Doctors Craft New Business Model

The medical care market is increasingly becoming like the real estate market:  you get what you pay for.  The top complaints from patients regarding  doctor visits typically include long waits for just a few minutes of doctor face  time, impersonal care, lack of appointments and slack follow up.


“Concierge” care has recently entered the medical scene offering more  personalized, around-the-clock treatment, but it comes at a hefty price tag: up  to $2,000 a year, and many concierge docs don’t accept insurance. With a growing  number of patients in need of more attention from doctors and an easier  experience getting the care they need, clinics nationwide are aiming to bridge  the gap between expensive concierge care and lost-in-the-shuffle  treatment.

At One Medical in San Francisco and GreenField Health in Portland, Ore.,   patients are charged an annual membership fee and are cared for by doctors  with an average of 800 to 1,000 patients on their roster. That’s less than  one-third the number of patients seen by doctors at most mainstream clinics  today. By limiting the number of patients served, the doctors are able to offer  more benefits such as longer one-on-one visits, and e-mail and phone  appointments.

At One Medical, owner and founder Dr. Tom Lee offers his patients office  visits without waiting-room time, 24-hour a day online and telephone access to  doctors and the ability to book appointments and request prescription refills  online. Membership costs $200 a year, and he accepts most major health insurance  plans. To help reduce overhead costs, Lee’s office has fully embraced the  virtual world. Instead of patients having to make a trek into the office every  time they get a sniffle, they can speak to their doctor via e-mail, instant  message, or Skype, and have a prescription sent directly to their pharmacy.

Lee says the model is a win-win for doctors and patients: membership fees  keep the doctors’ offices profitable despite the limited patient load, and  patients receive more personalized care.

“The membership fee allows us to do things not typically covered by health  insurance, like virtual visits and phone calls,” says Lee.

The model has been successful for One Medical, and the company now operates  six facilities in San Francisco, five in New York City and has plans for  expansion later this year in Silicon Valley and Boston.

The “problem” that clinics like One Medical are trying to solve is that  medicine has become purely a volume business for doctors who want to make a  living,  says Dr. Steven Fisher, owner of Fairfield County Medical  Group in Trumbull, Conn.

“Doctors have to run people through as quickly as they can in order to fit in  more patients in order to make more money, and what ends up happening is that  doctors do not have the time they should to spend with their patients,” he  says.

Lee agrees with this diagnosis, adding that physicians should never be paid  based on the quantity of patients they see. “Doctors should be paid based  on the quality of the service they provide, not the number of patients they can  squeeze in in an hour. We wanted to build a practice that would enable a better  experience for both the doctors and the patients.”

Lee says the doctors at One Medical enjoy more hours in their day without  having to run people through, and the patients enjoy a longer appointment time  and better access to their doctors. He encourages patients to think of the  clinic as “member supported” but not “members only,” and stresses that if  someone wanted to join One Medical and was unable to pay, the membership fee  would be waived without hesitation.

“It’s not an access fee, and in a perfect world, we would hope that this  level of care would be available to everyone.”

That’s the sentiment echoed at GreenField Health in Portland, Ore.,  where administrator Steve Rallison says members enjoy better care due  the annual fee they pay, which ranges from $120 per year to $756 per year  depending on age. GreenField uses the logic that the older you get, the more  specialized care you need; patients in their 30s would pay $396 per year, while  someone in their 60s would pay $612 a year.

“When the physician is not harried, all kinds of wonderful things happen,” says Rallison. “The membership fees enable a better doctor-patient relationship  simply because of the additional time they provide.”

Virtual visits help GreenField save both time and money. Patients have the  ability to call or e-mail doctors personally 24 hours a day, and book  appointments online at any time. The clinic also assures its patients of little  to no wait time, and same-day or next-day appointments.

But even with all these perks, neither One Medical or GreenField can be  considered true “concierge” medicine, says Fisher.

“True concierge doctors will only have around 400 patients, and many of them  won’t take any type of health insurance. On top of that, in most major cities  like Miami or New York, the fees are 10 times what One Medical is charging,” says Fisher.

Fisher says that in states including New York, California and Florida,  concierge fees currently stand at around $2,000 per year. He adds that for  people considering investing in concierge services, the prices aren’t likely to  go up anytime soon, as in the last few years the cost seems to have  plateaued.

“Honestly, some people spend $2,000 a year for their maid to go on vacation  with them,” says Fisher. “It’s all about what you find valuable. If you find  value in having your doctor’s number and the cost isn’t going to be a burden to  you, then I would absolutely recommend it. It’s like going to a hotel  and paying extra money for the ocean views. If you are happier with that view  and you can afford that view, then get it. If you’re happy looking at the  garden, then do that. The good thing is that for the people who want the ocean  views, they now have the option.”

Fisher’s clinic recently tested out a “hybrid” concierge model, where  patients were given the option to purchase concierge care for $2,000 per year.  Perks include longer appointments, hospital care from your physician and 24 hour  phone access to your doctor.

“It’s working,” Fisher says. “I have more time for appointments with my  concierge patients, but my regular patients also benefit from seeing a doctor  who is a little less stressed, a little less burned out and a little less tired.  I am not constantly going through my day saying ‘I gotta see another patient, I  gotta make another dollar.’ I have the cushion that saves me from having to take  on so many new patients.”

Fisher says that while he is a proponent of concierge care, he only  recommends it to patients who can afford it. However he says the need for more  personalized and 24-hour access increases with age.

“I carry my phone everywhere, and my patients can call me anytime. For some  people, just having that peace of mind is worth it.”

Concierge medicine is not without its critics, Fisher says, because  unfortunately the type of care given to the people who pay  the concierge fees is the type of care that everyone in the country  should be receiving.

“Unfortunately, the business model followed by most of today’s doctors  requires us to churn out patients. Concierge medicine allows us to be  the doctors we planned to be when we graduated medical school. I hope one day  this is the type of care we can give the population at large, but right now, the  system is broken.”