Bruce Japsen, Contributor | January 30, 2013 | As Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices will start direct pay or concierge medicine in the next one to three years.
New data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, analyzing 2012 practice patterns, found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years.
The movement is across all medical disciplines with 6.8 percent of all physicians planning to stop taking insurance in favor of concierge-style medicine or so-called “direct primary care.”
“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”
The data release comes less than a month after Congress waited until the 11th hour to avoid the fiscal cliff as well as the so-called “doc fix” on Medicare payments. Even though a cut of nearly 27 percent in Medicare payments to doctors was avoided, doctors remain upset at the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate formula also known as “SGR.”
Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.
Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient. It’s what the New York Times last spring called “concierge for the masses” because it was much cheaper than the historically high cost of concierge medicine some Congressional investigators found to be $5,000 to $15,000 a year or more.
“It’s not just for the rich and famous anymore,” Merritt Hawkins’ Smith said of concierge medicine and direct primary care practices. “If you can afford a gym membership, you can afford this kind of care.”
The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).
Under a proposal under consideration by Congress and Medicare officials, a pilot program would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Rep. Bill Cassidy, a Louisiana Republican and physician.
Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending that the concept can provide quality medical care and lower costs.