DeAtkine began his endocrine-based concierge practice in 2003 when he saw the third-party payer structure making it difficult for doctors to spend time with patients. “The system doesn’t put value on time or complex decision-making, and I had a lot of complicated and sick patients that needed time or expertise,” he says.
In researching alternative practice models, he read about and then chose to move forward with MDVIP, a Procter & Gamble-owned company that helps physicians transition to a concierge practice. They also handle certain office and marketing functions in return for that fee.
Within three years, DeAtkine had a full concierge practice of 600 patients with a waiting list. “Personally, I don’t think there is a downside to concierge medicine,” he says. “Originally my colleagues snickered behind my back and waited for my calamitous fall. But it didn’t happen.”
DeAtkine’s patients pay $1,650 annually, with a $35 copay for routine appointments. “We’re out of network for Blue Cross, but I do accept Medicare and other insurance,” he says, adding that patients still need health insurance to cover things like x-rays, prescriptions, and hospitalization. “Concierge medicine is not a health insurance product, it’s a relationship.”
Rob Spiegel, MD, of Signature Health, offers his concierge patients a sliding scale based on age. Those under 40 pay $750 annually, while those over 40 pay double at $1,500. Family members join at a discounted rate.
A third tier at $3,000 means Spiegel will accompany the patient to appointments with specialists and visit their homes. “It’s as much about safety in those home visits as medical care,” he says. “I get to see if maybe they’re not taking baths as often as they should or living in a ‘hoarder’s house’. You learn a lot when you go into someone’s home.”
Before starting his concierge practice in 2008, Spiegel had been a hospitalist at St. Vincent’s where he organized two hospitalists groups. When he realized he wanted to switch to a primary care practice, he also researched MDVIP. But because he didn’t have an existing practice, he didn’t qualify.
“I just had a lawyer set it up,” he says. “I started from the ground up with two patients who had said that as soon as I opened an office, they wanted to come with me.”
Spiegel’s now got 150 patients. Only about five percent of his patients join at the highest pay tier. “The mid-level is my meat and potatoes,” he says. “When I get to 300 patients, I’ll stop and reassess. If I’m able to provide the same services I can supply now, then I’ll get that number to go up. But no one should ever be sitting in my waiting room.”
The downside to concierge medicine for Spiegel is being continuously on-call. “It’s not about the number of times going out, it’s the possibility of having to go out,” he says. In four years, he’s had about 10 phones call between midnight and four a.m.
DeAtkine says his practice day still lasts eight hours. But instead of seeing 35 to 50 patients, he sees about 10 to 12. Visits to both physicians run about 30 to 60 minutes with routine physicals lasting one to two hours. “I spend more time in the room now with my feet up and talking about what’s bothering them and how they’re feeling,” DeAtkine says.
That time pays off for his concierge patients. “I had several patients with chronic fatigue, and I’ve had time to diagnostically find the potential causes,” he says. One had mold toxicity and responded to environmental changes and detox treatments. The other had a combination of a vitamin deficiency and potential Lyme disease, which also responded to treatment.
Having the time to solve those mysteries tops Spiegel’s enjoyment of concierge medicine. “It’s detective work without a gun,” he says.
The physician’s time to delve into complex health issues and their ready access are the real draw for concierge patients, which are misunderstood to be dominated by the wealthy. “At least half are middle class who’ve chosen this because they need access,” Spiegel says.
Patients with chronic heart disease or respiratory conditions have found they save themselves the distress and costs of the ER through concierge medicine, because they can see their physician for treatment often within hours.
For physicians considering the transition, Spiegel advises them to closely assess their choices. “The franchising fee can be very high, like 30 percent annually over five years. I paid a lot to my attorney at first, but not that much,” he says. He adds that a franchise can cover certain start-up or ongoing costs as well, like maintaining electronic health records.
“The most dramatic difference between my practice and the average internal medical practice is just the amount of time I spend with patients. It’s not that the things I do are fundamentally different or the treatments are different. They’re not,” DeAtkine says. “But concierge medicine reflects what patients want most from us, which is our time.”