Concierge medicine is a relationship between a physician and a patient in which the patient pays for more direct access in the form of an annual fee, per visit fee, or retainer. The physician commits to limit his or her case load in order to provide a higher level of service including increased accessibility, more time allotted for visits, and availability. There is some variety in the marketplace of types of “concierge” practices, what services they offer and how they charge. Some see patients only in the traditional office, while others provide a house call service.

The typical models of concierge medicine are retainer or membership based. This retainer covers most interaction directly with the physician in the office. Office visits are generally extended, giving ample time for questions and concerns to be addressed and for follow up on older issues. Services such as labs, vaccines and x-rays are not included in the retainer and are charged separately, sometimes by cash-only or through the patient’s insurance.

Some examples of the increased accessibility and availability that patients of concierge practices enjoy are unlimited office visits with no co-pay, little no waiting room time, same day access, direct/immediate email and text messaging to your doctor, telemedicine, and online consultations.

The concierge physician is still a rare find, but the trend is on an upswing. According to an article in the American Journal of Medicine, the concept of concierge practices were established in Seattle in the late 1990s. By 2010, there were 2,400 to 5,000 concierge practices in the United States and by 2014, the number had increased to 12,000. Also in this article the AJM sites that MDVIP, one of the largest concierge medicine practices in the US founded in 2000, grew to managing more than 800 physicians and 240,000 patients in 42 states by 2015.

There have been network television shows that have helped to increase the visibility of concierge medicine. Two of these, which debuted on the USA network, Royal Pains in 2009, and Rush in 2014, have highlighted physicians who provide direct access medicine to the rich and famous. Of course the shows feature some rather highly unlikely scenarios for the sake of entertainment, but they helped introduce the idea of concierge medicine to the general population.

More recently, hybrid concierge models have begun to appear in the marketplace. Some charge a retainer or membership fee for services that Medicare and other insurances do not cover such as more extensive wellness plans and evaluations. Services that can be covered by insurance will be billed as such. This model allows the physician to continue to see “non-conceirge” patients while their “concierge” patients receive a higher level of services. Allegiance’s innovative “convenience” model provides house calls to seniors who are homebound. While there is a convenience fee to cover the provider’s travel for the house call, insurance is billed for the actual patient visit, keeping the costs lower for the patient and making this model more accessible to the aging population in Northern Virginia.

Our Medical Director, Internist Dr. Rahel Yirga further discusses the topic in her interview on the Probate Nation, see the recorded video here.

About the Author: Pam Reynolds, CMC is the President and co-owner of Allegiance Aging Care Services. Pam has spent almost fifteen years working in senior care including long term care facilities and home health care. Her higher education is in Social Work, and she has been credentialed as both a certified Geriatric Care Manager and Licensed Assisted Living Administrator. Read more about Pam and her team of Aging Care Professionals here



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