In Pandemic More Are Paying For Direct Access To Their Doctors


This article originally appeared in the August 21, 2020 edition of  The New York Times, The New York Times Online, InStyle Online and Yahoo Lifestyle

Written by Paul Sullivan

Concierge care has grown fast as patients no longer want to sit in a waiting room with strangers. But it comes at a high price.

When the National Basketball Association announced that it would restart its season in a “bubble” at Walt Disney World in July, Kimberly Caspare, a physical therapist, was on board from the start.

She has been working inside the bubble for nearly two months, focused on the Philadelphia 76ers, who made the playoffs and extended her stay there. But she has still made time for her patients back home in New York City, guiding them through one-on-one virtual sessions to provide relief to their aching joints with techniques usually rendered by her well-trained hands.

“I’ve fixed people’s backs remotely,” she said. “Through observation and how they move and function, I am able to reverse the cycle of the pain.”

Dr. Caspare has also been a beneficiary of this type of virtual medicine herself, including a virtual dental visit during which she participated in cleaning her own teeth.

Concierge care, which offers personalized medical services for people who can afford it, has grown fast in the pandemic as patients seek direct access to physicians.

Basic telemedicine can bring with it cumbersome insurance protocols and hard-to-navigate health care portals. Concierge care, which is typically not covered by insurance, gets around restrictions placed on doctors and other health care providers. But it comes at a steep cost: Prices for services can be two to three times higher, and that comes on top of annual fees.

When more than 173,000 people in the United States have died from the coronavirus and millions of Americans remain out of work, the growing interest in concierge medical services may seem out of touch with the devastation the pandemic has inflicted.

But the concept is expanding in other areas. The affluent are able to pay a premium for a luxury pursuit that was relatively affordable before the coronavirus crisis, like pampering themselves with a private manicure or hiring a personal trainer for a home workout.

Doctors say they have had to expand their services or create new ones to meet the expectations of their wealthy patients.

“This stuff always starts at the top of the market because insurance companies are not paying for this,” said Dr. Yves Duroseau, an emergency room physician and adviser to OpenClear, which has offered about 600 in-home coronavirus screenings in Miami and the New York area since March.

OpenClear’s in-home tests cost as much as $1,000 and deliver results within 12 hours. There’s an additional $1,000 fee for a medical professional to travel to the Hamptons to perform a test.

For now, though, with single services that cost thousands of dollars, on top of five-figure annual concierge fees, this niche is the province of wealthy patients.

Dentists were hit particularly hard when the pandemic shuttered businesses, and many have continued to suffer because patients are returning slowly for routine care.

One Manhattan Dental, which began last year as a concierge practice that does not accept insurance, had to alter its offerings to stay relevant for its clients.

Dr. Robert Raimondi, a co-founder of the practice, said the office had no telemedicine offering when the pandemic hit, because dental work usually requires a physical examination. Within a few weeks, the practice began offering virtual hygiene checks. Dr. Raimondi said it had started providing dental boxes with electric toothbrushes, different types of floss and toothpaste, tongue scrapes and mouthwash.

Now that the office is open, its offerings have evolved into private appointments — $1,500 to be the only one in the office, compared with $295 for a regular cleaning. House calls are also available: $1,000 for the doctor to walk in the door, $500 for a cleaning and $600 for a whitening, up from $200 in the office.

“Coming to the dentist is not the most fun thing,” Dr. Raimondi said. “This makes it enjoyable for everyone involved.”

There are limits: no fillings or crowns, although a surgeon is available for in-home extractions, if necessary.

Credit…Devin Oktar Yalkin for The New York Times

Dr. Caspare reached out to Dr. Raimondi from inside the N.B.A. bubble. She was looking for oral health advice because she was wearing a mask whenever she was not in her hotel room at Disney World. Her mouth was dry all the time, and she felt dehydrated from not drinking water as she normally would. He sent her some products and then coached her via Zoom.

“When I’m in his office, it’s a passive interaction,” Dr. Caspare said. “I listen and I go home and forget half the things he said to me.”

Now, she has videos from the appointment as a reminder. “It’s created more compliance because I can continue to view them,” she said.

Others doctors have developed new approaches. Dr. Erika Schwartz, an internist who specializes in hormone-replacement therapy, has a practice in Midtown Manhattan called Evolved Science, but she has been able to work from her home in Greenwich, Conn.

This summer, she added a pop-up office in Southampton, N.Y., to serve clients who had fled the city. Taking over an empty office building, she set about recreating the soothing feel of her Midtown office.

She charges a $12,000 annual concierge fee, which is separate from the cost of treatments her practice provides. Some treatments may be covered by insurance, but others may not, like intravenous drips to strengthen immunity, which start at $500, and hormone replacement, which run $100 to $200 a treatment. Dr. Schwartz formulated an antiviral, anti-inflammatory and immune-supporting IV for patients during the pandemic.

Alana Dillon, a mother of four who splits her time between Manhattan and the Hamptons, went to Dr. Schwartz’s pop-up for her regular immunity-boosting infusions.

“They came out to my car and got me,” she said. “It was very streamlined. It still had the luxury component that you feel at the Fifth Avenue office. It still felt very private and relaxing.”

Ms. Dillon said she would rely on tailored services, like IVs that support the immune system, even more to keep her body healthy during the pandemic. “What can we do to make our bodies more healthy to fight this virus? Right now, it’s the focus of the practice,” she said.

Yet for those who don’t summer in the Hamptons or feel inclined to make the trip into Manhattan, Dr. Schwartz can send her medical professionals to them. Jeff Villa, a private-equity executive who lives in Brooklyn, used to enjoy traveling to her office, but that has become unattractive in the pandemic, he said. Instead, he has received preventive care, including an antibody test, in his home, a personal service that he said he would continue to rely on even after the pandemic.

“It just saves me so much time,” Mr. Villa said.

These high-end house calls do not come cheap. Dr. Marie V. Hayag, a dermatologist and the founder of Fifth Avenue Aesthetics, said she had done more than a half-dozen visits, four by helicopter, to homes in the Hamptons. Her fee is a minimum of $5,000 a visit with transportation included.

“I prefer helicopter transportation, but I’ve had clients’ drivers take me back and forth,” she said.

Dr. Hayag can do most any cosmetic procedure in someone’s home, but for a more serious medical issue, like skin cancer, she is limited to taking a biopsy. If her patient needs to come into the office, she offers the option of being the only person there, for an additional $2,000.

“Everyone’s stressed out, and they need more hand-holding,” Dr. Hayag said. She has always offered private time for clients, but she plans to continue doing house calls after the pandemic has passed.

Continuing these new practices seems to be a trend across specialties. Dr. Caspare, the physical therapist, said that some patients were eager for in-person appointments again, but that her practice is going to evolve.

“We’ll never go back to just in-office,” she said. “We’re going to be more powerful in how we take care of others.”