Physicians in retainer (“Concierge”) practice
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BACKGROUND: Retainer practices represent a new model of care whereby physicians charge an up-front fee for services that may not be covered by health insurance. The characteristics of these practices are largely unknown.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional mail survey of 144 retainer physicians (58% response rate) and a national random sample of 463 nonretainer physicians (50% response rate) to compare retainer and nonretainer practices. Outcomes of interest included physician demographics, size and case-mix of patient panel, services offered and, for retainer practices, characteristics of practice development.
RESULTS: Retainer physicians have much smaller patient panels (mean 898 vs 2303 patients, P<.0001) than their nonretainer counterparts, and care for fewer African-American (mean 7% vs 16%, P<.002), Hispanic (4% vs 14%, P<.001), or Medicaid (5% vs 15%, P<.001) patients. Physicians in retainer practices are more likely to offer accompanied specialist visits (30% vs 1%), house calls (63% vs 26%), 24-hour direct physician access (91% vs 40%), and several other services (all P values <.05). Most retainer physicians (85%) converted from nonretainer practices but kept few of their former patients (mean 12%). Most retainer physicians (84%) provide charity care and many continue to see some patients (mean 17%) who do not pay retainer fees.
CONCLUSIONS: Despite differences between retainer and nonretainer practices, there is also substantial overlap in services provided. These findings, in conjunction with the scope of patient discontinuity when physicians transition to retainer practice, suggest that ethical and legal debates about the standing of these practices will endure.
Key Wordsaccess to care retainer concierge boutique ethics
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- 1.Carey B. A visit with Dr. Delux: red-carpet treatment can be had for a price, but is “boutique” worth it? Los Angeles Times. July 22, 2002.Google Scholar
- 2.Retainer practices. Report of the council on ethical and judicial affairs. American Medical Association. 2004; Report 3-A-03.Google Scholar
- 4.American Society of Concierge Physicians. Available at: http://www.concierg.physicians.org. Accessed September 27, 2004.Google Scholar
- 6.Reinhardt UE. The emergence of “boutique medicine.” BMJ. 2003;327:129E.Google Scholar
- 7.Alert warns of Medicare conflict for concierge practices. American Medical News. April 19, 2004:1, 2.Google Scholar
- 8.Boutique care goes mainstream. American Medical News. August 4, 2003:26, 27.Google Scholar
- 9.GAO: Boutique hospitals treat healthier patients. American Medical News. July 16, 2003:10, 12.Google Scholar
- 10.Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.Google Scholar
- 13.Japsen B. Doctors on Retainer: Less Waiting, Less Fairness? Chicago Tribune. October 5, 2003.Google Scholar
- 14.Flocke SA, Stange KC, Zyzanski SJ. The impact of insurance type and forced discontinuity on the delivery of primary care. J Fam Prac. 1997;45:129–35.Google Scholar
- 16.Adams D. Conn. ob-gyn group delivers surcharge to offset liability pain. American Medical News. June 14, 2004:1, 2.Google Scholar
- 17.Japsen B. Doctors give extra fees a shot. Chicago Tribune. September 16, 2003;section 3, 1, 4.Google Scholar
- 18.Mays G, Claxton G, Strunk B. Tiered provider networks: patients face cost-choice trade-offs. Issue Brief #71. Center for Studying Health Systems Change. November 2003.Google Scholar