The Rise of Concierge-Style Medicine

Concierge and direct primary care medicine appeal to patients who seek personalized attention.



   Do you have a nagging sore throat? How about your sudden case of hives? What do the results of this blood test mean? Do you need to talk at length to a medical professional about your sinus infection, arthritis or any other health concerns that are worrying you?

   Imagine a world where you have quick access to the primary care doctor of your choice, and he or she knows you on a deep, personal level. They grow to become an invaluable part of your life and know your medical needs and concerns inside and out.

   To some people in the metro area, that world is already here  — or rather, here again, reviving the idea of the family doctor who may also make house calls — and growing.

   It comes in the form of concierge medicine and its younger and emerging cousin, direct primary care, or DPC. Though they are different and can vary widely in their structure and payment requirements, these health-care delivery systems are often referred to interchangeably because both are cash-based in exchange for personalized medical attention.

   “When I’m done with a physical, I know the patients so well that when they call me, I can help them out,” says Dr. Michael Monaco, whose concierge medical practice at Menorah Medical Center in Overland Park is so popular that he basically has stopped taking new patients. “I can usually deal with the problem off the top of my head and take care of my patients instantly because I know them personally.”

   At their core, both systems provide patients with prolonged visits with their doctor because the physicians see much fewer patients than traditional medical practices. In a typical primary care office, a doctor has 3,000 to 5,000 patients, whereas a typical concierge practice has 600 or fewer patients per physician, and a direct-care physician has less than 1,000, according to the Direct Primary Care Consumer Guide: Closing the Gap between Your Doctor, Your Health & Your Wallet, by Michael Tetreault and Catherine Sykes, who also edit The Direct Primary Care Journal, an independent trade journal and online news reporting publication that covers the DCP industry.

   Basically, in direct primary care (DPC), patients pay a monthly fee and can opt out at any time. In concierge medicine, patients pay an annual fee or retainer, which may or may not be in addition to other charges. Generally, direct primary care physicians opt out of insurance plans, whereas concierge physicians accept them.

   Depending on the practice, direct primary care costs for one person typically range from $100 a month or less, whereas concierge medicine ranges in cost from $1,200 to $3,000 yearly, according to Tetreault.

   Direct primary care practices don’t accept insurance because of their belief that third-party insurance middlemen get in the way of patient care.  

   “When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town,” Tetreault writes. “It’d be strange from him to say, ‘What kind of insurance does Opie have?’”

   DPC works with insurance carriers to co-create blended plans that integrate direct primary care with high-deductible insurance. Patients are urged to carry at least major medical health insurance that covers catastrophic illness or injury.

   On the other hand, the majority of patients using concierge doctors already possess health insurance. Their doctors may continue to bill Medicare and private insurance companies as part of their fee. The retainer can be spread out and is a supplement for those services not covered by Medicare or private insurance.

   Doctors in both concierge and direct-care practices provide routine care as well as ongoing maintenance, such as checkups. House calls may or may not be offered. Physicians refer patients to specialists, hospitals or emergency care within a desired network.

   “We get you through the door with access; we keep you through the relationship. We have the time to cultivate a relationship with the patient that you don’t get with traditional medicine,” says Dr. Mark Holcomb, who opened Choice Physicians Group in Overland Park within the last year. His DCP practice offers unlimited access and significant discounts on many prescription drugs, routine labs and X-rays. A former emergency-room physician for some 30 years, Holcomb relishes the relationships he develops with his patients. He hopes to grow his current patient load of 60 to 600.

   “I do this because I love it,” he says. “I don’t do this because I have to.”

     His monthly fee structure ranges from $25 for those under 19 years of age, $50 for those ages 20 to 50, $75 for those ages 51 to 64, and $100 for those older than 65. He charges $150 monthly for families.

   Elizabeth Collins, 36, of Atchison, Kansas, appreciates that for $150 monthly, Holcomb treats her, her husband and their five children ranging in age from 4 to 13. She loves the convenience of being able to see him any time she needs to.

