Concierge medicine has been around for over two decades but has recently exploded in popularity. Overwhelmed with high patient volume, high administrative costs, and low reimbursement rates from third party payors, primary care physicians are turning to the concierge model to provide better care to their patients without risking loss of income. The concierge model’s fee structure allows physicians to reduce their patient volume and in turn allows them to spend more time on patient care and less time on the administrative and billing tasks associated with the traditional model. However, as with anything in the heavily regulated health care industry, concierge medicine faces regulatory issues and compliance concerns.
This field guide is a four-part series and will cover the issues and concerns associated with concierge medicine physicians must navigate to set up a compliant model:
What Is Concierge Medicine?
In Part 1 of this field guide we took a broad look at why concierge medicine is becoming increasingly prevalent. Now we turn our attention to the details and explore what exactly it means to practice concierge medicine.
At its core, concierge medicine is a membership-based health care model offering an alternative to traditional primary care. It aims to promote better patient-physician relationships by enabling physicians to practice through reduction and elimination of insurance headaches and bureaucratic restraints. Additionally, physicians can reduce their patient volume without sacrificing revenues and maintain more control over their practice. Concierge medicine is particularly appealing to physicians because it solves the problem of heavy patient loads and insufficient time to see those patients. According to the American Journal of Medicine, a concierge physician sees “6 to 8 patients per day compared with 20 to 24 patients for the typical primary care physician.”
The practice is structured such that patients pay a periodic subscription fee, typically monthly or annually, in exchange for personalized and direct access to their physician. Although concierge practices may still accept insurance and its reimbursements in addition to membership fees, it is the membership fees that help physicians alleviate the burden associated with complex insurance billing and collection procedures.
The benefits patients receive as a result of their membership fee include longer, more in depth appointments with the physician, minimal wait times, same-day scheduling, wellness and nutrition planning, remote and immediate physician access, and personalized care plans. Appointments are usually thirty-minutes or longer and patients often have 24/7 access to their physician via phone or email. In some situations, physicians may even accompany patients on out-of-office visits to specialists or accept house calls. More high-end concierge services include spa-like amenities such as bathrobes and slippers during the appointment. As such, concierge medicine is an attractive option for patients seeking a more personal and accessible primary care physician.
What Is Direct Primary Care?
A Direct Primary Care (DPC) is a practice and payment model where patients and physicians enter into a contract for either a monthly, quarterly, or annual fee in exchange for a broad range of primary care services. Under the contract, most DPCs cover clinical and laboratory services, consultative services, care coordination, and comprehensive care management. Not only does the fee cover most services that primary care practices perform, but patients also get extended visits, virtual appointments, and access to doctors by phone or email outside of regular business hours. Indeed, patients are able to receive more personalized services and enhanced communication with their physicians, establishing a stronger doctor-patient relationship that is hard to come by in primary practices.
How Is Concierge Medicine Different from Direct Primary Care?
DPCs are a type of concierge medicine. Concierge medicine is a broad term with a few different non-traditional models for primary care practices and patients. While concierge medicine may charge the patient and bill insurance in some models, DPCs do not. DPCs deal solely with the patient/physician contract and their only source of income is from the patient. Sometimes, on the other hand, a concierge medicine practice, though following the DPC model, brands itself as a concierge medicine practice. In those instances, the level of services typically is expanded, there is more white glove in the treatment, and it is more expensive.
Concierge practices that desire to incorporate billing insurance such as Medicare or commercial payers into their model need to be mindful of the contractual and regulatory traps that exist.
In Part 3, we will discuss the biggest challenge to the concierge medicine model—the insurance issue. If you have any questions or would like to learn more about concierge medicine, schedule a consultation with us at email@example.com.