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Rebuilding the doctor-patient relationship

Andrew Malone

When you visit the doctor you might feel like you spend more time in the waiting room than in the actual examination room. But with dozens of patients a day, it can be difficult for primary care doctors to spend more time with each person.

This week on "Take Care," Tom Blue explains how patients can get more face-to-face time with their doctor through something called concierge medicine. Blue is a pioneer in concierge medicine and has been building private physician practices since 2002. He is also the executive director of the American Academy of Private Physicians, and is the co-founder and chief strategy officer of LeadHealth, which focuses on functional medicine to control health care costs and improve the lives of its members.

Concierge medicine got its start in the late 1990s when primary care doctors wanted to slow down the accelerated pace primary care had to be delivered, according to Blue.

"They were finding that they were increasingly frustrated, as their patients were increasingly frustrated, with longer wait time and shorter time with their doctor," Blue said.

Doctors took the approach of offering this service to their patients in a way similar to a health club: pay a monthly fee, decrease the wait time, and restore the doctor-patient relationship, Blue said.

When concierge medicine was first introduced it mostly appealed to older patients or those on Medicare. This is because doctors would continue to charge insurance companies or Medicare for the services they did cover, and the patient's membership fee would explicitly be for the things that they didn't, says Blue.

However, concierge medicine now has a second option for its membership fee that appeals more to working age people that may have high deductibles.

"The alternative is where the doctor has sort of separated him or herself from the payer system entirely and has opted out of Medicare and has opted out of a commercial health plan, and the subscription fee covers all aspects of their primary care," Blue said. "[This] is generally referred to as direct primary care."

There are thousands of doctors that offer both versions of concierge medicine, Blue says. But since it is paid out-of-pocket, doctors usually have some sort of written agreement with their patients that tells them what they will be receiving for the fee they're charged.

"It almost always entails a more thorough annual health evaluation and sort of a plan of prevention and care for the year, much easier access to the doctor, [and] longer appointments without waiting," Blue said.

Blue says many doctors also utilize telemedicine, which allows patients to receive the care they need without physically having to go to the doctor's office.

The average price a patient might pay a month for concierge medicine is around $125, Blue says. However, there are practices that have recently been offering lower prices for as little as $50 a month.

Although concierge medicine covers all primary care aspects, the cost does not cover injuries or illnesses that require further attention from a specialist. However, Blue says doctors will often pre-arrange prices for patients with the specialist they need to see.

"Great examples would be with lab testing and with imaging services where if patients are willing to pay directly up front for services in cash, the discounts can be astonishing?far better than the negotiated in-network rate with your insurance carrier," Blue said.

Paying out-of-pocket for concierge medicine and specialists visits may not seem the most ideal to the average working American, but Blue says with the way the system has been progressing it's becoming much more affordable and appealing to those who don't have a health insurance plan.