\n\tPhil Galewitz, KFF Health News<\/span><\/p>\n

Nonprofit hospitals created largely to serve the poor are adding concierge physician practices, charging patients annual membership fees of $2,000 or more for easier access to their doctors.<\/p>\n

It\u2019s a trend that began decades ago with physician practices. Thousands of doctors have shifted to the concierge model, in which they can increase their income while decreasing their patient load.<\/p>\n

Northwestern Medicine in Chicago, Penn Medicine in Philadelphia, University Hospitals in the Cleveland area, and Baptist Health in Miami are among the large hospital systems offering concierge physician services. The fees, which can exceed $4,000 a year, are in addition to copayments, deductibles, and other charges not paid by patients\u2019 insurance plans.<\/p>\n

Critics of concierge medicine say the practice exacerbates primary care shortages, ensuring access only for the affluent, while driving up health care costs. But for tax-exempt hospitals, the financial benefits can be twofold. Concierge fees provide new revenue directly and serve as a tool to help recruit and retain physicians. Those doctors then provide lucrative referrals of their well-heeled patients to the hospitals that employ them.<\/p>\n

\u201cHospitals are attracted to physicians that offer concierge services because their patients do not come with bad debts or a need for charity care, and most of them have private insurance which pays the hospital very well,\u201d said Gerard Anderson, a hospital finance expert at Johns Hopkins University.<\/p>\n

\u201cThey are the ideal patient, from the hospitals\u2019 perspective.\u201d<\/p>\n

Concierge physicians typically limit their practices to a few hundred patients, compared with a couple of thousand for a traditional primary care doctor, so they can promise immediate access and longer visits.<\/p>\n

\u201cEvery time we see these models expand, we are contracting the availability of primary care doctors for the general population,\u201d said Jewel Mullen, associate dean for health equity at the University of Texas-Austin\u2019s Dell Medical School. The former Connecticut health commissioner said concierge doctors join large hospital systems because of the institutions\u2019 reputations, while hospitals sign up concierge physicians to ensure referrals to specialists and inpatient care. \u201cIt helps hospitals secure a bigger piece of their market,\u201d she said.<\/p>\n

Concierge physicians typically promise same-day or next-day appointments. Many provide patients their mobile phone number.<\/p>\n

Aaron Klein, who oversees the concierge physician practices at Baptist Health, said the program was initially intended to serve donors.<\/p>\n

\u201cHigh-end donors wanted to make sure they have doctors to care for them,\u201d he said.<\/p>\n

Baptist opened its concierge program in 2019 and now has three practices across South Florida, where patients pay $2,500 a year.<\/p>\n

\u201cMy philosophy is: It\u2019s better to give world-class care to a few hundred patients rather than provide inadequate care to a few thousand patients,\u201d Klein said.<\/p>\n

Concierge physician practices started more than 20 years ago, mainly in upscale areas such as Boca Raton, Florida, and La Jolla, California. They catered mostly to wealthy retirees willing to pay extra for better physician access. Some of the first physician practices to enter the business were backed by private equity firms.<\/p>\n

One of the largest, Boca Raton-based MDVIP, has more than 1,100 physicians and more than 390,000 patients. It was started in 2000, and since 2014 private equity firms have owned a majority stake in the company.<\/p>\n

Some concierge physicians say their more attentive care means healthier patients. A study published last year by researchers at the University of California-Berkeley and University of Pennsylvania found no impact on mortality rates. What the study did find: higher costs.<\/p>\n

Using Medicare claims data, the researchers found that concierge medicine enrollment corresponded with a 30%-50% increase in total health care spending by patients.<\/p>\n

For hospitals, \u201cthis is an extension of them consolidating the market,\u201d said Adam Leive, a study co-author and an assistant professor of public policy at UC Berkeley. Inova Health Care Services in Fairfax, Virginia, one of the state\u2019s largest tax-exempt hospital chains, employs 18 concierge doctors, who each handle no more than 400 patients. Those patients pay $2,200 a year for the privilege.<\/p>\n

George Salem, 70, of McLean, Virginia, has been a patient in Inova\u2019s concierge practice for several years along with his wife. Earlier this year he slammed his finger in a hotel door, he said. As soon as he got home, he called his physician, who saw him immediately and stitched up the wound. He said he sees his doctor about 10 to 12 times a year.<\/p>\n

\u201cI loved my internist before, but it was impossible to get to see him,\u201d Salem said. Immediate access to his doctor \u201cvery much gives me peace of mind,\u201d he said.<\/p>\n

Craig Cheifetz, a vice president at Inova who oversees the concierge program, said the hospital system took interest in the model after MDVIP began moving aggressively into the Washington, D.C., suburbs about a decade ago. Today, Inova\u2019s program has 6,000 patients.<\/p>\n

Cheifetz disputes the charge that concierge physician programs exacerbate primary care shortages. The model keeps doctors who were considering retiring early in the business with a lighter caseload, he said. And the fees amount to no more than a few dollars a day \u2014 about what some people spend on coffee, he said.<\/p>\n

\u201cInova has an incredible primary care network for those who can\u2019t afford the concierge care,\u201d he said. \u201cWe are still providing all that is necessary in primary care for those who need it.\u201d<\/p>\n

Some hospitals are starting concierge physician practices far from their home locations. For example, Tampa General Hospital in Florida last year opened a concierge practice in upper-middle-class Palm Beach Gardens, a roughly three-hour drive from Tampa. Mount Sinai Health System in New York runs a concierge physician practice in West Palm Beach.<\/p>\n

NCH Healthcare System in Naples, Florida, employs 12 concierge physicians who treat about 3,000 patients total. \u201cWe found a need in this community for those who wanted a more personalized health care experience,\u201d said James Brinkert, regional administrator for the system. Members pay an annual fee of at least $3,500.<\/p>\n

NCH patients whose doctors convert to concierge and who don\u2019t want to pay the membership fee are referred to other primary care practices or to urgent care, Brinkert said.<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

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