Concierge care gains appeal as providers face lower payments, more patients

The influx of newly insured patients due to the Affordable Care Act--and the associated limits on reimbursements--are leading some providers to switch from conventional insurance to "concierge" practices, according to an opinion column by David Lazarus in the Los Angeles Times.

Under such a system, doctors and providers can see fewer patients and maximize those patients' value with annual fees for comprehensive treatment, which are separate from their medical costs.

"As a doctor, I might feel a pang of guilt about making a change like this," Dike Drummond, M.D., who runs a Seattle company focused on reducing physician burnout, told the Times. "But it's my life, and I want to practice medicine the best way I know how."

Jeffrey Helfenstein, M.D., a Beverly Hills-based cardiologist, said he considered switching to a concierge practice or total cash fee for service, but decided instead to charge patients an annual office fee of $350 to offset whatever insurers won't cover, such as additional paperwork or phone communication, according to the article.

Critics of switching to the concierge care system say it leaves patients who can't afford the upgrade to contend with long waits and overwhelmed providers. "I don't begrudge doctors and hospital execs for trying to maintain the income levels to which they've grown accustomed. But at some point, they're going to have to be part of the solution and not part of the problem," wrote Lazarus. "Americans already pay more for healthcare than anyone else in the world. Hitting patients up for even more money isn't just counterproductive--it's offensive."

Other providers are looking into other avenues to make up their shortfall, according to the article. UCLA Medical Center's Division of Geriatrics, for example, recently solicited charitable donations. "With federal research dollars and state funding more and more scarce and an aging population, philanthropic support is crucial to fulfilling our mission," said David Reuben, M.D., head of the division.

An increase in patients does not necessarily temper healthcare providers' financial struggles. Several Indiana hospitals announced job cuts late last year despite more insured patients, due to cuts to Medicare reimbursements and disproportionate share hospital (DSH) payments, FierceHealthcare previously reported.

To learn more:
- read the opinion piece

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.