have no other options for care.

To My Patients:
In the midst of the health reform discussions, I am sure you are aware of the fact that the costs of delivering medical care are increasing while reimbursement rates do not keep pace with increasing expenses. Over the years I have tried to provide a very personalized and comprehensive style of practice. I believe medicine can only be practiced by having enough time to listen to your patients and really know your patients. This is my goal. This is why I went into primary care.

I have a smaller number of patients in my practice and see fewer patients per day. However, this is not sustainable due to the above mentioned poor reimbursement and increasing expenses. There are many expenses that arise from meeting administrative demands that are not actually part of the delivery of medical care to my patients. This includes such things as providing medical support for family leave, absence from work, excuse for jury duty, travel forms, copies of medical records for the patients, and forms for life insurance. In addition, we assist you in getting in contact with specialists and we facilitate and arrange for hospital admissions.

I provide an annual preventive physical which goes beyond the criteria and reimbursement for an annual physical as defined by insurance companies. As you know, during your physical I review your previous annual physical to establish the status of those conditions. Then I go over every visit you had with me over the past year to review with you your progress of previous health concerns. In addition, I review test results over the year, consultations with your other physicians, medications and your self-management activities. This is a comprehensive and interactive encounter. Dialogue between you and me I feel is essentially important to your care; and this can only take place with adequate time.

I have maintained a smaller practice to provide more time for the extended physicals, follow-up visits and same day or next day appointments. Unfortunately, under the present conditions of health care I can’t maintain this style of care. Many primary care physicians have chosen to leave and move to areas where reimbursement is much higher and the cost of living much less. However, I am trying to find a solution so I can continue to practice in this town. Across the country many primary care physicians are implementing practices where they only accept cash payment from the patient, don’t accept Medicare or charge annual fees to be in their practice ranging from $1,500 to $4,000 per year.

Therefore, I need to make it a policy to charge an annual fee of $600 to my patients (this doesn’t include my fee for Medicare physicals). If you would like to continue to receive medical care from me, it is necessary for you to make this annual payment. If this will be a hardship for you, please contact this office and we can discuss an appropriate accommodation.

While I deeply regret the need to impose this additional expense on you, unlike some other primary care practices, I am asking a smaller fee to defray the escalating costs and poor reimbursement. Without this charge it would prohibit me from continuing to deliver the kind of medicine I believe is important and hopefully, you feel you have received and is equally important to you. I actually will limit the size of my practice to sustain and enhance my style of medicine: more time with you each visit, same day, next day visits where necessary and expectations of less waiting time for you appointment.

If you intend to continue your medical care with me, please sign the enclosed form and return it within thirty days with the annual fee of $600. I do look forward to hearing from you and I hope you will continue to entrust your care with me, a relationship I enjoy and am humbled to have. If you do not want to continue with my practice, I will be sorry to see our relationship end, but do understand. I will refer you to other resources or you can make your own arrangements but in the meantime I will be available for your care for 90 days.

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