By Phil Galewitz, KFF Health News
Charitable hospitals, originally intended for the poor, are now offering concierge medical services. They charge patients an annual fee of $2,000 or more for easier access to their doctors.
This trend started many years ago with individual doctors. Many doctors have switched to this model to make more money while having fewer patients.
Large hospital systems such as Northwestern Medicine in Chicago, Penn Medicine in Philadelphia, University Hospitals in Cleveland, and Baptist Health in Miami are offering concierge medical services. Patients pay yearly fees exceeding $4,000, in addition to copays, deductibles, and other expenses not covered by insurance.
Critics argue that concierge medicine worsens shortages in primary care, making access available only to the wealthy and increasing healthcare costs. However, for tax-exempt hospitals, the financial benefits are twofold. Concierge fees bring in new revenue and help attract and retain physicians. These doctors then refer their affluent patients to the hospitals that employ them.
Gerard Anderson, a hospital finance expert at Johns Hopkins University, stated, “Hospitals are interested in doctors who offer concierge services because their patients don't have unpaid bills or need charity care, and most of them have private insurance, which pays the hospital well.”
“From the hospitals' perspective, they are the perfect patients.”
Concierge doctors typically have a limited number of patients, offering immediate access and longer visits compared to traditional primary care doctors who have a few thousand patients.
Jewel Mullen, associate dean for health equity at the University of Texas-Austin’s Dell Medical School, expressed concerns that the expansion of these models reduces the availability of primary care doctors for the general population. Concierge doctors join large hospital systems for their reputations, while hospitals recruit concierge physicians to ensure referrals to specialists and inpatient care, helping the hospitals capture a larger share of the market.
Concierge physicians usually offer same-day or next-day appointments and give patients their mobile phone number.
Aaron Klein, who oversees concierge physician practices at Baptist Health, initially designed the program for donors.
“Wealthy donors wanted assurance of having doctors to care for them,” he said.
Baptist Health launched its concierge program in 2019, with three practices in South Florida where patients pay $2,500 annually.
Klein stated, “My philosophy is: It’s better to provide excellent care to a few hundred patients than inadequate care to a few thousand patients.”
Concierge medical practices began over 20 years ago, mainly in affluent areas like Boca Raton, Florida, and La Jolla, California. They primarily served wealthy retirees willing to pay more for better access to physicians. Some of the initial practices were supported by private investment firms.
A large company called MDVIP, based in Boca Raton, has over 1,100 doctors and more than 390,000 patients. It started in 2000, and since 2014, private equity firms have owned most of the company.
Some concierge doctors say their more attentive care leads to healthier patients. A study published last year by researchers at the University of California-Berkeley and University of Pennsylvania found no impact on mortality rates. However, the study did find that there were higher costs.
By using Medicare claims data, the researchers discovered that enrollment in concierge medicine led to a 30%-50% increase in total health care spending by patients.
Adam Leive, a study co-author and an assistant professor of public policy at UC Berkeley, stated that for hospitals, this is a way of consolidating the market. Inova Health Care Services in Fairfax, Virginia employs 18 concierge doctors, with each taking care of no more than 400 patients. These patients pay $2,200 a year for the privilege.
George Salem, 70, of McLean, Virginia, has been a patient in Inova’s concierge practice for several years along with his wife. Earlier this year he injured his finger in a hotel door. As soon as he got home, he called his doctor, who saw him immediately and stitched up the wound. He said he sees his doctor about 10 to 12 times a year.
Salem expressed that he loved his internist previously, but it was very difficult to get an appointment with him. Immediate access to his doctor gives him peace of mind.
Craig Cheifetz, a vice president at Inova who oversees the concierge program, mentioned that the hospital system became interested in the model after MDVIP started expanding into the Washington, D.C., suburbs about ten years ago. Today, Inova’s program has 6,000 patients.
Cheifetz challenges the claim that concierge physician programs worsen primary care shortages. He stated that the model allows doctors who were thinking of retirement to stay in the business with a lighter caseload, and the fees amount to no more than a few dollars a day, which is about what some people spend on coffee.
He also mentioned that Inova has an excellent primary care network for those who cannot afford the concierge care, and they are still providing all the necessary primary care for those who need it.
Some hospitals are beginning concierge physician practices in locations far from their main facilities. For example, Tampa General Hospital in Florida opened a concierge practice in upper-middle-class Palm Beach Gardens, which is about a three-hour drive from Tampa. Mount Sinai Health System in New York runs a concierge physician practice in West Palm Beach.
NCH Healthcare System in Naples, Florida, employs 12 concierge physicians who treat about 3,000 patients in total. James Brinkert, regional administrator for the system, mentioned that they found a need in this community for a more personalized healthcare experience. Members pay an annual fee of at least $3,500.
NCH patients whose doctors switch to concierge and do not wish to pay the membership fee are referred to other primary care practices or to urgent care, according to Brinkert.
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