Well, they're back--at least for a few. A handful of medical practices now promise what most folks have been longing for since the rise of managed care. You can have an (almost) personal internist who will answer questions 24/7, 365 days a year and get immediate appointments and same-day test results. Some doctors will accompany you on visits to specialists. They even make house calls.
The catch? This white-glove boutique medicine (also called concierge care) will cost you big time. Here's how it works: You pay a participating internist an upfront annual fee ranging from $900 to $20,000. The physicians limit their practice to only a few hundred patients. That allows them to see perhaps a half-dozen a day rather than the 25 to 30 a general practitioner would routinely see in a managed-care practice. Despite the cost, these boutique practices are popping up all over the country
It's hard to know if the care is better. But patients feel better about the extra attention. Meredith and Paul Allen--Paul is CEO of a Watertown (Mass.) marketing and advertising firm--pay $7,500 a year to be patients of Personal Physicians HealthCare in Chestnut Hill, Mass. Meredith, who is struggling with a serious but still-undiagnosed health problem, jumped at the promise of more intensive, personal care. "I had a lovely doctor who was part of a standard practice," she says. "Access to her was nearly impossible, response times were slow. Concerns I had with my health were magnified because of the difficulty I had with the system."
Now, she says, internist Jordan Busch is giving her far more attention: "What Jordan has been able to do is say, `Here are the two best guys who deal with this. I've already spoken to them, give them a call.' And I get an appointment quite quickly. That's huge." Busch, who started Personal Physicians earlier this year with partner Steven Flier, says coordination of specialist care is a critical advantage. "I'm able to make sure we're all on the same page," he says.
At Personal Physicians, the cost of care is over and above the annual fee. At MD2 (pronounced "MD-squared"), the upfront fee is $20,000 for a couple. But it covers primary-care exams, tests, and procedures done in the office. And the two doctors in each of its two Seattle-area offices see no more than 50 patients each.
Can't put out that kind of money? You might be able to find a practice that charges lower fees, though you'll have to compete with more patients for the doctor's time. Physicians at Seattle Medical Associates may see 800 patients each, but they charge $15 to $75 a month, or $900 a year, depending on your age. You'll still get more attention than you would at a managed-care practice, where an internist may carry 3,000 patients.
You can use the practices along with your company health plan. While the upfront fee may not be reimbursable, office visits, tests, and the like should be. You may have out-of-network deductibles and co-payments, and you'll have to pay out of pocket for other expenses, such as exercise and nutrition consultants.
With their hefty upfront fees, boutique practices are never going to be for everyone. But the doctors who have shifted to this kind of medicine love it because they can practice without the constraints of managed care. And their patients? Paul Allen likes the idea so much he's thinking of offering to pay the annual fee as an executive perk for his senior management. By Howard Gleckman