- Concierge medicine
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Concierge medicine (also known as direct care) is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care.[citation needed] Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design.
The practice is also referred to as membership medicine, concierge health care, cash only practice, direct care, direct primary care, and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. Estimates of U.S. doctors practicing concierge medicine range from fewer than 800[1] to 5,000.[2]
Contents
Business model
Concierge physicians care for fewer patients than in a conventional practice, ranging from 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year.[3] All generally claim to be accessible via cell phone or email at any time of day or night or offer some other "special" service above and beyond the "normal" care provided. The annual fees vary widely, from $600 to $5,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services.
Some concierge practices do not accept insurance of any kind. These are also referred to as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients.[4] They become "concierge" only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of those covered by insurance plans.[5] This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers.
In February 2010, an informal one year summary of findings related to the concierge medicine marketplace was released.[6] The summary of the study concluded that at the end of 2009:
- Over 66% of current U.S. concierge physicians operating practices today are internal medicine specialists.
- The second most popular medical specialty in concierge medicine is family practice.
- A surprising finding in this study was the increasing number of concierge dental and pediatric practices arising since February 2009.
A similar poll related to the economy and the recession was conducted online between October 2009 to January 2010. Concierge physicians were asked ‘how is your practice performing financially compared to one-year ago?’ Surprisingly, concierge physicians across the U.S. polling data shows:
- Nearly sixty percent (59.0%) of all current concierge physicians are doing ‘Better’ financially than one-year ago.
- Twenty-nine percent (29.0%) indicated ‘No Change’ and;
- Twelve percent (12.0%) indicated ‘Worse.’
Mostly concentrated on the East and West Coasts, in 2004 the Government Accountability Office counted 146 such practices. The American Medical Association does not track the number of concierge practices because the concept is still so new.[7]
Concierge medicine vs. direct primary care
Both are variants to the traditional practice of medicine or primary care most common in the US during the twentieth century. They represent a financial relationship that changes the sole dependency on a traditional insurance model.
Direct primary care (DPC) is a term often linked to its companion in health care, 'concierge medicine.' Although the two terms are similar and belong to the same family, concierge medicine is a term that fully embraces or includes many different health care delivery models, direct primary care being one of them. Practically, the terms are still interchangeable in the marketplace.
Similarities
DPC practices, similar in philosophy to their concierge medicine lineage - bypass insurance and go for a more 'direct' financial relationship with patients and also provide comprehensive care and preventive services for an affordable fee. However, DPC is only one branch in the family tree of concierge medicine.
Differences
DPC practices, unlike some models, remove one of the financial barriers to accessing care whenever it is needed: the DPC annual fee is often inclusive of most or all physician services. This model does not rely on insurance co-pays, deductibles or co-insurance fees, unlike models like MDVIP where the annual fee is structured to cover a wellness plan[8] so that doctors can still receive insurance or Medicare reimbursement for most other services. The DPC model of eschewing insurance helps cut the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent.
According to sources DPC is a mass-market variant of concierge medicine, distinguished by its low prices. Simply stated, the biggest difference between direct primary care and retainer based practices is that DPC takes a flat rate fee whereas models usually charge an annual retainer fee and promise more access to the doctor. Both health care delivery models are providing affordable, cost-effective health care to thousands of patients across the U.S.
"This primary care business model [direct primary care] gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach," said Norm Wu, CEO of Qliance Medical Management. "One in which the provider's incentives are fully aligned with the patient's incentives."
History
The origins of concierge medicine are often traced to MD2 International ("MD Squared"), which was launched in 1996 in Seattle by Dr. Howard Maron. Dr. Maron has said of the term: "...I only came up with the concept—not the term concierge medicine. I know what a concierge is, but to describe what I do as simply opening doors and directing people.... I prefer highly attentive medicine."[9]
Other consultancies assisting physicians in the marketplace also include Concierge Choice Physicians, Direct Care Group, Elite MD, EliteHealth, MDVIP, Practice Transformation Solutions, ModernMed, SignatureMD, Transfusion, LLC.
