Doctor retainer fees: LI patients pay extra to get better personal care, quicker access

Long Island doctors are willing to personalize their approach and cater to patients' schedules — for a fee.

Physicians are spending their weekends fielding calls, sorting through images of rashes and calling in prescriptions for shingles and ear infections. But care like that comes with more than a copay. 

This style of medicine — often called concierge or boutique care — uses retainer fees to support practices. Membership rates on Long Island range from $1,800 to more than $10,000 a year. These subscription payments allow doctors to cap their caseload.

The model has gained momentum among private physicians and smaller practices. Large, hospital-run physician groups like the New Hyde Park-based Northwell Health and Mount Sinai Health System also are taking another look at concierge care in the wake of COVID-19.

Concierge physicians say they have the time to provide better medical care since they treat up to 600 patients, compared to standard caseloads that may be 2,000 or more. The setup offers patients an array of perks, including same-day appointments, access to their doctor's cellphone number, and in some cases, the ability to have clinicians treat them while abroad or perform minor surgeries at their home. Supporters say concierge care offers an alternative to the frustrations of modern health care, where patients feel like they can't get the attention they need, and doctors complain of being overworked.

The pandemic exacerbated challenges for primary care providers, many of whom suffered financial hardship when they shuttered their offices. Doctors could resume providing elective care in May 2020, but dealing with pent-up demand under heightened health risks strained providers and pushed some physicians to leave the field. This added to long-standing staffing shortages and clinician burn out. The idea of delving deeper with a smaller number of clients gained appeal for some doctors. Struggling practices can use membership fees to stabilize their finances, and large physician groups sometimes see concierge divisions as a recruiting and retention strategy, doctors and industry experts said.

More patients are open to paying membership fees because they are frustrated by how hard it is to schedule prompt appointments, doctors said. A number of Long Islanders have independently sought out a concierge physician, rather than followed a provider who made the shift, they said.

But the spread of concierge care has raised concerns for some health policy experts. This style of medicine tends to draw wealthier patients, and research shows it may not lead to better health outcomes. By reserving some physicians for a select number of patients, concierge care limits the number of doctors in the remaining primary care system and increases the workload for its already-strained physicians, said Dr. David Podwall, president of the Nassau County Medical Society, a trade group.

“I know concierge guys who said, 'I had a ton of patients who told me if you do concierge, I'll pay for it,'” Podwall said. “COVID really accelerated this.”

A survival strategy

Independent doctors have been experimenting with the model for decades, said Dr. Thomas LaGrelius, president of the American College of Private Physicians, a trade group for concierge doctors. Doctors got more comfortable with the setup when the U.S. Department of Health and Human Services announced in the early 2000s that physicians could legitimately charge retainer fees and take Medicare. They must, however, make sure the membership dues go to services that aren't covered by the public insurance program, which LaGrelius said might include services like system navigation or wellness coaching. Commercial insurers have not prevented doctors in their network from using the model either, he said. 

Running an independent practice got harder in recent decades as insurers limited payments for primary and preventive care, LaGrelius said. Many doctors filled their day with 15-minute sessions — the reimbursement standard used by many insurers — and put in extra hours to maintain their standards. Moving to concierge care was a survival strategy for some.

“There were times where I actually could not draw a salary,” Dr. David Horowitz said of his primary care career before transitioning to a concierge model around 2010.

The Smithtown doctor has a $1,800 annual membership rate, but says he sees some longtime patients on a “scholarship” basis and accepts many insurance plans.

“I didn't want to be in a situation where what's good for the patient is not good for me — cutting corners, having some lower level provider take care of them, doing a test on everybody that they don't need,” he said. “It took me off the treadmill and allowed me to continue doing a good job.”

Concierge has evolved: some doctors' retainer fees are large enough to cover all the care they provide and remove insurance from the equation; others still bill for specific treatments, tests and services, and may or may not accept insurance.

Data on concierge care is scarce, but the trade publication, Medscape, has been polling physicians about it as part of an annual survey of more than 10,000 American doctors. Adoption peaked at 4% of primary care physicians around 2014, before falling to 1% of all physicians in 2022 and picking up again in 2023, Medscape reports show.

COVID inspired clinicians to reassess their professional lives, said Dr. Jonathan Jassey, who opened Concierge Pediatrics in Roslyn in late 2022. He had worked for a practice owned by his brother in Bellmore for years, Jassey said. Despite taking on more patients, the budget remained tight, and the business was sold to a large health group. Jassey stayed on for a few years, but didn't feel it was the right fit.

Concierge Pediatrics opened a Woodbury location about a year ago and plans to expand throughout the metro area, Jassey said.

“We have doctors that, again, have had a longtime interest in pediatrics and realize that they are not happy,” he said. “They're willing to take the chance now.”

Jassey declined to share Concierge Pediatrics' retainer fee, but said it encompassed all the services provided by him and his team. The package includes: hourlong checkups complete with hearing tests, an analysis of the heart's rhythm and blood work; home visits for newborns; 24/7 access to doctors who can digitally provide routine sick care such as examining ears and throats, as well as remotely assess hearts and lungs; and DNA tests to gauge how kids metabolize medication.

