Concierge Care Due Diligence Essential questions to ask when deciding whether to use a concierge physician: 1. How many critically ill patients do you care for? 2. Is your practice independent, or is it a franchise? 3. What are your educational and professional credentials? 4. Does your firm have any specialists on staff? 5. What leading specialists do your patients have access to?  In what fields? 6. Does this practice have admitting rights to the leading  hospitals in my area? 7. Does this practice accept patients with preexisting medical conditions?  8. Can you provide references from existing patients? 9. Given the limited size of this practice, what are you doing  to keep your medical knowledge and skills up to date? 10. How do you advocate for your patients when they   require specialized or long-term care?

Like many popular specialists, Barley sets his own fees and bills patients directly, which allows him to spend more of his time getting to know patients and monitoring chronic conditions without limiting the size of his practice. “I have colleagues out there who are charging $2,000 to $25,000 a year for what I provide routinely for a lot less, most of which the patients are reimbursed by their own insurance,” he points out.

Health care consumers do not always need to spend more to get more, argues Michael Fleming, a Shreveport, La.-based physician who has practiced general medicine for 27 years and now chairs the board of the American Academy of Family Physicians. Rather, he says, they need to invest their time and energy in selecting their doctor and developing a long-term relationship with a trusted, experienced medical practice, what he calls a “personal medical home.” That may come more easily in a concierge practice. “But they don’t need to pay extra to get that. Concierge care is a triumph of style over substance,” Fleming argues.

Fleming may have rejected the fee-for-service aspect. But in practice, his services do not differ much from the concierge model. He leaves half of his daily appointments open every morning so he can see patients the same day they call, if necessary. Recently, one of his patients called Fleming at home at 5 am, saying, “I’ve got the flu again; I’m flying home in my jet. Would you meet me at the hospital?” Fleming got dressed and met the patient at the hospital. He helped the staff determine that this was not just another bout of flu; the patient had myeloma, a form of bone marrow cancer. “We had the kind of relationship where he knew he could do that,” Fleming says.

Moreover, just because a patient is willing to pay does not mean he will make the cut at premier concierge services. “There is always a face-to-face meeting between the doctor and the prospective patient to see if there’s a good fit—it’s a mutual selection,” Moses says. A doctor may decide he cannot treat someone. “If a person has complex health problems, he might need more specialist skills than our doctors can provide; no one wants to be a doctor to patients he can’t serve properly.”

Such practices lead some to worry that there is a risk of concierge practices cherry-picking their patients. Individuals with a chronic medical condition need to consider this when considering hiring a retainer-based doctor. “To make it work, they can’t have too many patients demanding lots of time with major medical issues,” Connolly observes. “That’s a potential ethical minefield.” Concierge practices can end up with a healthier-than-average population of patients because of these deliberate selection practices. This is more likely at a newly created medical practice than at one that is converting to the concierge model, Connolly says. The patients who opt to join are generally healthy 40-somethings willing to pay their doctors what they pay their personal trainers to stay healthy. Ultimately, this trend may skew the results of any research that is conducted on whether concierge care actually improves general health.

As more concierge clinics open their doors, most analysts agree that the model is unlikely to come to dominate the health care system. It is too early to determine how successful the concierge model will be in offering better medicine. Connolly explains, “Really, it’s like getting on a plane to Los Angeles,” he says. “It takes off and lands safely and on time. Some people go in economy class, some in business and some pay for first class. Everyone has the same outcome—only the price and the comfort level change. For now, that’s all we can say about concierge care.” 

Suzanne McGee is a New York-based freelance writer. suzanne.mcgee@gmail.com. Additional reporting by Marilen Cawad.

Photography by David Allen Brandt.

Additional Information
 The "Highly Attentive" Approach
 All Access?
 Concierge Medicine Resources
 Principles in Practice: The Ethics of Concierge Medicine
 A Guiding Hand