MDs building concierge, cash businesses with patient-friendly promises

From longevity to 24/7 physician access, the promises from a growing crop of concierge and direct-pay practices are not just grabbing headlines, but also the attention of an impressive clientele of patients willing to pay retainer fees out of pocket. And if a Senate bill proposing to roll back recent restrictions on HSAs and FSAs passes, the market for high-touch services, such as extended-length consultations and wellness counseling, may expand even further.

The change would come as welcome news to Drs. Michael B. Wald and Nilay Shah of Integrated Medicine in Mount Kisco, NY, who recently told Westfair Online that the strained economy has bumped the ranks of its charity care patients from 25 percent to 35 or 40 percent. Part of the reason the cash-only practice can subsidize nutritional treatment for such a large part of its patient base may be the $3,000-fee that regular customers pay for a "longevity package," which includes constant monitoring and correcting of metabolic issues that could potentially affect a patient's life span. Yet another segment of Integrated Medicine patients pay $15,000 per year for enhanced personal service, which includes around-the-clock cell phone access to Wald and Shah, as well as house calls.

Wald told the newspaper that about 95 percent of the practice's patients prepay for care, while patients might get reimbursed for approximately one-third of the group's services when filing direct claims with health plans.

Meanwhile, in Virginia, the recently opened Direct Access Internal Medicine is looking to build a hybrid concierge clinic that will ultimately serve 2,500 to 3,000 traditional patients in addition to 800 to 1,000 who would pay an annual fee of $300 to $1,650 per year, depending on age, for specialized services, including 24/7 access to Dr. Ronald Haggerty and his partner, Katherine Beamer, a board-certified family nurse practitioner.

"Our goal is to be much more accessible than the average physician," Haggerty told the Daily Press. "Usually you just don't have the time to sit down and listen to the patient, to do some research if necessary, and have a good conversation about everything that may be affecting their health. We want to be able to provide that." Both Haggerty and Beamer told the newspaper that the practice was growing slowly but steadily.

According to American Medical News, The Family and Retirement Health Investment Act of 2011, introduced by Sen. Orrin Hatch (R, Utah) in late May, would clearly allow HSAs, FSAs, and other tax-exempted accounts to be used to pay for direct primary care, concierge care, and other similar retainer care services. With confusion reigning thus far on the issue, plan administrators have been making the final expense eligibility determinations and have not reached a consensus, said Norm Wu, president and CEO of Qliance Medical Management Inc., a Seattle-based practice that offers medical homes with unlimited primary care for a monthly fee.

To learn more:
- read this article from Westfair Online
- see this piece from the Daily Press
- check out this legislation update from American Medical News

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