More and more seniors are turning to concierge medicine.

Haven’t heard of it? A doctor who has a concierge practice charges an additional fee for a range of special services to the patient, such as same-day appointments, extra preventive care, even house calls in some cases.

For the concierge physician, the practice frees them from restrictions imposed by insurance companies and Medicare red tape (if they also decline Medicare payments and rules, as many do). It is also called “boutique,” “retainer-based medicine,” or “direct care.”

Concierge medicine is said to have begun in 1996 when Dr. Howard Maron gave up his traditional practice for about 3,000 patients. This, according to a description of concierge medicine developments by the University of Pennsylvania’s Wharton School of Health.

Dr. Maron turned his practice into a program furnishing exclusive care for a retainer to 50 families. Now, according to the American Academy of Private Physicians (AAPP), concierge doctors treat about a million patients across the country.

AAPP represents concierge doctors who provide health care for a fee. The association says about 3,500 physicians in the U.S. provide health care for a fee, and expects the number of concierge physicians to double every year or so.

Most of the concierge physicians retain their traditional practice but take fees from some of their patients for whom they give special treatment or services not covered by typical insurance policies or Medicare.

Doctors building their practice strictly on retainers — opting out of Medicare, Medicaid and private insurance — charge fees ranging from a charitable $60 a year up to $60,000 for a family’s care.

The benefits of concierge medicine for the patient are the services and time provided by the doctor. Services include such care as house calls, email consultations, and preventative tests that insurance won’t cover.

One concierge physician, for instance, uses a type of ultrasound to detect plaque in arteries, a test not typically covered by insurance. According to this doctor, 88 percent of heart attack victims would have been considered low to moderate risk on the day before a heart attack, and 86 percent would have passed a stress test. “We watch subclinical vascular disease all the time,” he said. Cardiovascular disease increases in the aging.

Fees from $200 to $300 a month may make concierge medicine affordable for most people, suggests Wharton Health Care Management Professor Guy David. “That’s more than some people shell out for Sawbucks coffee,” he said.

Some doctors, however, might resent patients who won’t pay for concierge service and skimp on their health care as a result, David suggested as a possibility. “I don’t see concierge medicine as the model for 300 million Americans,” he said. “Most people can’t afford to pay retainer fees on top of other insurance costs.”

The hybrid model of concierge medicine “may offer a solution,” according to Dr. Wayne Lipton, founder of Concierge Choice Physicians, based in Rockville Centre, N.Y. It aids doctors in developing a traditional practice with a concierge practice. Physicians usually keep about 2,000 patients, but transition about 75 or 100 patients into a concierge class that pays $150 or $200 a month extra for enhanced care.

“Patients have the option of changing to concierge without changing doctors,” Lipton says. And they can change back if they can’t afford it, he adds.

Concierge medicine could grow as the country’s population of aging boomers grows. They may demand more care, says Wharton Professor Jonathon Kolstad. And physicians buried under increasing paperwork may well find it an appealing option.

A study last year published by Health Affairs found that doctors spend on average $82,975 a year just to process Medicare and private insurance forms and billing, and the staff spends more than 20 hours a week on such paperwork.

Dr. Stephen Knope, a concierge doctor in Tucson, Arizona, believes concierge medicine can solve part of the problem of shortage of primary physicians in the country today. “I think the only way you can make primary care attractive is to do some sort of fee-for-service medicine.”

Knope sees 12 to 15 patients a day, instead of 30 or 40, giving him time for pro-bono work for the elderly and veterans. Altogether, he has about 300 patients, half of whom pay his fee of $10,000 for a couple. And “half who pay nothing or sometimes give me a chicken.” He says some of his long-time patients in their 90s pay nothing, or give him $5 a year.

The Department of Health and Human Services (HHS) has warned concierge doctors that charging an added fee to Medicare patients could be considered double billing — a no-no.

Medicare is in financial trouble, and is reducing its payments to doctors, making Medicare patients, much less desirable for physicians. An American Medical Association survey found that 78 percent of doctors said the threat of future Medicare cuts makes it “an unreliable payer.” Many are dropping out of medicine entirely.

Tait Trussell is an old guy and fourth-generation professional journalist who writes extensively about aging issues among a myriad of diverse topics.

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