Concierge Medicine – Is it For You?

The last time you called your doctor’s office, how long did you have to wait for a reply? How long do you usually have to wait to get an appointment or wait for a prescription to be called in? When you get to the office, how long do you spend in the waiting room and how much time does the doctor spend with you?

Did you get all your questions answered? How many seconds do you have in the beginning of your appointment to explain your symptoms before you are interrupted? Do the nurses and doctors seem to be more interested in their computers or their charts than they are to you?

If your experiences are like most people, your answers to these questions are not very flattering to the medical profession and to the health care system in general. Most doctors don’t really want their practices to be like this, but they don’t have much choice. They have to have a high volume of patients in order to make ends meet financially. The high volume makes the clinic a very busy place and most patients don’t feel like they get much attention.

In 1996 in Seattle, a doctor named Howard Moran thought there should be a better way to do this. He pioneered the concept of having a lower volume practice with highly attentive medical care provided as a service for patients in return for a retainer fee, much like many attorneys or accountants use. This fee may be in addition to, or in lieu of, the regular office fees that are billed to insurance companies. This concept allows the practice to remain financially solvent while providing better, more attentive medical service to its low volume of patients (usually keeping the patient count down to about one tenth of the number in a typical traditional primary care practice).

Unfortunately, health insurance companies currently don’t pay for this type of service, so that means the patients have to pay this out of pocket, but if the service is good, it may be worth it. Patients who join these practices are encouraged to keep their usual insurance which they will need for visits to other specialists, laboratory testing, radiological testing and/or hospital services if needed.

Many concierge practices offer same or next day appointments, no long waits for appointments or prescription refills, direct access to your personal physician day or night, house calls if necessary, continuing care if hospitalized, complete physical examinations, audiometry screening, cardiovascular and cancer risk screening, more attention to preventive care, unrushed appointments, all questions answered, family meetings if needed, coordination of care with specialists, provision of personal health records on CDs or flash drives, etc., etc.

Depending on the type and number of services that are provided, the flat retainer fee can vary widely from one area to the next ranging from $100 to $20,000/ year, most probably averaging around $1500-3000/year. There were only a few hundred of these physicians a few years ago, but there are over 5000 of them now all over the country. Many of them, but not all, are listed at the main website for the American Academy of Private Physicians – http://www.aapp.org/. Patients may be able to find a concierge physician in their area on this site.

There has been some controversy surrounding some of these practices because some authorities feel the growth of concierge medicine will lead to a 2-tiered medical system in this country – one for the wealthy and one for the not-so-wealthy. Also, with the current shortage of primary care physicians (PCPs), with increasing numbers of concierge practices, the number of PCPs available for traditional offices will be even smaller, and access to care for patients served by those practices will suffer. On the other hand, more medical students may become interested in primary care if opportunities in concierge medicine are available to them when they finish their residencies.

Some of these practices have come under fire from insurance companies who say that concierge physicians are basically providing an insurance plan for their patients without having an insurance license to do so. The practices must therefore be legally and financially structured in such a way that avoids this criticism.

Overall, the concept of concierge medicine provides a good alternative to the currently unsatisfying traditional model of medical practice. The fee may seem high to some, but in most instances, it probably isn’t much higher than the cost of the local cable or telephone bill, or about the same as what a family would spend eating out at a restaurant once a week. 

Posted in Uncategorized | Tagged , | Comments Off on Concierge Medicine – Is it For You?

Direct Primary Care and Concierge Medicine – What’s the Difference?

The Difference Between Concierge Medicine and Direct Primary Care

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.

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.

DPC, like concierge health care practices, remove many of the financial barriers to ‘accessing’ care whenever care is needed. There are no insurance co-pays, deductibles or co-insurance fees. DPC practices also do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent (See Sources Below).

Differences

According to sources (see below) 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 low, flat rate fee whereas omodels, (although plans may vary by practice) – usually charge an annual retainer fee and promise more ‘access’ to the doctor.

According to Concierge Medicine Today (MDNewsToday), the first official news outlet for this marketplace, both health care delivery models are providing affordable, cost-effective health care to thousands of patients across the U.S. MDNewsToday is also the only known organization that is officially tracking and collecting data on these practices and the physicians — including the precise number of concierge physicians and practices throughout 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 based in Seattle, Washington. “One in which the provider’s incentives are fully aligned with the patient’s incentives.”

References and Sources

“Doc This Way!: Tech-Savvy Patients and Pros Work Up Healthcare 2.0”. New York Post. 4/7/2009.

Who Killed Marcus Welby? from Seattle’s The Stranger, 1/23/2008

“Direct Medical Practice – The Uninsured Solution to the Primary Medical Care Mess” with Dr. Garrison Bliss (Qliance Medical Group of WA).

“Direct Primary Care: A New Brew In Seattle”. Harvard Medical School – WebWeekly. 2008-03-03.

DPCare.org

Qliance.com

ConciergeMedicineToday.com

Posted in Uncategorized | Tagged , , , , , , | Comments Off on Direct Primary Care and Concierge Medicine – What’s the Difference?