By Laura Turner
SDN Staff Writer

“Boutique” or “retainer” medical practices have been steadily growing since 2005.  In this practice model, patients pay an annual retainer fee outside of insurance to gain greater access to their physician. (1)

While it is growing in popularity, some physicians, ethicists, and policy makers are concerned about the trend. (2)

“Concierge care…is like a new country club for the rich,” Representative Pete Stark, Democrat of California, said at an economic committee hearing to Congress in April 2004. “The wealthy will pay for exclusive access to quality care, and everyone else will continue to have inferior access to primary care physicians, specialists, and basic medical advice.” (3)

Proponents of concierge medicine, on the other hand, say that it enables doctors to provide the best possible care and remain in a clinical setting.  Dr. Bernard Kaminetsky, an internal medicine physician in Florida, told the New York Times he would be working for a pharmaceutical company if he hadn’t been able to move to a concierge model.  “I’m really helping a lot of people.  I feel good about what I do,” he stated. (2)

To learn more about this growing trend, the Student Doctor Network spoke with Arney Benson of SignatureMD located in Santa Monica, California.  SignatureMD helps primary care physicians transition their practice to a retainer medicine model.  He is a graduate of the Massachusetts College of Pharmacy & Allied Health, and has over 25 years of healthcare consulting experience. He currently serves as President of AB Consulting and Senior Vice-President for Physician Development for SignatureMD.

How do you define “concierge” or “retainer medicine”?

Retainer medicine, sometimes referred to as “concierge” or “boutique” medicine, is a different type of care delivery experience in which physicians limit the size of their patient panel in order to provide more proactive health care services and greater convenience and access to their patients.  Patients pay a defined fee to experience this type of care, the specifics of which vary among physician practices.

How do retainer practices fit into the current health care structure (i.e., Medicare, insurance companies, etc.)?

A retainer practice focuses on patients in a proactive continuum of care.  You get to know your patients well and help them to coordinate their healthcare.  Instead of building your practice up to a panel with thousands of patients, you will have a panel between 300-500 patients.  While you can still accept insurance, you will also assess a yearly membership fee from your patients.

This retainer model typically requires fewer supporting personnel because of the lower patient load.  Therefore, you will have fewer patients and fewer staff to manage.

The retainer practice also offers a different service level that might include cell phone and/or e-mail access, same day appointments, longer physicals and routine appointments, coordination with fitness and nutrition providers and 24/7 access.

However, any practice continuing to participate in insurance plans must take into consideration the view of retainer fees by those insurance providers.  When the legality of retainer medicine comes into question, it’s typically because an insurance provider has a provision that does not allow the patient to be billed a fee for such management.  It is wise to work with a team of legal advisors, or a company like SignatureMD, to mitigate your risk.

One needs to always remember that a retainer fee is for non-covered services. If you stick to that, there should be no added issues for the current carriers.

What do you see as the benefits of the retainer medicine model for patients?

Many patients complain today that by the time they get in to see their primary care physician, they have 10 to 15 minutes to explain their concerns before the physician is exiting the exam room.  Your patients need a relationship and a physician that knows them and thinks about the bigger picture.  A retainer practice allows for more time and more questioning.  A retainer practices focuses on prevention and the overall continuum of care.  Many physicians who practice in this manner also include their patient in the process in a more educational manner so they work on wellness plans together and discuss options in an informed (and un-rushed) manner.  If you were the patient, wouldn’t this type of care be what you prefer?

What do you see as the benefits of the retainer medicine model for physicians?

Here are the benefits we find:

• Increased income
• More time to spend with patients:  This increased time available to spend with each patient will allow you to address all of their problems, rather than just one or two. It also gives you the luxury of having the time to truly explain their diagnosis and treatment, which will enhance the patient’s trust, education, compliance, and satisfaction.
• More compliant patients
• Patients who value and respect their physician
• Less time at the office

 

Our company, and others like it, also provide help with practice management, such as:

• Secure online electronic medical records (EMR)
• Ongoing patient marketing
• Help with business operations
• Help with regulatory and legal issues

What types of personalities enjoy a retainer practice versus a more traditional structure – do your doctors tend to be more entrepreneurial, for example?

Not necessarily more entrepreneurial … but what that physician is: a forward thinking healthcare service provider that wants to deliver a quality of care model, and not the run of the mill reimbursement model (which is) stealing the only commodity necessary to function well in medicine, and that is the time factor.

The typical physician, if there is such a thing, that would do well has to have a driving force to change the status quo and deliver the kind of medicine and diagnostics as he or she sees fit and not be buried under the bureaucracy of the reimbursement model of short time diagnostics and paperwork equal to the time, and sometime more, than the treatments the physician delivers.

Is this a model that a physician could enter immediately out of residency?

Typically no. However, one could start a retainer practice, advertise the concept and build it from there. Realistically, that would take the better part of 24 months to 36 months to get to a reasonable patient enrollment to support the overhead of an office and earn a living. However, a better suggestion would be to seek out a retainer medical clinic for employment to build a relationship with patients so in 3-5 years, once your “affinity” relationship is such to support a retainer model, you can consider a boutique or concierge model.  By the affinity relationship I mean, would the patient be willing to pay a retainer to keep you as their primary care physician.  We find that a good professional relationship takes between 3 to 5 years to establish.

How would you anticipate retainer medicine changing if universal healthcare is implemented?

I think that’s it’s not a matter of if universal healthcare were to be implemented but a matter of when.

That being said, the retainer practice model will continue to gain popularity, as it has, as an example, in Massachusetts where healthcare for all has been implemented for the last two years. The reasons are many, but the driving force for many patients is that they are already frustrated with the existing system, including the wait times and care they receive from a 5 to 10 minute appointment.

The system will be a tiered system where everyone will have healthcare and those that wish a different service offering will seek out an alternatives, i.e. retainer model or a different delivery option for their primary healthcare needs.

Footnotes:

1)    Jeff Levine, “Boutique Medicine: For Your Well-Being?  Or the Doctor’s?”

AARP Bulletin Today, April 18,

http://bulletin.aarp.org/yourhealth/policy/articles/boutique_medicine.html

2)    Abigail Zuger, “For a Retainer, Lavish Care by ‘Boutique Doctors’”,

New York Times, October 30, 2005

http://www.nytimes.com/2005/10/30/health/30patient.html

3)    Congress of the United States – Joint Economic Committee Hearing,

Opening Statement, Representative Pete Stark, April 28, 2004

http://www.jec.senate.gov/archive/Documents/Releases/starkopenstate28april2004.pdf