Don't Look to "Concierge Medicine" to Save the Healthcare System
One Medical Group, a new nationwide physician group that practices a form of "concierge medicine," styles itself as a new model for healthcare. But One Medical Group and other concierge practices -- including those that cater to the affluent -- are more like the last gasp of the old fee-for-service, cottage-industry model of medicine.
One Medical Group, which has attracted interest from Silicon Valley investors, currently has 31 primary care physicians in San Francisco and New York. What distinguishes its practice from most other concierge outfits -- which provide extra services to patients in return for a fee -- is that they charge patients only $150-$200 per year. That's quite reasonable compared to the annual fees of $1,000-$5,000 levied by the high-end concierge groups that cater to the well-heeled.
In return for their modest fees, the doctors of One Medical Group provide longer-than-usual appointments, same-day access for acute problems, e-mail consultations, and other amenities. The physicians see no more than 16 patients a day, in contrast to other primary care doctors who typically see 25-30 patients a day. This leisurely pace pleases both physicians and patients.
But about those economics...
So how do the economics work? According to a New York Times article, One Medical Group accepts insurance, and it works on a lower-than-average overhead. The combination of extra fees and lower costs allows doctors to spend more time with patients and provide them with services that insurance doesn't cover.
Sounds great. But if the practices have only half the staff of a normal primary-care practice, how do patients get through on the phone? Also, while One Medical Group flaunts some of the characteristics of a patient-centered medical home, such as same-day appointments, you have to wonder whether its doctors do a better job of care coordination than the average practice. If not, its patients aren't going to be any healthier -- just happier.
Investors are happier, too
In any case, One Medical Group has convinced at least one important constituency that it's on the right track: investors. The venture-capital firm Benchmark Capital has invested several million dollars in the practice, and more investors are being sought. But some observers are skeptical that, even with venture capital behind it, One Medical Group will ever attract more than a small percentage of doctors.
That view makes sense, considering that none of the various approaches to concierge medicine have taken off in the past decade. While it's true that only a few other practices like Greenfield Health in Oregon and Greenhouse Internists in Philadelphia have adopted the low-end concierge model, many other doctors have tried charging their patients modest amounts for various services that aren't reimbursed by insurance. To date, the results have been unspectacular.
Ultimately, neither the concierge model nor the patient-centered medical home will save primary care. What's needed is a completely different approach that puts primary-care doctors in charge of the healthcare system and gives them financial incentives to control costs. When that happens -- perhaps as part of the new accountable care organizations -- doctors will flock into primary care again.
Image supplied courtesy of Wikimedia Commons.
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