Incorporating Concierge Medicine into Pain Management
An interview with Christopher Ewin, MD, President and Founder of 121MD in Fort Worth, Texas, Elmer G. Pinzon, MD, MPH, Medical Director at University Spine & Sports Specialists, Knoxville, Tennessee, and Michael Tetreault, Editor-in-Chief of Concierge Medicine Today and The Direct Primary Care Journal.
Q: What is concierge medicine and what are the varying types of concierge medicine business models that are in use?
Dr. Pinzon: Concierge medicine is an emerging form of practice in which private health professionals are expanding out beyond the fixed insurance model of medicine. Because of the restrictive nature of insurance companies, these companies are not always able to cover newer, more novel approaches that are not considered mainstream medicine. It can take a long time for research to be recognized and covered by health insurance companies; some patients don’t want to wait that long.
Concierge medicine models allow patients to pursue other options that their insurance plans will not cover—such as regenerative medicine, prolotherapy, acupuncture, and nutritional approaches.
I practice musculoskeletal medicine and physical medicine and rehabilitation, and have patients who are willing to pay for certain procedures not covered by their insurance, such as interventional spine procedures and ultrasound-guided musculoskeletal injections in the knee, shoulder, and other joints. I am able to incorporate these interventions into my practice using concierge medicine.
In addition to physician-based models, psychological, nutritional, and exercise-based models of concierge medicine exist. Or you can have a practice that offers a continuum of models.
Mr. Tetreault: Although concierge medicine started out as a concept for the affluent nearly 20 years ago, over time, the movement has taken a clearly middle-class turn. Today, we can see impressions of old-fashioned medical care, in which a doctor will see you the same day you make an appointment, no questions asked, or carries a medical bag into your home, or even visits you when you’re in the hospital because … it’s simply the best way to provide care for the patient at that time.
Moreover, there are more people searching for these types of doctors every day. From the mid 1990s to present day, concierge medicine has matured into countless service variations within our local communities. Annual fees today reflect the level of personal attention and service that a doctor provides, and patients are deciding to make a personal investment in their own health care.
The overwhelming benefits of concierge medicine can be summed up in 2 words: time and transparency. Concierge medicine typically is understood to be a transparent, cost-
effective relationship between a patient and physician in which the patient pays an annual fee or retainer. All concierge doctors generally claim to be accessible via telephone or email at any time of day or night or offer some other service above and beyond customary care. While all concierge medicine practices share similarities, they vary widely in their service offerings, payment requirements, costs and forms of operation.
It is estimated that there are between 6,000 and 12,000 concierge medicine doctors operating in primary care, family medicine, and specialty practices across the country, according to surveys conducted by Concierge Medicine Today. Their surveys show that annual fees at most concierge medicine practices vary nationally from $101 to $225 per month, but fees usually are billed annually.
Although many concierge doctors also accept and/or participate in insurance and/or Medicare, concierge medicine fees are for services that are not covered by Medicare or patients’ insurance. What also is fundamental to the various clinics operating a concierge medicine practice across the country is that patients decide to make a personal investment in their own health care. This is a relationship-based service, not a transactional service.
Q: Which patients are best served under the concierge medicine model of care?
Dr. Pinzon: It really depends. The majority of patients in my practice under the concierge medicine plan tend to be more demanding in terms of their type of care. They understand that their private insurance companies are not going to cover the services they want, and they are tired of fighting their insurance companies to obtain services.
It may take weeks, and in some cases months, to get a response from insurance companies on whether a service is covered. And in some cases, we know that an insurance company is not going to approve coverage because the service is not included in evidence-based guidelines. So we offer patients another way to receive those non-covered services.
Mr. Tetreault: Concierge medicine patients tend to skew upper middle class, with typical household earnings between $125,000 and $250,000 per year (Table). They also tend to be Baby Boomers, generally in their 50s to 80s. From a psychology perspective, this age group makes buying decisions based on brand loyalty and brand enhancement. They want to know that that doctor is up-to-date on the current research and current tests, and strives to help his or her patients be healthier.
Q: When did you start offering concierge medicine and how has it benefitted your practice?
Dr. Ewin: I do not consider my practice a concierge practice. I consider it a direct primary care (DPC) practice, whereby I work for my patients and not for the insurance companies. I started my DPC practice in January 2003. Previously, I had more than 4,000 patients—today that number has dropped to 400 patients. The benefit has been being able to spend more time with my patients and really listening. I consider my patients to be like family and I have more time to care for their needs. I am practicing old-school family medicine, which is why I became a physician. More importantly, it’s all about the patient. They benefit by having timely access to care with their trusted physician.
Dr. Pinzon: I have been in private practice since 2008. The practice I worked for prior to that was an orthopedic multispecialty-type practice, where some of the younger orthopedists started offering concierge medicine options. I got the idea from these orthopedists, and over the past 5 years started dabbling into the concierge medicine option in my own private practice.
Q: How does payment provided under concierge medicine plans work in your office?
Dr. Ewin: I use a fee-for-care model—no private insurance. I am on retainer and have regular office hours like any family practice. For a monthly fee, patients are given prompt access to office-based services and telephone conferences. After hours, people can contact me if their needs are urgent.