By Phil Galewitz, KFF Health News
Hospitals, originally intended to serve low-income individuals, are now offering specialized physician services for an annual fee of $2,000 or more to provide easier access to doctors.
Decades ago, many doctors shifted to a model where they charge an annual fee to provide better access and reduce the number of patients they see.
Large hospital systems like Northwestern Medicine, Penn Medicine, University Hospitals, and Baptist Health are offering specialized physician services for an annual fee that can be over $4,000, in addition to other costs not covered by insurance.
Opponents of this type of medicine believe it worsens shortages in primary care, making access only available to the wealthy, and driving up healthcare costs. However, for tax-exempt hospitals, there are financial benefits as the fees bring in new revenue and help in recruiting and retaining physicians who then refer their affluent patients to the hospitals that employ them.
Gerard Anderson, a hospital finance expert at Johns Hopkins University, said, “Hospitals are interested in physicians offering specialized services because their patients usually have private insurance, pay their bills, and do not require charity care.”
“From the hospitals’ perspective, they are the ideal patient.”
Specialized physicians limit their patient numbers to provide immediate access and longer visits, unlike traditional primary care doctors who see a couple of thousand patients.
Jewel Mullen, associate dean for health equity at the University of Texas-Austin’s Dell Medical School, believes that as these models expand, the availability of primary care doctors for the general population decreases. She also mentioned that concierge doctors join large hospital systems because of their reputation, while hospitals engage concierge physicians to secure more referrals and inpatient care, helping them to capture a larger share of the market.
Specialized physicians typically guarantee same-day or next-day appointments and often provide patients with their mobile phone number.
Aaron Klein, who oversees the specialized physician practices at Baptist Health, stated that the program was initially meant for donors.
“High-end donors wanted to make sure they have doctors to care for them,” he said.
Baptist Health started its specialized program in 2019 and now operates three practices in South Florida, where patients pay $2,500 a year.
Klein stated, “My philosophy is: It’s better to offer top-notch care to a few hundred patients rather than provide inadequate care to a few thousand patients.”
About 20 years ago, specialized physician practices began in affluent areas like Boca Raton, Florida, and La Jolla, California. They mainly served wealthy retirees who were willing to pay more for better access to physicians. Some of the initial practices were backed by private equity firms.
One of the biggest, MDVIP based in Boca Raton, has over 1,100 doctors and more than 390,000 patients. It was established in 2000, and since 2014 private equity firms have had a majority share in the company.
Some personalized care doctors claim that their more attentive treatment results in healthier patients. A study released last year by researchers at the University of California-Berkeley and University of Pennsylvania found no effect on mortality rates. However, the study did reveal higher costs.
According to Medicare claims data, the researchers discovered that enrollment in personalized medicine was linked to a 30%-50% rise in total health care spending by patients.
Adam Leive, a study co-author and an assistant professor of public policy at UC Berkeley, stated, “For hospitals, this is an extension of their market consolidation.” Inova Health Care Services in Fairfax, Virginia, one of the state’s largest tax-exempt hospital chains, employs 18 personalized doctors, who each attend to no more than 400 patients. Those patients pay $2,200 a year for the privilege.
George Salem, 70, of McLean, Virginia, has been a patient in Inova’s personalized 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.
Salem stated, “I loved my internist before, but it was impossible to get to see him.” Immediate access to his doctor “very much gives me peace of mind,” he said.
Craig Cheifetz, a vice president at Inova who oversees the personalized 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’s program has 6,000 patients.
Cheifetz disputes the claim that personalized physician programs worsen 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 — about what some people spend on coffee, he said.
“Inova has an incredible primary care network for those who can’t afford the personalized care,” he said. “We are still providing all that is necessary in primary care for those who need it.”
Some hospitals are starting personalized physician practices far from their home locations. For example, Tampa General Hospital in Florida last year opened a personalized practice in upper-middle-class Palm Beach Gardens, a roughly three-hour drive from Tampa. Mount Sinai Health System in New York runs a personalized physician practice in West Palm Beach.
NCH Healthcare System in Naples, Florida, employs 12 personalized physicians who treat about 3,000 patients total. “We found a need in this community for those who wanted a more personalized health care experience,” said James Brinkert, regional administrator for the system. Members pay an annual fee of at least $3,500.
NCH patients whose doctors convert to personalized and who don’t want to pay the membership fee are referred to other primary care practices or to urgent care, Brinkert said.
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