April 30, 2013

My Internist, Like Many Others, Is Switching to Concierge Medicine

My long-time internist has informed all his patients that he is changing his practice to "concierge" medicine. If I want to continue with him, I will have to pay a $1,500 annual fee.

If you haven't faced a similar choice already, there's a pretty good chance you will. About one in three private-practice physicians are considering transitioning to subscription-based care, like concierge medicine, according to a recent Accenture study.

This trend -- and the issues it raises -- are so important that I'm going to explore the pros and cons over the next several days. Since my internist's proposal is fairly typical, I'll describe what it involves today.

Background
My internist, Richard Schubert, has been in private practice in Washington, D.C. since 1979. For the past 20 years, he has been affiliated with Foxhall Internists, a group of internal medicine physicians.

Their offices are a convenient five-minute drive from my house. Often cited as one of the best physicians locally and nationally, Dr. Schubert has been my primary physician for more than 20 years. I've often mentioned him in my blog.

I get an annual physical from him and see him fairly often during the year as health issues arise. He has frequently referred me to specialists I've liked. 

In his March 15 letter to me, Dr. Schubert noted that both patients and doctors are adapting to the new realities in medical care. He goes on to say:
At Foxhall Internists, we have been monitoring the situation closely and have come up with a solution that enhances our ability to provide you with the thorough, expert, proactive medical care that keeps you healthy and well.
The Solution: Concierge Medicine
On July 1, 2013, Dr. Schubert advised, he will be shifting his practice entirely to "Foxhall Internists Prime," a subscription-based arrangement available for an annual fee of $1,500.

Because this concierge practice will be available to a limited number of patients, Dr. Schubert says, "it will allow me the opportunity to give enhanced service to those enrolled."

He explained that he'll enroll patients on a first-come, first-served basis through July 1, 2013, or until the practice is filled. But he is offering current patients like me an exclusive enrollment period through May 15th, after which he will extend enrollment to other interested persons.

What Would I Get for $1,500?
The annual-fee program includes the following:
  • An expanded physical of up to 90 minutes "to review the various details of your health, suggest preventive and wellness measures, provide instant Web-based medical research, review nutritional  issues, and describe alternative health options."
  • Appointments within 24 hours of your request and no waiting time. The appointments would not necessarily be with Dr. Schubert. If he wasn't available, you'd see someone else in the Foxhall Internist group, and not all the doctors there participate in the concierge practice. 
  • Cutting-edge research in any area of health concern, conducted by Dr. Schubert and "accessing the latest medical research and database." An example is given: "Using a specific genetically based drug interaction model, your doctor will be able to predict how various medications interact with each other and what, if any, medication adjustments are necessary."
  • Enhanced communication. "You will continue to have 24/7 access to the on-call doctor at Foxhall Internists. In addition, every effort will be made to contact your personal doctor [i.e. Dr. Schubert] 24/7 for assistance with serious medical problems.
  • A secure internet site for e-mail communication with Dr. Schubert. "This site may be used contact us, ask questions, make requests, etc. Of course, for emergencies and after hours, a phone call is needed to ensure that messages are received."
  • An electronic summary of your health records on both a thumb drive for you to carry and on a secure Internet site for reference or for access in any emergency
What Is Not Covered
The $1,500 fee does not cover regular office visits. Only the annual physical is covered. Home visits are not offered.

The $1,500 fee will not be reimbursed by patients' health insurance. In fact, Foxhall Internists does not accept insurance plans at all.

The concierge program does not cover Medicare's new one-time introductory "Welcome to Medicare Physical" or the new "Annual Wellness Visit." But the $1,500 fee will be reduced to reflect the payment the doctor receives from Medicare. For instance, if Medicare pays the doctor $183 for your Annual Wellness Visit, the fee will be reduced to $1317.

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That's the offer. Tomorrow, I'll review the media's coverage of the pros and cons of concierge medicine. Then I'll report on my preliminary attempt to answer the question: "Should I Sign Up?"  

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