Texas Medical Association Journal

The Careful Concierge:
Concierge Medicine Attractive,
But Possibly Risky

(excerpts from original article)



Law Feature – June 2008

Tex Med. 2008;104(6):33-38.
By Crystal Conde
Associate Editor

Imagine seeing only a handful of patients each day, being able to spend enough time with them, and focus on prevention. Now imagine never filing claims with health care payment plans or government payers.

This scenario isn’t a dream for some primary care physicians.

They’ve found a different way to practice medicine and get around Medicare cuts, decreasing reimbursement, increasing patient loads, and bureaucratic hassles. By offering an enhanced suite of services that includes house calls, same-day appointments, 24-hour access to physicians, preventive health and wellness advice, and coordination of specialist care, they can spend more time with their patients and provide what they describe as more in-depth, higher quality health care.

This concept has a name: concierge medicine. In this approach to practice, patients typically pay physicians a yearly membership or retainer fee for access to services not covered by insurance. The model is popular among family physicians because it allows them to scale back their patient loads, provide greater one-on-one attention, and focus on preventive care – not just treat the sick.

Making the Transition

William Jones, MD, founder of Concierge Family Medicine in Austin, recognizes the monumental leap of faith physicians take when they do away with managed care altogether. He says they place their lives’ work on the line.

He switched to a concierge model of practicing medicine four years ago. His son, Mason Jones, MD, joined the practice last year.

The elder Dr. Jones has been in practice for 35 years. In the early 1990s, he practiced under a managed care model but says he stopped when administrative burdens took the joy out of his job.

Six years ago, he gradually terminated all of his managed care contracts over an 18-month period.

“The sky didn’t fall when I did that,” he said, referring to his patients’ willingness to pay cash at the time of visits to continue to see him.

About 80 percent of Dr. William Jones’s 3,000 patients chose to change doctors, leaving him with about 600 truly active patients who he says can be counted on to come in on a regular basis and who generate the stable revenue stream that sustains a primary care practice.

After he fully transitioned to a cash-only business, he attended a meeting of the Society for Innovative Medical Practice Design, formerly the American Society of Concierge Physicians. The idea of charging an annual fee for service, rather than asking patients to pay for each service at each visit, appealed to him.

“It really puts the joy back in practicing medicine,” Dr. William Jones said.

He says converting to a cash-only practice before evolving into a concierge model is a good way to test the waters. It allowed him to find out how many patients were willing to pay up front for services, and it gave him a safety net that would allow him to return to managed care if many patients were unwilling to switch.

Both physicians have opted out of Medicare. They don’t have individual contracts with patients, but those older than 65 sign a private contract that stipulates they won’t submit claims to Medicare for any medical services they receive from the practice. Younger patients who have private insurance can file claims themselves.

Dr. William Jones and Dr. Mason Jones each have a client roster of 600 patients they see throughout the year.

“We get paid for performance, but not by the insurance company; it’s by the patients,” Dr. William Jones said.

The annual retainer fee varies by age and enrollment status designation.

Services include ample time with the doctor, same-day appointments, immediate cell phone access to the doctor 24/7, and prompt access to specialists and state-of-the-art care…

original article continues…