More doctors turn to fee-based ‘concierge medicine’ to ease insurance woes

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Working as a hospital doctor, Guy Delorefice used to see 40–50 patients a day. Feeling pressured, overworked and not spending enough time with family, last year Delorefice started practicing concierge medicine, charging a yearly fee for access to his services.

He now sees eight–12 patients a day.

“Life was passing me by,” said Delorefice, whose practice is in Sonoma. “I knew I had to make a change.”

The only insurance Delorefice takes is Medicare. He doesn’t have the worry or overhead for billing various insurance companies or wonder who is going to pay him and when. He also gets to know his patients personally.

“It’s very freeing to be insulated from the medical and insurance industries,” he said.

While we normally think of celebrity-type patients who pay thousands of dollars a month for lavish treatment, the concierge medicine model takes many forms, and is increasingly available to more people.

Patients get more face-time with the doctor, can make same-day appointments or reach their doctor by phone. Delorefice gives his patients his cell phone number.

Cost for concierge service varies. Of the estimated 5,500 concierge practices nationwide, about two-thirds charge less than $135 a month on average, up from 49 percent in 2014, according to Concierge Medicine Today, a trade publication that also runs a research collective for the industry.

The practices are adding offices at a rate of about 25 percent a year, according to the American Academy of Private Physicians.

“The concierge model is pretty simple,” said Ellen Barnett, M.D., co-founder of Integrative Medical Clinic of Santa Rosa. “Get rid of all that overhead, charge people and see who comes. It’s a nice model, and I think it’s appropriate for a lot of patients.”

Her clinic has been operating for 15 years. It started offering concierge service as an option about 10 years ago. The service is a small part of what they do, with about 30 patients or families members out of about 2,000 active patients.

The cost for the service at the clinic is about $1,400 a year for individuals, $1,600 for couples. How much to charge is kind of arbitrary, Barnett said. It’s roughly based on the cost of one visit per month, or about $110.

The clinic takes Medicare as well and is a “very patient-centered practice.” The motivation for Barnett to offer this kind of service was to meet all her patients’ needs, which often includes phone visits.

But Medicare doesn’t reimburse for phone visits, which is unfortunate, Barnett said.

“Because so much of medicine could be done by phone. In many cases it’s perfectly safe and appropriate medical care to do it over the phone,” she said.

Some families with elderly members want unencumbered access to talk about concerns they have for them.

“Some people use it all the time, and other people don’t ever use it, so we figure [the price] comes out in the wash,” Barnett said. “Some people just like the idea they can call me any time and talk with me. It’s also good for certain people who have very complicated medical situations. Mostly, I’d say it’s just an extra level of security that they feel.”

Concierge medicine is something people usually have on top of their regular insurance. It doesn’t cover other treatments like MRIs or surgery.

Delorefice has been practicing medicine in Sonoma since 1999 and has built relationships with other doctors. When one of his patients needs a referral, he said he facilitates the request himself.

There are cases where people would like the service but can’t afford it.

“The problem with [concierge medicine] is it’s a select group of patients that can afford it,” Barnett said. “We didn’t want to limit our practice only to that group of patients. We felt very strongly that we wanted to be Medicare providers, so those patients could have access our services. Of course we’d like to offer it to more people.

“It’s funny, some people just think it’s a crazy amount of money for what they’re getting, and other people think, ‘Really? That’s all?’ People have different takes on it, around whatever is important to them.”

Barnett got interested when she started seeing concierge services appear in medical literature about 10 years ago. At that time, additional reporting requirements to participate in Medicare were introduced. Doctors also were being pressured to move toward implementing electronic medical records. This became prohibitive for many small practices, Barnett said, and seemed to coincide with the rise of the concierge movement.

“Things got pretty crazy,” she said. “The reimbursement for primary care hasn’t increased in 20 years and has gone down in many situations, but our costs have gone up.”

So what do you do in that situation?

“In a regular physician’s office, you figure, how much money are you spending on billing for insurance?” she asked. “The question is can you have a smaller practice, offer more personal service… and still make it economically? [Concierge medicine] is another creative way to look at how you run your practice.”

After the hospitalist medical group, Delorefice was working with was bought out by a large national company in 2014, he subsequently had an opportunity to take over another physician’s concierge practice and took it.

He previously had about 2,000 patients. His goal now is to grow to about 300.

Some doctors are practicing it individually, while others are joining concierge networks, such as MDVIP, Signature MD or Paragon.

“We go to medical school; we don’t know anything about business,” Barnett said. “That’s why so many people go to the big organizations because they handle [the business side] for them. We like our independence but business is nothing we’re trained in.”

Cynthia Sweeney covers health care, hospitality, residential real estate, education, employment and business insurance. Reach her at or call 707-521-4259.

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