Like their patients, concierge practices holding up quite well
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.