The Affordable Care Act has left hospitals short on doctors and waiting room chairs. As the newly-insured queue for healthcare, some patients are shelling out thousands to skip the line. Hospitals are increasingly catering to more affluent patients, but some physicians wonder whether this is ethical, or even effective.
Concierge medicine has been a hot topic over the last few months. In this healthcare model, patients pay a fee for 24/7 access to a personal doctor, including same-day appointments and streamlined referral services. Private concierge practice is booming in the United States, having increased from between 2,400 and 5,000 practices in 2010 to 12,000 in 2014.
To stay competitive, hospitals are bolstering their own concierge medicine programs. DukeHeath’s Signature Care advertises “unparalleled convenience,” Mayo Clinic’s Medallion Program markets “a serene, unhurried atmosphere,” and Virgina Mason Concierge Medicine promotes a “waiting room with no waiting.”
“When we’re talking about primary care physicians in private practice, I think concierge medicine is a very good system,” said James Dalen, former Dean of the College of Medicine at the University of Arizona. “In hospitals, I don’t think it’s a good idea.”
Physicians like Dalen feel that concierge programs could sap resources from ordinary hospital patients—clashing with the standard hospital mission to provide equitable care for all.
Hospital concierge memberships run between $2,500 and $6,000 a year. Programs employ a handful of doctors, each of whom is responsible for about 300 patients, as opposed to the usual average of 2,500 patients. Concierge programs claim physicians with fewer patients can practice at their own pace, deliver more conscientious treatment and address preventative care.
“I think the best part of it is the one-on-one physician communication—bringing back the personal touch both for the patient and the physician involved in their care,” Sanziana Roman, a Duke Signature Care physician, told The Chronicle at Duke.
Hospitals have adopted concierge medicine under the banner of personalized care. On the business end of things, they institute these programs to improve their bottom line.
“Patients are expecting more convenient care and more responsive physicians,” wrote William Shrank, Chief Medical Officer at the University of Pittsburg Medical Center, online in the Journal of General Internal Medicine in Feb. 2017. “The marketplace is adapting to meet the needs of consumers.”
Offering concierge programs helps hospitals retain patients that might turn to private practice and keep their money flowing into the system. Often, money from this affluent population is funneled back into other programs.
“We are not doing this just to make more money—we are doing this to make money to put back into the mission of the hospital,” said Paul Huang, Massachusetts General Hospital concierge physician, in Modern Healthcare.
Despite their theoretical advantages, hospital concierge programs have not been formally assessed. There are no studies comparing their outcomes to standard care, nor is there proof they don’t deprive “normal” patients of vital resources.
“If you’re paying more for personalized care, do you get the better doctors? That’s the implication, and once you get into that, it’s a slippery slope,” Dalen said. “If one group gets better care than the other, that means one group gets inferior care.”
Paradoxically, another concern is that concierge patients may receive worse care. Physicians at hospitals with VIP services feel pressured by hospital staff, VIP patients and their family members to perform unnecessary testing and treatment, according to a study in March’s Journal of Hospital Medicine.
“There is a risk that patients that are paying extra, out-of-pocket, for a higher level of service, will have greater expectations that their requests will be satisfied,” said Shrank.
MDVIP, America’s largest concierge medicine service with over 280,000 members, opened two new practices just this month. In face of this relentlessly growing force, more and more hospitals will offer concierge memberships. It is time to assess whether these programs are ethical, effective and worth their price tag.