Private concierge services are rolling out all the stops for their highest-income patients—but some providers, concerned about catering to elite patients, are raising concerns about the growing gap in health care inequality, Nelson Schwartz writes for the New York Times.
Data show average patient appointment wait times in the United States are on the rise. According to a recent survey, individuals on average wait 29 days for an appointment with a family care physician, up from an average wait of 19.5 days in 2014. The survey found the wait is longer for some specialists, with individuals waiting an average of 32 days for an appointment with a dermatologist and 21 days to see a cardiologist. And once a patient gets in for their appointment some providers say the visit often only lasts 15 or 20 minutes, according to the Times.
These access barriers and hectic provider schedules have given rise to concierge-type health care in which providers charge an annual fee for patients who want to receive more personalized care and have access to same-day appointments. And while some providers price their services based on the average income in their area, an elite form of concierge services is going beyond same-day appointments and charging patients thousands—and in some cases tens of thousands—of dollars for their personalized care and services.
Elite health care concierge services offer quicker access to care, at a price
Elite concierge services charge members high fees in return for quick, and often same-day, access to medical services such as primary care, as well as accelerated access to high-quality emergency care and specialists.
For instance, the California-based Private Medical charges between $40,000 and $80,000 per family per year—more than 10 times the typical concierge practice—while the California-based MD Squared charges couples as much as $25,000 annually.
According to the Times, Private Medical's annual fee does not cover hospitalizations, but it does include the total cost of members' health care visits, tests, and procedures for the year, as well as individual health plans and detailed quarterly health goals. The physicians also will make house calls or meet members at their workplaces or other locations, if needed.
In the event of an emergency, Private Medical's providers will ensure patients are brought to the best facility and will meet the patient there—even if that means flying across the country—to coordinate care. Private Medical also will connect members to nationally acclaimed specialists, make the necessary appointments, and accompany members on the visits.
Private Medical owner Jordan Shlain said his service caters to higher-income individuals who can pay for such medical bills out of pocket. As Shlain put it, his annual fee "is cheaper than the annual gardener's bill at your mansion."
Higher-income patients are not the only ones who benefit, the Times reports. Providers at the elite concierge practices typically receive higher pay and have a more manageable patient load.
Shlain said a successful internist based in New York or San Francisco could have an annual income between $200,000 to $300,000, but that Private Medical could pay practitioners between $500,000 and $700,000 annually.
Further, these practices limit the number of families practitioners treat, which providers say allows them to spend more time thinking about their patients. For instance, Private Medical caps the patient load at 50 families per doctor.
Harlan Matles, an internal medicine specialist who works at MD Squared, said not only is he "able to give the time and energy each patient deserves," but he is able to prioritize time with his own family, which he was not able to do at his "old practice."
The debate over widening the inequality health care gap
But some providers have raised concerns about catering to elite patients—and are taking steps to equalize health care access. For instance, Henry Jones, a California-based concierge doctor at the Palo Alto Medical Foundation's Encina Practice, said he is focused on making concierge health care services affordable. Jones charges $370 per month for his services. "It's priced so the average person in this ZIP code can afford it," he said.
Shlain also has taken steps to "democratize" his expanding elite concierge business. He founded the software company HealthLoop, which allows users to communicate with their physicians directly via text messages and digital checklists (Schwartz, New York Times, 6/3).
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