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More doctors offer concierge care

Dr. Chris Ewin of Fort Worth has run a concierge practice for nearly a decade.  Ewin says, "I don't have to go through a bean counter, insurance and the government.  Therefore I get the cost down."

Gus Bates had had enough. Enough standing in lines. Enough copayments. And enough of reminding his physician who he actually is.

Then he heard about a doctor with a different kind of practice. 

“It's like the little house on the prairie medicine, where you have a one on one relationship with your physician,” Bates says.

Call it “boutique care” or “direct primary care”, but it's best known as concierge care.  Generally, patients pay a monthly fee like a gym membership.  And what do they get? A physical, and 24/7 access to their doctor.

It's the second time this week Gus Bates has seen his doctor in Fort Worth. 

"I know his house, he knows mine, he's been over,” says Bates. “I have told him everything.  Where, before, I didn't tell a doctor everything.  I'm not going to get through, ‘Do you take Tylenol PM every night?’ ‘Yeah. Whatever, bud.” But he has coaxed it out of me to where he knows my… everything."

Of course, this kind of care is expensive. Bates can afford $1,700 a year for service. His wife pays a bit less. They also pay for high deductible insurance to cover anything their concierge doctor can't -- like emergency care. 

"The consumer looks at it and says, is this worth it to me?” says Chris Ewin, Bates' doctor.

Dr. Ewin says not having to deal with HMOs and paperwork saves a lot of money. 

"Today I don't nickel and dime him,” he says. “EKGs, urine, spirometry, all the testing I do here I don't have to go through a bean counter, insurance and the government... therefore I get the cost down."

Across the country, 4,000 doctors offer concierge care. That's 30 percent more than last year. It's growing fastest in states like Texas, California and Florida.

The nation's largest states also have seen the greatest percentage increase in concierge care practices. (Meritt Hawkins/The Physicians Foundation)

"Of course it's attractive to physicians to go from maybe 3,000 patients to down to 600. Who wouldn't want to do that?” says Sandra Carnahan, a professor at South Texas College of Law.

"Is this about the patient or is this really about the doctor?” asks Carnahan.In my opinion, it's really about the doctor wanting more money and better quality of life than it is about better patient care."

So does concierge care keep patients healthier? There's not much research, but one Tufts University study shows patients do receive better service and faster referrals to specialists. The other big question is where concierge fits in once more people have insurance under Obamacare. Dr Ewin isn't worried. 

"Even if you have insurance, you still don't have access to care,” says Ewin. “You can have all the insurance you want. You still can't get in to see the doctor."

Which is why thousands of people are willing to shell out thousands of dollars a year to have their doctor's cell phone on speed dial.


How Does It Work?

Every concierge practice is different -- but generally patients pay a yearly fee in return for an extensive physical and enhanced access to their doctor. Visits are typically longer, you don’t have to pay for services provided in the office, such as labs and check-ups, and you can call your doctor any time. Many concierge practices don’t accept health insurance, which doctors claim frees them from spending money and time on bookkeeping and documentation.

How Much Does It Cost?

The big sticking point with concierge care for many potential patients is cost.

While some doctors charge a standard fee for all patients, most charge a monthly or yearly fee determined by age.

Here's what Dr. Chris Ewin of Fort Worth charges:

  • Ages 6-20:  $90 a month.
  • Ages 21-39: $130 a month.
  • Ages 40-59: $195 a month.
  • 60 and over: $295 a month.

Though there are practices that charge much more, Michael Tetreault of the magazine Concierge Medicine Today says more than 60 percent of concierge medical plans cost less than $135 a month.

Still, the cost is out of reach for many patients. Professor Sandra Carnahan of South Texas College of Law calls concierge care “an alternative for wealthy people," and says that unless doctors can prove they are providing better quality care and "not just some white-glove handling, I don’t think they’re going to be as successful as they like.”

Why Do People Want It?

Both patients and doctors say they’re turning to concierge care because they’ve become frustrated with the current health care system. Dr. Connie Casad , a gynecologist based in Dallas,  recently transitioned from the traditional model to a hybrid system: She still sees old patients, but about 100 have opted to pay for concierge services. Casad says the switch was about the ability to spend more time with patients.

“I really did not have time in a conventional practice to spend with patients to really make a difference in their life,” Casad says. “A lot of women have sleep disorders, hormonal disorders, nutritional disorders, difficulty losing weight, and you cannot take care of those types of problems in a 15 minute pelvic exam type visit.”

For patients like Gus Bates, a Fort Worth resident who pays $1,700 a year for concierge care, it was also about securing access to a doctor in the future.

“My fear is that we’re not going to have enough physicians,” Bates says. “I doubt there’s going to be good quality internists, knowledgeable folks that don’t have 5,000 people as patients, and I want to have better care than that. I think we all want to have better care than that.”

There isn’t much research on whether concierge care keeps patients healthier, but one study from Tufts University shows these patients do receive better service and faster referrals to specialists.

How Does It Work With Insurance?

Concierge care is not a replacement for insurance. According to Michael Tetreault of Concierge Medicine Today, many patients combine a high deductible catastrophic health care plan with concierge care. This keeps them covered in case of a serious illness or accident, and they can go to their concierge doctor for the common cold, checkups and preventative care.

Check out this article from AARP for more on concierge care. 

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