October 28, 2016

Welcome to the Concierge Doctor: ‘Your Credit Card, Please’

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

What would you think about paying a $59 monthly flat fee plus $10 per visit to see your primary care physician and never having to deal with premiums, deductibles or health insurance hassles?

Patient Paying Doctor

Moreover, your flat rate would entitle you to spend a half hour with your doctor instead of the typical eight-minute visit.

Interested? Please open your wallet and welcome to the concierge doctor, whose business model is called direct primary care. But before you rush to cancel your insurance policy (probably the only really satisfying call you ever would have with your carrier), you must understand exactly what direct primary care can and cannot do for you.

First, it may come as no surprise that doctors are as sick of health-insurance companies as patients are. Insurance companies reimburse doctors on a fee for service basis, paying for each separate item of care, each test and service, rather than a visit. Critics say this discourages integrated care, makes for shorter visits and limits doctors to a myopic view of the patient.

Second, processing insurance claims represents a significant administrative cost: 60 percent in a typical primary care practice. A Wall Street Journal article on concierge medicine says “eliminating insurance billing cuts 40 percent of the practices’ overhead expenses, enabling doctors to keep fees low.”

While still representing only a small fraction of doctors nationwide, the concierge concept is catching on. According to an article in Bloomberg , there were 4,400 concierge doctors in the U.S. in 2012, 30 percent more than the prior year.  USA TODAY claims that 7 percent of practices already offer direct-pay services, and more plan of them plan to go that route.

For the patient, concierge medicine has one very large limitation: If you need a specialist, hospital or extensive testing, you still will need health insurance. To address this problem, some direct-pay doctors participate in clinics that offer some specialty care and testing. Nevertheless, their patients typically still carry some form of insurance.

Concierge doctor fees and what they cover vary widely. CNN Money reported that concierge doctors generally charge patients a membership fee − typically $1,800 a year − outside of the traditional insurance system. They often have fewer patients, usually no more than 600, compared with more than 2,500 for a typical physician. This enables concierge doctors to spend more time with each patient. For some physicians, the annual fee covers all office visits. For others, it only buys patients a comprehensive yearly exam, same-day appointments and after-hours care.

The Wall Street Journal explains how direct primary care meshes with mandatory Obamacare coverage:

“While some insurers are developing special health plans around concierge practices, most patients who see concierge doctors pay for it on top of their regular insurance. The rationale: Many of the new health plans have high deductibles that most members will never hit, meaning patients will still be paying thousands of dollars out-of-pocket anyway − possibly even more than what they’d spend on concierge medicine.

“People with deductibles of $5,000 or more should think about how many times a year they typically see the doctor and for what, keeping in mind that annual checkups are free under the Affordable Care Act. If a doctor visit typically costs $150 and the patient has six appointments a year, a concierge practice offering the same services for $40 or $50 a month might be cheaper.

Dr. Brian Forrest, who describes his $39-a-month Access Healthcare clinic in Apex, North Carolina, as “concierge-lite,” cited one of the benefits: prostate-cancer tests for $5 from the same lab that would charge a Medicare patient at least $175. “Sometimes, it might be cheaper for them to use their insurance, but in some cases it isn’t,” Forrest said.

Concierge Medicine Today, the industry’s leading news organization, suggests asking these questions when deciding if direct primary care is right for you: Do I need to pay if I never use the service, and, are there discounts for families?

In another potential benefit, the direct primary care model may encourage doctors and patients alike to focus on health issues instead of fighting with insurance companies. A Healthline News report in 2015 covered MDVIP, an organization with 800 doctors nationwide. CEO Bret Jorgensen says their direct primary care model encourages preventative care, adding:

“Everything in our system today — and this has changed a bit, which is one of the positive developments of the ACA — historically has been about sick care,” Jorgensen said. “The driving event is that the patient feels sick and goes to the doctor.” The direct primary care model offers longer-than-average doctor visits, and physicians are encouraged to discuss lifestyle and nutrition with patients, for a more comprehensive approach. “The goals of the ACA are very compatible with what we do,” he said.

Latest Blogs