Inside A Practice

REVIEW: Hybrid Payment Systems and Concierge Medicine

A Better Image for Concierge Medicine?

By McKesson Corporation

JUNE 2013 – The influence of third-party payers in the delivery of care to patients was a driving force in the move to retainer-based or concierge medicine in the 1990s. As the number of physicians offering concierge medicine has increased, hybrid payment models have emerged that allow patients to use insurance benefits for covered services and a retainer fee for extra services. The American Medical Association recently examined claims about the benefits of concierge medicine in their Ethics Forum.

The article acknowledged the benefits of lighter patient loads, more time at each patient visit and more accessibility to patients, fewer physician resources devoted to billing and administration, and lower burnout rates. But the authors questioned its long-term viability in providing solutions for healthcare delivery for most patients. Three drawbacks were highlighted:

  • The necessity for most patients to also carry major medical health insurance coverage and its associated costs, thus limiting participation by lower-income people.
  • The lower patient loads of concierge physicians increases the number of patients seeking care from other primary care physicians, and primary care physician numbers are not increasing.
  • The hybrid payment model adds back at least some of the influences from third-party payers, along with increased administrative resources.

Their conclusion: “Significant questions remain about whether it should be promoted as a model that can meet the needs of most patients in society even with the advent of hybrid models.”


1 reply »

  1. “…hybrid payment models have emerged that allow patients to use insurance benefits for covered services and a retainer fee for extra services.”

    It would seem unlikely that there are enough patients that can ‘go it alone’ in the case of catastrophic illness or injury. So a ‘hybrid’ model would be the normal case.

    But there are numerous medical items and procedures that many people could pay for if allowed to do so.

    Somehow we’ve got to the point where people think everything should be “covered” but can you imagine the relief on the system were people to actually budget for the routine physical, blood-work, etc. and just pay for them when they happen.

    Currently we pay our doctor an annual fee for the so called “concierge” model. The access and consultation provided in this has worked out well for us. But, as the quote above notes, they still use the insurance we maintain as well as Medicare.

    Now, granted we are quite healthy and with not inconsiderable effort maintain a healthy lifestyle. Next step is to get them to abandon the insurance racket for the routine stuff.

    Physicians have to be in the forefront of the evolution of medical and healthcare models. Unless they stand firm as well as become imaginative and innovative, they will end up as government drones working in fields they’re told to as well as where they’re told to. It’s my personal opinion that 0bamacare was designed not to ‘solve’ anything but to finally make the wheels come off a doddering and intentionally inadequate system.

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