JUNE 7, 2013 – Fed up with declining reimbursement from third-party payers, getting the runaround when you follow up on unpaid claims, and the overhead associated with billing and collections? Who isn’t? The hassle factor involved with being a participating provider for insurance companies and Medicare is driving doctors across the country to convert their business model to concierge or direct-pay practices.
The underlying principle of concierge medicine and direct-pay practices is that patients have greater access to their doctor and receive comprehensive outpatient care (usually excluding all but the most basic diagnostic testing) for a flat fee that’s paid either monthly or annually. Physicians who practice under these models typically offer same-day and longer appointments and make themselves readily available to their patients by phone, e-mail, text message and/or Skype. Practices benefit from more consistent cash flow and lower overhead because they’re not dealing with insurance billing and collections. A few doctors who practice concierge or direct care medicine give up their offices entirely and make house and workplace visits to care for patients. Most, however, maintain an office and venture out for house calls only when that’s necessary.
The original concierge practices catered mostly to well-to-do patients who paid their primary care physician a flat annual fee (often in the thousands of dollars) to provide all of their routine, outpatient medical care. These practices are still around, along with others that charge a more modest annual fee coupled with small office visit co-pays, and still others that charge patients a monthly subscription fee.
Hybrid concierge practices have emerged in recent years. In this model, physicians continue to care for patients in the traditional way (including accepting insurance) and also offer a concierge or direct care model for patients who choose that option. This solution allows doctors to continue to care for long-time patients who are covered by insurance or Medicare while, at the same time, provide more personalized service for patients who wish to sign up and pay for the concierge service. Some patients who have insurance elect to pay the fee to be in the concierge pool so that they have more immediate access to their doctor. The downside of the hybrid model is that the office is still dealing with insurance billing and collection issues.
One important issue to consider if you’re transitioning to concierge medicine is whether to opt out of Medicare. This is not a decision to be taken lightly. Once you opt out you can’t submit claims to Medicare for two full years. You must formally inform Medicare (during a certain window of time) and give your Medicare-eligible patients plenty of advance notice about your plans to opt out. You must also have a written agreement with each patient who is eligible for Medicare confirming that you are entering into a private contracting arrangement for care and payment. The American Academy of Family Physicians has a nice summary about Medicare participation on their Web site (revised January, 2013) and sample notification forms.
Source: Medical Arts Press Blog