VIP treatment: Just what the doctor ordered?
By Peter Davidson • Bankrate.com

Primary care doctors across the country are changing the way they do business and that could be good news or bad news for you -- depending on your health-care needs and the size of your bank account.

Still small, but ever increasing, numbers of physicians are converting their practices to "concierge," "luxury," or "VIP" practices -- offering patients same or next-day appointments with no waiting time, unhurried visits with their doctor, an annual comprehensive physical, a wellness plan and the ability to reach their physician 24 hours a day via personal pager or cell phone.

To make this possible, these doctors are downsizing the number of patients they treat from a few thousand to a few hundred.

If you're worried about or already struggling with health-care costs, the growing trend might be something new to fret about. But if you've got plenty of excess cash and are more upset over waiting times and rapid-fire exams, a concierge practice may be just what the doctor ordered.

To make up for the reduced billings doctors making the switch are charging hefty annual retainers ranging from $1,500 to $20,000 on top of insurance payments, co-payments and out-of-pocket fees.

What's more, they're closing their doors to longtime patients who won't come up with the annual fees.

No long lines
The practice isn't widespread yet. There are fewer than 500 doctors across the country operating concierge practices today, according to Dr. John Blanchard, a concierge practitioner in Michigan and president of the American Society of Concierge Physicians. But if your doctor makes the change, or if you're considering making a switch yourself, here are seven things you should know about concierge practices:

• Internists and family practitioners are most likely to become VIP doctors, not pediatricians, cardiologists and surgeons, experts say.
• While concierge doctors say they can spend more time treating patients, experts say there is no evidence their patients actually get better medical care.
• If you're considering joining a concierge practice, make sure you examine your contract carefully to learn which services are included in your retainer fee and which aren't.
• Some practices will bill your health insurance and some won't, but not all concierge practices accept Medicare and traditional insurance coverage. Find out before you make a commitment.
• Even if you have health insurance, and your doctor will accept it, you will be responsible for co-payments, deductibles and out of pocket costs.
• Even if your doctor tells you to pay up or find a new physician, he's still required to continue to treat you until you find another physician and to facilitate the free transfer of your records to a new practice.
• The number of doctors changing their practices is expected to be very limited. "Even if there were 1,000 doctors in the country doing this, that would be from an overall pool of 300,000 primary care doctors," says Andrew Ripps, CEO of MDVIP, a Florida-based company that helps doctors convert their practices from the traditional model to the concierge model.

Case histories
The fees and services vary widely. Here are some examples:

• In Seattle, Wash., MD2 (pronounced "MD Squared") charges $20,000 and includes marble showers and personally monogrammed robes for its patients. MD2 is the brainchild of Dr. Howard Maron, a former team doctor for the Seattle Supersonics of the National Basketball Association. Launched in 1996, it was the nation's first concierge practice.
• In Boston, Personal Physicians health care charges an annual membership fee of $4,000 a year in addition to fees for services. "We want to be able to spend more time with patients," Dr. Steven R. Flier told the Boston Globe. "We're desperately struggling to create a system that lets us do that within the limitations of managed care."
• In upstate New York, Dr. Paul DiEgidio was the first Rochester-area physician to launch a concierge practice. He says it's a way for him to escape the crushing load of 2,000 patients, and for his patients to get better health care. Dr. DiEgidio offers standard care for $2,500 and platinum care for $5,000 ($10,000 for families). Standard care patients get his cell phone number and house calls, while platinum patients get additional benefits such as immediate appointments and he'll even accompany them on visits to specialists. "Doctors are overloaded," he says. "Everybody I know is dissatisfied with the health-care system. I'm offering a way out."
• In Cincinnati, Ohio, internist Douglas Magenheim quit a high-volume practice with 2,700 patients to open his "luxury primary care" practice. For $1,500 annually, he promises same- or next-day appointments and personally returns patients' phone calls and e-mails day or night, holidays or weekends. Dr. Magenheim plans to limit his patient load to 800, which means he stands to pocket $1.2 million in fees alone.

"There have been a lot of complaints about how people have to wait too long to see a doctor. This is my answer to fix that," Dr. Magenheim says.