Meredith Worth, 45, of Plainview, signed her three kids up for Concierge Pediatrics because she didn't want to lose their longtime physician. Soon she was sold on the model. Her 16-year-old grew seriously ill, and it took two weeks to discover that he had severe mononucleosis, Worth said. Her son would have been hospitalized if she hadn't been  working with Concierge Pediatrics, she said, adding she would have agonized while waiting for providers to call her back.

“He had a fever for 27 days,” said Worth, who works in human resources. “Do you know how nice it is to just text [Jassey] and say: hey, the school needs a doctor's note, and in seconds I had a doctor's note?”

Worth is now looking at concierge care for herself and her husband.

Beckoning the big guys

Established concierge companies say demand from patients has been steady, and big health systems are increasingly looking to meet it.

Both MDVIP, a national network of concierge practices, and Concierge Choice Physicians LLC, a Rockville Centre firm that consults and assists such doctors, have served hospital-run physician groups, their executives said. The Florida-based MDVIP now has about 15 physicians on the Island, CEO Bret Jorgensen said. Concierge Choice Physicians went from working with about 200 to more than 300 doctors in the U.S. over the past five years, according to founder Wayne Lipton.

Northwell Health, the largest health system in the state, has posted job ads for concierge physicians. The organization is exploring launching a membership program in response to patient inquiries, according to spokeswoman Barbara Osborn. She said it was too premature to share more.

The Manhattan-based Mount Sinai Health System has one concierge physician in Greenlawn. He collaborates with MDVIP, which charges an average annual retainer fee of $2,000, according to Jorgensen.

The system also is studying an expansion of a more elaborate model born in Hudson Yards, a high rise development recently built atop railroad tracks in Manhattan. Mount Sinai's Hudson Yards clinic was set up to cater to nearby businesses by offering extended hours and on-site mental health, physical therapy and other specialty care, according to its medical director Dr. Louis DePalo.

The site then developed a membership program for executives with demanding schedules, homes in multiple locales or otherwise unconventional lifestyles, DePalo said. Annual retainer fees start at $16,000, which covers all care provided on-site. This includes unlimited in-person and digital consultations, imaging and tests, care coordination and an array of personal services, such as DePalo's daily meeting with a patient on a weight loss program.

The service has opened outposts in Florida and is considering bringing the program to the Upper East Side of Manhattan and other places with potential demand like Brooklyn and Long Island, DePalo said.

Mount Sinai is moving slowly and deliberately because it is committed to ensuring all patients have equal access to quality care, DePalo said.

“We have a lot of constituents with different health needs and with different resources,” he said.

Dr. Asma Rashid, of Water Mill, says she is glad bigger systems are exploring concierge care, though they may have a harder time personalizing physicians' approach. 

“We finally get to pay off our loans and provide very satisfying medical care,” she said of her team. “But it's sad for me to see that it's not easily accessible to the masses.”

Rashid said her practice, Hamptons Boutique Medicine, has an annual retainer “way above” the more typical $5,000 to $10,000 rate because she serves celebrities, high-profile executives and politicians. She will travel — sometimes internationally — to treat clientele focused on privacy, and sew up wounds and perform other minor surgeries in their homes.

What happens to nonmembers? 

When her doctor moved to a concierge model about eight years ago, Karen Edelstein, 56, signed up and became one of the first people in her circle to use this sort of service. Now, she knows a few people in membership medical programs.

“Even though the membership fee is money, it's probably saved me money indirectly,” said Edelstein, of East Rockaway, who has a background in corporate benefits management. “I don't have to go to urgent care. I don't have to go to the emergency room.” 

But the rise of membership practices can be disruptive for Long Islanders who can't or don't want to pay retainers. Nicole Christensen, of Freeport, said her doctor's office announced it was launching a concierge model about five years ago. She stuck with the traditional business line the office still offered, but moved on a few years later, in part, because she got a new provider at every appointment. 

“It takes work,” Christensen said, noting that she is relatively young and healthy, but the transition may be more challenging for others. “Switching doctors is such a pain on insurance.”

Christensen, who has a patient advocacy business called Care Answered, has seen concierge care fall short of some peoples' expectations, so she urges people to research what retainers cover before paying them. 

It's unclear how membership health models may impact the larger health system, said Molly Candon, senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Wait times may rise, she said. But the model may also bolster the provider base by keeping older doctors from retiring and convincing more medical students to go into primary care, she noted.

So far, concierge care hasn't driven down adverse outcomes like mortality, but has increased costs, according to Candon's review of Medicare claims for people who stuck with a doctor that transitioned to concierge care, as well as those who left the physician's practice and found new providers. That's likely because concierge care attracts healthier people from higher-income neighborhoods, she said. Candon says the model still holds promise if it reaches those with greater medical needs.

Others say it's wiser to address the issues driving consumer demand for concierge care.

“If the system was working great, you wouldn't need this,” Podwall said. “This is an indictment of the system.”

By Sarina Trangle

sarina.trangle@newsday.comSarinaTrangle

Sarina Trangle covers affordability and cost of living issues and other business topics. She previously worked as an editor and reporter at amNewYork.