Back in the good old days, the family doctor could be reached anytime, day or night, and often visited sick patients in their own homes. Well, those days are long gone, as we all know. A trip to the doctor now involves an often hard-to-get appointment, a long stop in the waiting room, insurance forms, co-payments—all for a quick 10-minute consultation.
The situation is frustrating for all parties, and some doctors are cutting ties with insurance companies and slashing their patient loads in an effort to recreate the “good old days” of medicine. It’s a movement called retainer-based medicine—or concierge medicine—and more doctors, and their patients, are opting in.
Dr. Wes Wylie practices in Provo and is affiliated with ModernMed, Inc., a national retainer-based medicine company. Wylie’s patients pay a monthly fee and in return receive quick appointments with no waiting time, access to the doctor’s cell phone and email address, and even home visits on occasion.
Dennis Chambon, a patient of Wylie, says he can usually reach the doctor by phone in five minutes. “It isn’t his assistant who answers. I always talk to the doctor,” says Chambon, who owns Vertec Tools, Inc. Chambon, a patient for two years now, has phoned Wylie about two dozen times. When he arrives for an appointment, there is no waiting time.
“While my ModernMed membership is an extra expense that some people would consider a luxury, I wanted to have ready access to the best doctor, and I feel I’ve accomplished that,” says Chambon “My confidence in him is the greatest thing, and my insurance pays for everything he prescribes.”
Dr. Jami Doucette, CEO of ModernMed, explains that within the retainer-based medicine concept, patients have a more direct financial relationship with their physicians than they do within the regular insurance model. Patients pay a monthly, quarterly or annual fee for services the physician provides.
At ModernMed, Doucette says that a patient pays about $125 per month to subscribe. “It’s about $4.19 a day—less than a cable bill and about the same price as drinking Starbucks coffee regularly. We feel it is affordable for almost everybody who cares about their health and well-being.”
In return for the payment, patients receive “24/7 access to their physician’s cell phone and email, same day/next day appointment guarantees and no waiting in the waiting room. Many such practices don’t even need to have a waiting room,” says Doucette. Retainer-based patients also receive house calls or workplace visits, total care coordination and an annual executive physical with lab work. “That physical sets the tone for the next year to help the physician and patient as a team,” says Doucette.
Some physicians may be turning to retainer-based medicine, but it is not a model that most practitioners have adopted, says Michelle McOmber, CEO of the Utah Medical Association. “Most Americans utilize health insurance or are covered by a government plan if they qualify for it. Within the typical insurance model, a care provider gives care to a patient and a third party pays for most or all of it,” she says. “Within the retainer-based model, the provider and patient make arrangements without the insurance company in between.”
McOmber says that such a practice allows a physician to spend more time with the patient and be more accessible on a daily basis, depending on how they structure the fee-based model and how many patients they take. Additionally, the concept “puts the care back into the hands of the patient and physician,” removing the third-party insurance company from healthcare decisions.
The traditional insurance model is a volume-based incentive model, where physicians get paid based on the number of patients they see or the number of procedures they do. “This incentive is not in the best interests of the patient or the physician,” says Doucette.
Because retainer-based physicians typically see about eight patients a day, compared to the 20 to 30 patients a day in traditional practices, more time can be spent addressing patients’ needs and concerns. “There is more focus on prevention, wellness, early detection and chronic disease management along with the episodic sick care,” says Doucette. This enables the physician to provide higher-quality care in terms of early detection and chronic disease management.
Doucette explains that the retainer model “is a quality-based incentive model where physicians have the incentive to provide the appropriate amount of care with incredible customer service in an effort to retain the patients in the practice.” He adds, “In some aspects, it is a return to old-fashioned medicine, where the physicians had time to develop very strong relationships with the family and the patient.”
However, McOmber clarifies that retainer-based medicine is normally primary care or well care. “It usually covers things that are routine. The specialty side—with conditions such as heart disease or surgery—doesn’t necessarily fit in with what you are paying for in maintenance services. Patients still need insurance for hospitalizations, big tests, surgeries and specialists.”
Doucette agrees that membership in retainer-based medicine does not replace the need for insurance, and adds that most members subscribe to retainer-based medicine and also purchase health insurance. He himself maintains a $5,000 deductible on his insurance and pays for his retainer-based medicine membership with a health savings account. “I am paying less for my premium and membership than I would pay if I had a $2,500 deductible.” He says that ModernMed’s physicians will coordinate care with a cardiologist or specialist, “and once the patient is in the hospital, their insurance kicks in.”
While retainer-based medicine is emerging as a trend, McOmber isn’t sure that it will work for most people—particularly as the ultimate effects of health reform are still unclear. “Some physicians could make a living doing [retainer-based medicine] and decide they are tired of all the paperwork, regulation, insurance companies and government, and it just comes down to the care,” she says.
While health reform is still an unknown, Doucette says, “There are a couple of different retainer models and they fit very nicely into reform as it stands right now. It is difficult to know, however, exactly what will be implemented given the back and forth in Washington.”
Dr. David N. Sundwall, who served as executive director of the Utah State Department of Health from 2005 to 2010 and is currently a professor of public health at the University of Utah School of Medicine, views retainer-based medicine as a legitimate, if somewhat elitist, attempt on the part of some doctors and providers to streamline the current process and provide more personal care to patients who are willing—and able—to pay for it.
From a public policy perspective, Sundwall has mixed feelings about retainer-based healthcare. While it does have benefits for patients and physicians alike, “My frustration is that these concierge systems only see those people with means and do not participate in care for the poor,” he says.
“We in public health are trying to get doctors to participate in Medicaid for the poor and Medicare for the elderly. But that doesn’t pay as well as traditional insurance. As a public health official, I worked hard to get doctors to see Medicaid and Medicare patients, because it is absolutely critical for people to have access to timely healthcare,” says Sundwall. But retainer-based medicine simply leaves those patients behind.
“I understand its appeal to patients and physicians. Ideally, it allows the doctor to treat the patient as a person, to have enough time and be compensated adequately for what they need,” he says. However, “it is kind of an elitist sort of thing, because it [only] benefits the doctors and people who can afford to pay.”
On the other hand, Sundwall says he is not opposed to retainer-based medicine and views it as a legitimate response to a healthcare system that has become “clogged up with paperwork and regulations…a complicated, complex and costly system.”
Doucette agrees and adds that retainer-based medicine actually creates healthcare consumers who are better informed about the true cost of care. “The current system is pretty convoluted. The patient pays a premium to an insurance company who acts as an intermediary, and the true cost is lost to the patient.” Because of the direct financial relationship between the patient and physician within the retainer-based practice, “patients end up being true consumers and customers of healthcare.”