Since 2003 there has existed a professional society of concierge and other direct practice doctors known as the Society for Innovative Medical Practice Design or SIMPD. As of mid 2008 this organization had about 200 members and by late 2008 was growing at the rate of a member a day. In 2009, SIMPD estimates that there are over 5000 physicians nationwide, most of which are not SIMPD members. SIMPD offers many member benefits including national care networks, discounts for direct practice doctors on malpractice insurance, annual meetings and many more.
In late 2009, early 2010, SIMPD changed their name to the American Academy of Private Physicians or AAPP.
Controversy
The concept of concierge medicine has been accused of promoting a two-tiered health system that favors the wealthy,[10] limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. Detractors contend that while this approach is more lucrative for some physicians and makes care more convenient for their patients, it makes care less accessible for other patients who cannot afford (or choose not) to pay the required membership fees.[11]
One physician in a CNN.com article noted that he might not be treating patients at all if he hadn’t made the switch to concierge medicine: "…many doctors are becoming so disillusioned with primary care that they are quitting altogether." Others physicians feel like they can't abandon patients unwilling to pay the additional fee. This was where physician Brent Cohen[12] ended up after considering the model, for example.
Proponents of concierge claim that it meets consumer demand, allows physicians to provide the treatment they deem necessary, and improves quality of care by increasing the amount of time that can be spent on preventive medicine.[13] Preventive care such as lifestyle advice, and follow-up phone calls and emails are not usually reimbursed by insurance. Physicians significantly reduce the number of patients they see in a day, which allows them to spend extra time and attention with each patient. It has also been noted that while some concierge medicine practices do not accept insurance, all of their patients are encouraged to carry health insurance for services utilized outside of the practice.
The hybrid model is an alternative approach to concierge medicine and does not disenfranchise patients or exacerbate the physician shortage. Physicians with a hybrid practice only accept about a dozen patients from their current practice who choose to join the concierge option. Patients who do not want to join the concierge model, do not have to leave the practice and can still see their primary physician as they always have. However in these practices, doctors are awkwardly juggling two classes and a large number of patients. While concierge patients get a special contact number, they cannot truly get the same quality of care as in a pure model since their doctor is still seeing upwards of 1,000 patients.
Some say that concierge medicine is not the solution to the healthcare system’s woes, but is a symptom of "too much emphasis being placed on cost control and too little emphasis on the patient."[10]
In early 2008 it was reported that one health insurer was dropping from their provider networks some physicians who charge an annual fee. Another insurer also expressed opposition to annual fees. Other insurers do not oppose concierge medicine as long as patients are clearly informed that the fees will not be reimbursed by their health plan.[14]
Concierge medicine in popular culture
The USA Network television series Royal Pains focuses on such a doctor's introduction to the practice of concierge medicine.
The Robin Cook novel Crisis focuses on a medical malpractice trial involving a doctor practicing concierge medicine.
See also
References
- ^ University of Chicago/Georgetown University Study
- ^ Daily Finance article quoting AAPP (formerly SIMPD)
- ^ "On Panel Size" Physicians Practice journal, June 2005
- ^ "Cash-Only Healthcare Still Works" Physicians Practice journal, July 2008
- ^ United States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.
- ^ [1]
- ^ "Boutique Medicine: When wealth buys health," CNN.com, October 19, 2006.
- ^ http://www.mdvip.com/patient/yourwellnessplan.aspx
- ^ "The Highly Attentive Approach", Worth magazine, July 2005.
- ^ a b "Your Own Private Doctor," by Mary Duenwald, Departures magazine, November/December 2004.
- ^ United States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.
- ^ "Concierge Medicine" Physicians Practice journal, Feb 2004
- ^ John Abramson, Overdosed America, MD, pgs. 169–194.
- ^ Lynn Cook, "Insurers, doctors at odds over 'concierge' care", Houston Chronicle, March 13, 2008.
External links
Categories:- Healthcare in the United States
- Health economics
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