Concierge medicine gaining ground: competition forces medical center into 'boutique' business - Innovation

Physician Executive, Sept-Oct, 2002 by John Kirkpatrick

MUCH IS BEING WRITTEN and said these days about concierge medicine.

Also described in the media as "boutique," "retainer," "platinum," "gold-plated," "premium," "old-style," "Main Street" and more recently, "luxury primary care," (1) the concept generates considerable debate.

At issue are patients' rights to purchase more time and attention from their physicians, the physicians' moral and ethical obligation to treat all patients, and the potential emergence of a two-tiered, and some say multi-tiered, (2) health care delivery system.

But in today's health care climate, can large health care organizations afford not to seriously examine the social and economic potential of this type of practice?

Two Seattle general internists established the first concierge practice in 1996. Similar private practices now exist in Florida, Massachusetts and California, and are planned in many other states.

Large medical centers avoided this practice model, choosing instead to offer patron patients luxury hospital suites that provide specially prepared meals and other amenities. VIP patients are often given prompt side-door access at the request of the CEO's office or foundation.

Competition in Seattle

Initially, Virginia Mason Medical Center in Seattle, where I have practiced for 25 years, chose not to participate in concierge medicine, as well. Then, three years ago, a number of dedicated benefactor patients quietly departed and the idea gained new respect. Competition played a part.

Two popular, local internists had opened the original concierge practice just two blocks from the doors of our medical center. Like other large cities, Seattle had experienced the usual turf battles for patient loyalty over the years, with "quality" topping everyone's list of potential advantages. No organization easily and consistently differentiated itself.

But this threat was different. Our patron patients were hearing from friends who joined the new practice that service now meant 24/7 cell phone access to their doctor, who actually answered his own phone. The doctor made house calls and business office calls, had time for longer appointments and paid more attention to their questions and requests.

Suddenly the common buzzwords "access," "patient-centered" and "quality" took on an entirely different meaning. Some of my long-term patients apologetically left my practice, often with a note claiming, "Dr. K, it's nothing against you personally, but the service in your medical center just isn't what it is at _____."

After responding to one too many requests to forward a patient's medical records and after hearing legendary tales about the service these docs provided, it became clear that we had a significant problem.

However unappealing the idea of charging patients premium prices for extra time and attention was our medical center could not afford to lose so many of its most devoted patrons, especially when achieving a positive bottom line was an increasing challenge.

Getting our organization to approve concierge care seemed an onerous task to many and nearly impossible to most. But with the aggressive help of some committed and loyal patients, the endorsement of a retired Virginia Mason administrator with a national reputation, and the support of both our CEO and president, a year-long debate over the relative risks and merits of such a program finally concluded with the decision to move forward to establish the first premium service program within a major medical center.

Concierge arrives

Our program began in January of 2000 with two primary care internists, two capable nurses and a talented medical assistant. Nearly three years later, our program is thriving.

We have achieved a rare win-win-win feat, satisfying patients, physicians, staff and our medical center leadership. Patients are happy with the 24/7 phone access and appreciate the service package we offer that includes:

* Same-day appointments

* Longer appointments

* Housecalls

* Business office calls

Our patients get more time and attention from a less harried physician and a staff with the time to help. The staff appreciates the benefits of supporting fewer patients. They feel less stressed and enjoy greater flexibility and more autonomy, taking pride in giving truly personalized attention to each patient as he or she walks into the clinic.

Gone is the need to apologize to patients for lengthy waits, delays and the incomplete or unintentional miscommunication inherent to overloaded systems.

Communication in all areas is enhanced.

Physician pay-off

Participating physicians are equally enthusiastic. They are able to spend more time with each patient in their panel, with less production pressure and reduced paperwork. And they are experiencing the old-fashioned joys of house calls.

Physicians also report unanticipated educational opportunities as they accompany patients to specialist appointments and procedures and they are finding more time to keep up with medical journals.