Like their pa­tients, concierge prac­tices hold­ing up quite well

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iven the fi­nan­cial and reg­u­la­tory uncer­tainty en­gulf­ing most of the health­care in­dus­try, re­tainer-based pri­mary-care med­i­cal prac­tices are do­ing just fine, in­dus­try ex­ec­u­tives say.

Ex­ec­u­tives for these types of prac­tices, which use ap­proaches com­monly known as concierge medicine, bou­tique medicine or di­rect pri­mary care, say their busi­nesses re­main rel­a­tively healthy amid weak­ness in the econ­omy and threat­ened and ac­tual cuts to fed­eral re­im­burse­ment in the works.

Re­tainer-based pri­mary-care prac­tices are far­ing well for dif­fer­ent rea­sons, de­pend­ing on the kind of fee-based ac­cess ap­proach be­ing of­fered.

Concierge or bou­tique prac­tices, with a fo­cus on ac­cess, ser­vice and ameni­ties, have been able to weather the rocky eco­nomic times be­cause their gen­er­ally wealth­ier pa­tients are in a bet­ter po­si­tion to con­tinue to pay the fees even when fi­nan­cially stressed, ex­ec­u­tives say

Ser­vices gen­er­ally in­clude en­hanced ac­cess to physi­cians—some­times even 24-7—as well as lengthy, in-depth an­nual phys­i­cal ex­ams that in­clude di­ag­nos­tic test­ing as well as an ex­ten­sive bat­tery of screen­ing tests. The prac­tices, which can work in con­junc­tion with Medi­care and pri­vate in­sur­ance, of­ten of­fer same-day or next-day ap­point­ments, ready physi­cian ac­cess via e-mail and longer vis­its in gen­eral.

A vari­a­tion on the concierge ap­proach, known as a hy­brid model, in­volves a prac­tice of­fer­ing tra­di­tional lev­els of care and carv­ing out a por­tion of their time and ef­fort for concierge-type care, an ap­proach also do­ing well, pro­mot­ers of that con­cept say.

Di­rect pri­mary-care prac­tices cater less to the wealthy and are a lower-cost op­tion of­fered to em­ployed peo­ple with no in­sur­ance or with high-de­ductible in­sur­ance, among oth­ers. This ap­proach, which also of­fers eas­ier ac­cess to care but ac­cepts no in­sur­ance, also ap­pears to be hold­ing steady or grow­ing. The ap­proach has at­tracted some pos­i­tive at­ten­tion from Congress (See story, p. 30).

The dif­fer­ent styles of re­tainer-based care likely also are ben­e­fit­ing from the fact that they have not sat­u­rated the mar­ket de­mand for their ser­vices yet, so as pa­tients leave a prac­tice for fi­nan­cial rea­sons, oth­ers are will­ing to take their spot.

Ex­ec­u­tives for the Lewis and John Dare Cen­ter, a concierge medicine prac­tice af­fil­i­ated with Vir­ginia Ma­son Med­i­cal Cen­ter in Seat­tle, say their busi­ness has de­clined but not sig­nif­i­cantly.

“There hasn’t been a marked drop off,” says Dr. John Kirk­patrick, in­ter­nal medicine spe­cial­ist and med­i­cal di­rec­tor of the Dare Cen­ter. Even though the concierge medicine prac­tice’s busi­ness is down about 10% over­all in the past cou­ple of years, the prac­tice just added its fifth physi­cian and cur­rently has about 1,100 pa­tients, Kirk­patrick says. The Dare Cen­ter lim­its each of its doc­tors’ pa­tient panel to 300, he says.

He noted that the prac­tice ebbs and flows in terms of the num­ber of pa­tients, with pa­tients leav­ing be­cause of death—their prac­tice tends to at­tract older pa­tients and has an av­er­age age in the 65 to 70 range—mov­ing out of the area, and also for fi­nan­cial rea­sons.

At full ca­pac­ity

An­other concierge prac­tice af­fil­i­ated with a hos­pi­tal sys­tem, Scripps Health in San Diego, has not seen a drop-off in busi­ness be­cause of the econ­omy or for other rea­sons. “De­spite the cur­rent down­turn in the econ­omy, our prac­tice is op­er­at­ing at full ca­pac­ity and we are even look­ing to ex­pand our ser­vices to ac­com­mo­date more pa­tients,” Dr. Gas­ton Molina, divi­sion head of the Pri­vate In­ter­nal Medicine Cen­ter at Scripps Clinic, says in an e-mailed state­ment. The cen­ter has four physi­cians, each car­ing for about 300 pa­tients, ac­cord­ing to Molina.

Hos­pi­tal-af­fil­i­ated concierge prac­tices are just one small part of the in­dus­try, with inde-

Pa­tient re­newal rates at concierge chain MDVIP are about 92%, ac­cord­ing to the com­pany. At left, Dr. Dean Car­ring­ton, who is af­fil­i­ated with MDVIP, per­forms an exam at his of­fice in Ar­ling­ton, Texas.

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