Concierge Medicine: Is it right for you?

By Dina Megretskaia, CFP®, EA

Wealth Manager, Principal

January 26, 2024

Have you had the experience of showing up early or on time to an appointment with your primary care physician and then having to wait for over an hour to be seen by your doctor?

Have you called to schedule a well-visit appointment and found out the earliest available date would be in four months? Navigating the medical care landscape in the U.S. can be frustrating given the reality that primary care doctors may have thousands of patients and your insurance may only cover certain medications, procedures, or doctors within a network. Whether your health is generally good, or you’re treating chronic conditions, wanting to be heard and cared for is universal. Concierge medicine is a growing business model that some doctors and patients feel leads to a better dialogue between doctor and patient and, in its ideal form, may allow for better preventative care rather than just treatment of symptoms.

 

What is the concierge medicine business model and how does it work with my insurance (employer-provided or Medicare)?

Concierge medicine practices lack uniformity, but at the core they involve physicians, most commonly primary care physicians, who take on patients who pay a monthly fee for access. This model means that physicians can have fewer patients while still earning a salary they find to be reasonable. They may also be able to have a better work and life balance, as well as be more responsive and present with their patients. This monthly fee does not replace insurance premiums and is in addition to a patient’s coverage, whether through Medicare, the Exchange, or an employer. The doctor bills the patient’s insurance company for procedures and preventative care visits, as would any doctor. There may be other out of pocket costs as well.

 

Why do some doctors and patients choose the concierge business model and who is it right for?

Doctors enter the medical profession to heal people and there are fantastic physicians practicing under both the traditional and concierge models. Not all physicians have a client base that can or would choose to pay a monthly fee for access and so they choose to stay within the traditional model. However, some physicians feel that the current business model for primary care leads to burnout. They may also feel it doesn’t allow them to spend sufficient time with their patients and provide the best care. In theory, the concierge medicine model provides doctors with a reliable stream of income (through monthly fees), a reduced workload, and more satisfaction in the care they are giving which prompts them to choose to practice in this model.

Some patients transition to the concierge business model when their current physician implements the change and they’d like to continue being treated by that same physician. Others transition after becoming frustrated with a doctor who double-books appointment times, has long waits, and perhaps does not have the ability to recall their medical history. The retirement of a long-term physician or a change in a patient’s health status or wealth can also prompt patients to review their options.

 

What questions should you ask of any concierge medicine practice you’re considering?

In addition to determining a doctor’s qualifications and experience, it is important that you have a personality fit with the doctor. It is also important to bear in mind that concierge medicine practices vary greatly, not only in their monthly fees, but also in their policies regarding client communication and responsiveness, referrals to specialists, and sharing patient care across the physicians involved in the practice.

Because the theoretical benefit of a concierge medicine practice is better access and more personalized care, you will want to ascertain:

  • if the doctor has a cap for number of patients they see and how many patients they currently have
  • how many patients they typically see in a day and approximately how long each visit lasts
  • how they handle taking vacation time
  • whether they share patient responsibilities across the practice and, if so, what is the policy for communication amongst the physicians
  • how quickly an appointment can be scheduled and how quickly they can be reached during and after business hours
  • whether they offer any unique services
  • how referrals to specialists are handled

Finally, ask why they made the choice to transition to a concierge model, how long the practice has existed in its current form, what has been learned, and what changes are anticipated in the future.

 

How do Modera advisors work with our clients who are considering a physician who uses a concierge medicine model?

Conversations about medical care are extremely personal and cost is but one factor in determining the right fit. Depending on a practice’s model, services, geographic location, and clientele, the monthly fee will vary greatly. Our desire is to run the numbers, using sophisticated long-term projections, not only to be confident that decisions we make today will help leave you in a position of strength in the future, but also to explore the full range of outcomes and stressors for your financial plan. Medical costs, whether for private insurance or various Medicare plans, have historically been rising at a greater rate than broader inflation numbers and are incorporated in our projections.

If your finances provide the flexibility of considering the concierge medicine fee in addition to insurance premiums and other out of pocket costs, we have a framework of questions, explored briefly in this article, to help you make a thoughtful choice about whether or not concierge medicine is right for you. Please reach out to us at any time.

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