In the most comprehensive study of its kind, the Government Accountability Office has concluded that concierge care will not limit access to medical services for Medicare patients because so few of the nation's physicians now charge membership fees for these so-called boutique practices.
Indeed, the GAO identified only 146 concierge physicians in a nationwide survey conducted in fall 2004; the survey was mandated by the Medicare Modernization Act of 2003, which required the agency to study concierge care and its relationship to Medicare.
The 44-page report noted that HHS has allowed physicians to impose special membership fees as long as they don't duplicate charges for items or services that Medicare already covers. Officials said they identified only 146 physicians who charge membership fees for services -- a tiny fraction of the estimated 692,000 doctors in the U.S. who provide patient care and the approximately 470,000 who submitted Medicare claims in 2004.
"The small number of concierge physicians makes it unlikely that the approach has contributed to widespread access problems," the study said.
In an analysis of responses from 112 concierge physicians, almost all involved in primary care, the report found that annual membership fees for patients ranged from $60 to $15,000, with about half the respondents reporting fees of $1,500 to $1,999. For the extra money, the study said, patients received such benefits as same- or next-day appointments for nonurgent care, 24-hour telephone access and periodic preventive-care examinations.
The study said critics believe concierge care creates a caste system for medical services, carving out a lucrative new niche for a few select physicians and providing added convenience to a handful of patients who are willing and able to pay a premium. Supporters call it a way for physicians to regain control of their practices and provide more personalized services to a smaller group of patients.
Most of the physicians who charge annual membership fees practice on the East and West coasts, the study found. California had the highest number, with 26, while Florida had 22. On average, concierge physicians who responded to the GAO survey said they had 491 patients under their care -- far fewer than the average of 2,716 for the year before they launched the specialized practice, the report said.