Characteristics of Concierge Care

Concierge care is practiced by a small number of physicians, located  primarily in urban areas on the East and West Coasts. Although nearly all of  the concierge physicians who responded to our survey reported practicing  primary care, they differed in many of the characteristics of practice  design, including the annual membership fee charged, number of patients  treated, features offered, whether they billed health insurance, and their  relationship to the Medicare program. Amount of Annual Membership Fee

The annual membership fee for an individual to join a concierge practice  ranged from $60 to $15,000 among the physicians responding to our survey. The most frequently  reported features were same- or next-day appointments for nonurgent care,  24-hour telephone access, and periodic preventive-care physical  examinations. Eighty-five, approximately three-fourths, of respondents reported that they  billed patient health insurance for covered services. Aspects of Concierge Care of Interest to Medicare and Its Beneficiaries

Two principal aspects of concierge care are of interest to the Medicare  program and its beneficiaries: its compliance with Medicare requirements  and its effect on beneficiary access to physician services. The small number  of concierge physicians makes it unlikely that the approach has  contributed to widespread access problems. The memorandum states that physicians may enter into retainer  agreements with their patients as long as these agreements do not violate  any Medicare requirements. For example, concierge care membership  fees may constitute prohibited additional charges if they are for Medicare- covered items or services. In March 2004, HHS OIG issued an alert “to  remind Medicare participating physicians of the potential liabilities posed  by billing Medicare patients for services that are already covered by  Medicare.” The alert stated that “charging extra fees for already covered  services abuses the trust of Medicare patients by making them pay again  for services already paid for by Medicare.” As an example, the alert referred  to a Minnesota physician who paid a settlement and agreed to stop offering  personal health care contracts to patients for annual fees of $600. The small number of concierge physicians at the time of our review, along  with information from available measures of access to services, suggests  that concierge care does not present a systemic access problem for  Medicare beneficiaries at this time. In its comments,  HHS agreed that concierge care has had a minimal impact on beneficiary  access to physician services at this time. HHS noted, however, that the  agency is interested in developments in concierge care and will continue to  follow this area and to evaluate whether any further steps are indicated. We identified concierge physicians through a variety of methods, including  a nationwide literature search, telephone interviews, and referrals from  other concierge physicians. To assess what is known about how concierge care might affect Medicare  beneficiary access to physician services, we reviewed national surveys and  reports on overall Medicare beneficiary access. GAO. Results from the 2003 Targeted Beneficiary  Survey on Access to Physician Services among Medicare  Beneficiaries.
Why GAO Did This Study

Concierge care is an approach to medical practice in which physicians charge their patients a membership fee in return for enhanced services or amenities. The recent emergence of concierge care has prompted federal concern about how the approach might affect beneficiaries of Medicare, the federal health insurance program for the aged and some disabled individuals. Concerns include the potential that membership fees may constitute additional charges for services that Medicare already pays physicians for and that concierge care may affect Medicare beneficiaries' access to physician services. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to study concierge care and its relationship to Medicare. Using a variety of methods, including a nationwide literature search and telephone interviews, GAO identified 146 concierge physicians and surveyed concierge physicians in fall 2004. GAO analyzed responses from 112 concierge physicians. GAO also reviewed relevant laws, policies, and available data on access to physician services and interviewed officials at the Department of Health and Human Services (HHS) and representatives of Medicare beneficiary advocacy groups.

What GAO Found

Concierge care is practiced by a small number of physicians located mainly on the East and West Coasts. Nearly all of the 112 concierge physicians responding to GAO's survey reported practicing primary care. Annual patient membership fees ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500 to $1,999. The most often reported features included same- or next-day appointments for nonurgent care, 24-hour telephone access, and periodic preventive care examinations. About three-fourths of respondents reported billing patient health insurance for covered services and, among those, almost all reported billing Medicare for covered services. Two principal aspects of concierge care are of interest to the Medicare program and its beneficiaries: compliance with Medicare requirements and its effect on beneficiary access to physician services. HHS has determined that concierge care arrangements are allowed as long as they do not violate any Medicare requirements; for example, the membership fee must not result in additional charges for items or services that Medicare already reimburses. Some concierge physicians reported to GAO that they would like more HHS guidance. The small number of concierge physicians makes it unlikely that the approach has contributed to widespread access problems. GAO's review of available information on beneficiaries' overall access to physician services suggests that concierge care does not present a systemic access problem among Medicare beneficiaries at this time. In comments on a draft version of this report, HHS agreed with GAO's finding on concierge care's impact on beneficiary access to physician services and indicated it will continue to follow developments in this area.