For example, she recalls the time when her daughter had a bad ear infection on a Sunday afternoon. She called Holcomb and described her daughter’s symptoms with him through a video conference with her daughter. Within an hour, Collins had prescription medicine.

   “Instead of having a horrible, miserable night, by the next morning she was much better,” Collins says about her daughter. “It’s really, really nice to have a doctor who is just committed to me and my family. I don’t feel like I’m a bother. He’s always happy to hear me call, and it’s nice.

     Susan Jacobs, 45, of Stilwell, Kansas, also loves the convenience factor for her family of five. She and her husband’s three children range in age from 10 to 20. Admittedly, they have no major health-care issues.

   “I’ve known Dr. Mark for a long time, and when he opened I thought this is perfect for my family because we’re busy, and I just love the ease of it,” she says.

   She realizes this way of thinking about primary care is scary for some people.

   “I don’t think a lot of people understand that a lot of the money that we’re paying for health insurance, a lot of it is just to shuffle paper,” she says. “We’re paying for the insurance company to process all this stuff. If you take that fact out of it, there’s no reason why our health care cannot be affordable to the everyday person.”

   Holcomb acknowledges that DPC might not work for those with chronic or major illness. “We’re not the answer for everyone and everything, but we are an answer for a whole bunch of folks out there,” he says.

   Monaco’s concierge practice is offered through MDVIP, the nation’s largest concierge medicine practice. The annual membership fee of $1,650 to $1,800 breaks down to $137 to $150 a month or $4 to $5 a day and can be paid quarterly, semiannually or annually. Five MDVIP-affiliated physicians are located in the Kansas City area, including one in Lawrence. A sixth physician is opening a practice this month.

   Monaco recently celebrated the fifth anniversary of Hearts and Soles, a walking group he participates in with about a dozen of his patients. They walk for an hour every Tuesday at Menorah Medical Center. He’s been known to give medical advice during the walks.

   The joy of concierge medicine is the personalized care he is able to provide, Monaco says in a telephone interview, just after he spent three hours — 90 minutes each — with a couple in their 80s.

   “To me it’s very rewarding as an internal medicine doctor to have challenging patients and to have the time to be able to take care of all the issues,” he says. “It’s been a very gratifying practice. This is great medicine.”

   Pat Teegarden, 72, of Overland Park, has been a patient of Monaco’s for some 25 years, including when Monaco switched to a concierge practice in 2009.  Because Monaco was on top of her medical needs, she says she scheduled a routine colonoscopy last year at his advice. When the results came back, she discovered she had early-stage colon cancer. However, it was caught so early that she did not have to have extensive surgery or chemotherapy.

   “I was lucky,” she says, adding that it is worth every penny to have a health advocate who answers when she calls or texts and schedules appointments within the same day or the very next day. She appreciated the fact that Monaco coordinated with her specialists in the hospital about her care.

   Concierge medicine does have its detractors, with some arguing that it favors those who can afford to pay for such specialized care. But Monaco’s rebuttal answer is you can’t put a price on your health.

   “I can tell you that if you look at the demographics of the patients I have, there are people with money, no question about it. But my practice demographics have not changed,” he says. “Quite honestly, I’ve got a number of employees at the hospital who don’t make a lot of money, including one of the janitors who’s worked in maintenance for many, many years. Six years ago I said to him, ‘How do you do it?’ He said, ‘Doc, I just dropped the sports package on my cable bill. To me, it’s more important to have my health.’ That really meant a lot to me.”

   It comes down to making choices, Monaco says.

   “Once you realize that there are things that can be done to keep people healthy, whether it’s just being a good coach — somebody to make sure you’re doing the right things, eating better, exercising, keeping your weight down, not smoking —those are the things we can do where basically we’re mentors, we’re counselors, we’re physicians,” he says.