In this News Insight, The New York Times looks at the trend of concierge emergency rooms. For a focused view on how technology can enhance the patient experience, download our e-book. —Samsung Insights editorial team
At 3 a.m. on a recent Sunday, Herb Wilson’s wife fell backward in the bathroom of their New York apartment and hit her head. It was not her first fall. She has Parkinson’s disease and has fallen many times, causing him worry.
The previous time his wife had fallen, Mr. Wilson, 79, had taken her to a hospital emergency room, where they spent five hours waiting for her to be examined and discharged. This time, they went to a concierge emergency room for faster service.
“I called up at 3:15, and they said come over,” Mr. Wilson said. “I walked in there at 3:30 in the morning, and a physician, a technician and a physician’s assistant were waiting for me, literally, at the door.”
The facility, Priority Private Care, administered a CT scan and read the results on the spot. Mr. Wilson’s wife was fine, and they went home. “I was out of there in 40 minutes,” he said.
For such service, he pays $10,000 a year. The fee covers concierge emergency room access for him, his wife and their adult daughter. Fees for treatment are charged per visit.
Paying more for better, faster care may not be fair, but the concept has been around for decades.
Concierge physicians often charge patients directly, bypassing insurance companies that discount their rates. They do this through annual membership fees but also with charges for each visit. In return, patients get direct access and more time with a doctor.
Top hospitals have also started to provide concierge services, offering programs with stately names that are meant to coddle dignitaries, celebrities and international patients paying their own way. In New York, Mount Sinai Hospital has its Executive Services Department, the Hospital for Special Surgery offers its Ambassador Services, and Weill Cornell Medicine provides its International Patient Services.
But emergency rooms by law treat the sickest patients first. If you’ve been shot, you’ll be seen right away. If you’re stable, you’re going to wait — and you could keep waiting depending on who else comes in.
According to research by ProPublica, the average time a patient spends in an emergency room in New York State before being sent home is three hours. In certain hospitals in New York City, the wait can stretch to closer to five hours.
Waiting in emergency rooms is the norm. In Maryland, it’s about three and a half hours on average; in North Dakota, the wait is comparatively speedy: You’re in and out in about an hour and a half.
A lot of people are fed up with the process, but few can do anything about it. That’s where Priority Private Care, with its care center on the Upper East Side, saw an opening for a clientele familiar with the costs and benefits of concierge medicine.
Dr. Bernard Kruger, a board-certified physician in oncology and internal medicine, started the company 18 months ago with two partners. He had a concierge medical practice for 15 years but saw its limitations, particularly on weekends if a patient was hurt and needed an X-ray or blood work.
He got the idea for a concierge emergency room after helping a patient, an actress, who had fallen off a horse. “I brought her to Mount Sinai,” Dr. Kruger said. “The head of the department came down. We still waited five hours for a CAT scan. I said something is wrong here.”
The Priority Private Care facility is sleek and modern, with a Chuck Close painting hanging on the wall. In addition to being well staffed, the center has the imaging machines and laboratory equipment for blood work to get results quickly and help doctors make a diagnosis.
Dr. Kruger summed up the experience: “You get seen right away. You get treated right away. You have a consistent doctor with you.”
It has its limits. It is not equipped to handle a gunshot wound, for instance, and it is not a surgery center. But according to a 2013 study by Truven Health Analytics, about three-fourths of emergency room visits by people with insurance did not require emergency room-level care.
That’s a lot of waiting (and unnecessary visits), given that the Centers for Disease Control and Prevention estimates that there are 141 million emergency room visits each year. The same C.D.C. study said that 11.2 million emergency room visits resulted in people being admitted to the hospital and 1.8 million, or about 1 percent, of those visits ended with people being admitted to critical care units.
The founders of Priority Private Care envisioned a service focused on three areas. The first is emergency care. They believe they can handle about 80 percent of the cases that require emergency care.
The second is access to a network of specialists and the ability to get patients in to see someone quickly. This was one thing that attracted Russ Coniglio, a businessman who lives in Boca Raton, Fla., but keeps an apartment in Manhattan.
“You call a specialist on Park Avenue, and they say six months,” said Mr. Coniglio, who works in the beauty care business. But when Dr. Kruger calls a specialist, he said, “they say come right over.”
“I don’t know how you put a price tag on it,” he said. “If you have a problem and wait three weeks for the appointment, that’s hard to do.”
Mr. Coniglio also put his children on the plan, and both of his college-age sons have used it for emergency services for sports-related injuries.
Those medical connections also extend to getting a patient admitted into a hospital through its V.I.P. services, if additional care is needed.
The third is convenience for any ailment, like a sore throat or a cough, that crops up after hours or on the weekend. “As long as we have to staff a full facility to effectively run empty, people can use us for convenience services,” said Andrew Olanow, a co-founder of Priority Private Care.
The center differs, though, from hospital emergency rooms, which have to take anyone who walks in off the street. Priority Private Care is not obligated to do that, though Mr. Olanow said it would.
“If they’re gushing blood, we’d stabilize them and walk them the one and a half blocks to Lenox Hill,” he said of a nearby hospital.
And the center, which is regulated as an urgent care facility by New York State, offers free care to the schoolchildren and teachers in its neighborhood as community outreach.
Texas has addressed concierge emergency rooms in a different way. The state allows free-standing emergency rooms, many of which act as concierge providers. The advantage is the greater attention and the quicker passage through the emergency room. Like Priority, though, if you’ve been shot or need surgery, the staff members will get you to a hospital emergency room.
“I get to spoil my patients and go over every lab and sit with them,” said Dr. Harvey Castro, a former emergency room doctor who is now medical director of Coppell ER in the Dallas area. “We have extra staff who can go and walk a person’s dog. We’ve picked up children at school.”
In lieu of a membership fee, Coppell ER bills insurance companies and collects the hefty emergency room payments. That can be lucrative for the emergency room, if expensive for the insurance company.
Priority Private Care’s membership fee decreases as more family members are included. Mr. Wilson said it was $5,000 for him, $3,000 for his wife and $2,000 for their daughter.
The center has 1,100 members, from about 350 families. Mr. Olanow said it planned to cap membership at 2,000 to 2,500, depending on how crowded the facility got.
But like a hospital emergency room, it also gets patients who come in with nonemergencies. Mr. Wilson, who lives just a few blocks away, said he had awakened one morning with a pimple and wondered whether Priority Private Care could take care of it.
“It was really bothering me,” he said. “They said come on over.”
When the concierge E.R. is empty, a visit for any ailment is welcome.
This article originally appeared in The New York Times.
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