Abstract
Background: Concierge medical practice is a relatively new and somewhat controversial development in primary-care practice. These practices promise patients more personalized care and dedicated service, in exchange for an annual membership fee paid by patients. The experiences of patients using these practices remain largely undocumented.
Objective: To assess the experiences of patients in a concierge medicine practice compared with those in a general medicine practice.
Methods: Stratified random samples of patients empanelled to each of the four doctors who practice at both a general medicine and a concierge medicine practice separately situated at an academic medical center were drawn. Patients were eligible for the study if they had a visit with the physician between January and May 2006. The study questionnaire (Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, supplemented with items from the Ambulatory Care Experiences Survey) was administered by mail to 100 general medicine patients per physician (n = 400) and all eligible concierge medicine patients (n = 201). Patients who completed the survey and affirmed the study physician as their primary-care physician formed the analytic sample (n = 344) that was used to compare the experiences of concierge medicine and general medicine patients. Models controlled for respondent characteristics and accounted for patient clustering within physicians using physician fixed effects.
Results: Patients’ experiences with organizational features of care, comprising care co-ordination (p < 0.01), access to care (p < 0.001) and interactions with office staff (p < 0.001), favored concierge medicine over general medicine practice. The quality of physician-patient interactions did not differ significantly between the two groups. However, the patients of the concierge medicine practice were more likely to report that their physician spends sufficient time in clinical encounters than patients of the general medicine practice (p < 0.003).
Conclusion: The results suggest patients of the concierge medicine practice experienced and reported enhanced service, greater access to care, and better care co-ordination than those of the general medicine practice. This suggests that further study to understand the etiology of these differences may be beneficial in enhancing patients’ experience in traditional primary-care practices.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stein M. Independent personal medical care. J Am Physicians Surgeons 2007; 12(1): 28–9
US Government Accountability Office. Physician services: concierge care characteristics and considerations for Medicare [report to Congressional Committees; GAO-05-929]. Washington, DC: US GAO, 2005 Aug [online]. Available from URL: http://www.gao.gov/new.items/d05929.pdf [Accessed 2008 Feb 17]
Carter J. What makes a high-earning family physician? Fam Pract Manag 2005 Jul; 12(7): 16, 19-20
Glendinning D. Medicare trustees: gloomy forecast for physician reimbursement rates. Am Med News 2005 Apr 11 [online]. Available from URL: http://www.ama-assn.org/amednews/2005/04/11/gvl10411.htm [Accessed 2008 Feb 17]
Brennan TA. Luxury primary care: market innovation or threat to access? N Engl J Med 2002 Apr 11; 346(15): 1165–8
Landon BE, Aseltine Jr R, Shaul JA, et al. Evolving dissatisfaction among primary care physicians. Am J Manag Care 2002 Oct; 8(10): 890–901
Landon BE, Reschovsky JD, Pham HH, et al. Leaving medicine: the consequences of physician dissatisfaction. Med Care 2006 Mar; 44(3): 234–42
Montgomery JE, Irish JT, Wilson IB, et al. Primary care experiences of medicare beneficiaries, 1998 to 2000. J Gen Intern Med 2004 Oct; 19(10): 991–8
Murphy J, Chang H, Montgomery JE, et al. The quality of physician-patient relationships: patients’ experiences 1996–1999. J Fam Pract 2001 Feb; 50(2): 123–9
Murray A, Montgomery JE, Chang H, et al. Doctor discontent: a comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med 2001 Jul; 16(7): 452–9
LeClaire J. Is there a doctor in the house? Edward Goldman thinks patients will pay a premium for personalized preventive health care through membership in MDVIP. South Florida CEO 2006 Mar [online]. Available from URL: http://findarticles.com/p/articles/mi_m0OQD/is_3_10/ai_n16125613 [Accessed 2008 Feb 12]
Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians: results of a statewide demonstration project. J Gen Intern Med 2006 Jan; 21(1): 13–21
Rodriguez HP, von GT, Chang H, et al. Patient samples for measuring primary care physician performance: who should be included? Med Care 2007 Oct; 45(10): 989–96
Stata Statistical Software. Release 10 [computer program]. College Station (TX): StataCorp LP, 2007
Damberg CL, Raube K, Williams T, et al. Paying for performance: implementing a statewide project in California. Qual Manag Health Care 2005 Apr; 14(2): 66–79
Rodriguez HP, Anastario MP, Frankel RM, et al. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention. BMC Med Educ 2008; 8: 3
Tai-Seale M, McGuire T, Colenda C, et al. Two-minute mental health care for elderly patients: inside primary care visits. J Am Geriatr Soc 2007 Dec; 55(12): 1903–11
Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res 2007 Oct; 42(5): 1871–94
Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med 2007 Sep; 5(5): 457–61
Yarnall KS, Pollak KI, Ostbye T, et al. Primary care: is there enough time for prevention? Am J Public Health 2003 Apr; 93(4): 635–41
Ostbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005 May; 3(3): 209–14
Rodriguez HP, Rogers WH, Marshall RE, et al. The effects of primary care physician visit continuity on patients’ experiences with care. J Gen Intern Med 2007 Jun; 22(6): 787–93
Rodriguez HP, Rogers WH, Marshall RE, et al. Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care. Med Care 2007 Jan; 45(1): 19–27
Wagner EH, Reid RJ. Are continuity of care and teamwork incompatible? Med Care 2007 Jan; 45(1): 6–7
Alexander GC, Kurlander J, Wynia MK. Physicians in retainer (“concierge”) practice: a national survey of physician, patient, and practice characteristics. J Gen Intern Med 2005 Dec; 20(12): 1079–83
Sweeney J, Hausknecht D, Soutar G. Cognitive dissonance after purchase: a multidimensional scale. Psychol Marketing 2000 May; 17(5): 369–85
Goroll AH, Berenson RA, Schoenbaum SC, et al. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med 2007 Mar; 22(3): 410–5
Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995 May 1; 152(9): 1423–33
Acknowledgments
No sources of funding were used to assist in the preparation of this study. David Fairchild, MD, MPH, holds a position as Chief Medical Officer at Tufts Medical Center and practices at both the General Medicine Clinic and Concierge Medicine Clinic (Boston, MA, USA). His patients were sampled for the study, but Dr Fairchild was blinded to patient involvement in the survey and study. Furthermore, Dr Fairchild was not involved in any activities related to data collection or analysis.
The other authors have no conflicts of interest that are directly relevant to the content of this study. No sources of funding were used to assist in the preparation of this study.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Ko, J.M., Rodriguez, H.P., Fairchild, D.G. et al. Paying for Enhanced Service. Patient-Patient-Centered-Outcome-Res 2, 95–103 (2009). https://doi.org/10.2165/01312067-200902020-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/01312067-200902020-00005