MDVIP: “I don’t think we’re anywhere near the saturation level in any market,” said Dan Hecht, the company’s chief executive officer. “The more we do, the more interest there is from patients.”

Concierge medicine cuts patient load, red tape for primary-care doctors

Published: 13 December 2013 11:07 PM –The patients slowed to a trickle, and the doctor’s income was cut by 25 percent.

Still, Dr. Paul Cary, a Dallas internist, does not regret changing his traditional primary care practice three years ago into a concierge model, which charges patients an annual fee.

innovators“The overall picture hasn’t changed in terms of the doctor and patient satisfaction,” he said. “I get more time with my patients, and everybody is happy.”

Cary whittled his 2,500 patients to about 400 by joining MDVIP, a national network of concierge doctors. The company is owned by Procter & Gamble and based in Boca Raton, Fla.

Most of his patients left rather than pay Cary an annual fee. Some signed on with the other doctors in his group, although a second physician recently joined MDVIP, causing further patient shuffling.

In the Dallas area, MDVIP’s annual fees range from $1,500 to $1,650 for patients of the 17 doctors enrolled so far. And the network is likely to grow.

concierge medicine MDVIP“I don’t think we’re anywhere near the saturation level in any market,” said Dan Hecht, the company’s chief executive officer. “The more we do, the more interest there is from patients.”

Patients lose doctors

For more than a decade, concierge medicine has been an attractive alternative for primary care doctors, who tend to receive the lowest compensation of all physicians.

“It’s all about the quality of the work life,” said Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School. “Primary care doctors are asked to do many things, work long hours.

“Often, they’re in practices that don’t work very well, with lots of paperwork, being on call and needing prior approval by insurance companies.”

Primary care doctors made up the lowest-paid categories in Medscape’s 2012’s compensation survey. Family medicine physicians averaged $175,000 last year, and orthopedic specialists earned $405,000.

Concierge care is a rational response to a system that’s not working well, by creating additional pay,” Phillips said. “But 1,700 patients lose their doctor everytime one of them joins MDVIP in the Boston area. It’s a threat to our health.”

concierge doctor directoryDoctors receive an annual fee of about $1,100 per patient from MDVIP, which promises an annual infusion of about $660,000 into any practice that reaches the optimal size of 600 patients.

But Hecht noted that every MDVIP doctor runs his or her own practice and pays overhead costs and staff salaries from the patient fees and any other insurance billing. The doctor gets only what’s left from that.

Hecht rejected the idea that doctors are opting for these smaller practices simply to raise their incomes.

“It is not about the money,” he insisted. “We do hope they’re making the same or even better. They do it because they want to deliver great patient care and they are frustrated.”

Transition help

MDVIP’s share of the patient fees covers the transition cost of turning a regular physician practice into a concierge model. The company stations an employee in the doctor’s office to explain the change, which takes about four months to accomplish.

Patients are told the benefit of staying with their doctor’s practice, which includes easier access and a complex annual physical not typically covered by insurance.

“If you’re on Medicaid, the average person probably can’t afford it,” Hecht said. “But average to upper incomes certainly can. It’s more of that priority choice. If people can afford to smoke, they can afford MDVIP.”

concierge doctor guideNearly 700 doctors have been recruited to join the company’s national concierge medicine network since the company formed in 2000.

“We reach out to doctors who we think will be right for our model,” Hecht said, describing the process as a courtship of phone calls and office visits by company representatives. Sometimes an MDVIP doctor will help in the bidding.

Getting into the network involves a detailed analysis of the physician’s practice, including patient demographics such as ZIP codes in affluent and middle-class areas.

Patients also are contacted to determine their loyalty to the doctor, which translates into their likelihood to stay with the practice.

“We turn away nine out of 10 doctors,” Hecht said of the analysis, which concludes with a fairly reliable income estimate for the doctor.

“The doctor starts on day one with a successful practice,” he said of going into concierge medicine.

While Cary, the Dallas doctor, lost income when he made the change, it has been a good transition, he said.

Fewer patients and a shorter workday have persuaded him to continue working even though he has turned 65.

“I enjoy what I’m doing,” Cary said. “This practice has become so much more enjoyable that I will continue doing it.”


2 replies »

  1. There is definitely room for growth in concierge and direct pay medicine. I don’t believe we have come close to seeing the peak of the curve in this payment model. As networks get challenged for dominance in the market by value-oriented, lifestyle friendlier services , you will see many folks abandoning traditional health plans in favor of other means of obtaining routine medical services.

    One of the main criticisms of Direct Pay Medicine or Concierge care is probably one of the easiest to counter and has the least economic credence. Some claim, as alluded to by a Dr. Phillips from Harvard in this article, that 1,700 patient lose their doctor when a PCP transitions to Concierge. This is nonsensical on several levels. Doctors transition in and out of networks all the time. You never hear any talk of abandonment issues when doctors drop a network OR are not renewed by the carrier. The affected patients in their panel chose another network doctor and move on. Doctors don’t get criticized or singled out because they are still operating within the sanctioned third-party system; still members of the country club, so to speak. The same third-parties are criticized heavily for micromanaging benefits, but when doctors find better and CHEAPER ways to render care that involve dropping out of the network, you would think they refused Mary & Joseph a room at the Inn.

    Does going Concierge squeeze the system a little? Sure it does at first and it’s supposed to. Any emerging market or new technology is disruptive to the mature markets that it is merging into. Patient demand on networks give patients choices and give doctors leverage. Since when do third-party networks have a monopoly on rendering and financing medical care? They do not. Furthermore, if a doctor and patient wish to enter into a contract without a third-party, then they should have the freedom to do so.

    This is not nearly as much about higher incomes as much it is a desire to maintain autonomy and protect the doctor-patient relationship. Doctor’s incomes usually don’t go up right away after a transition to concierge or Direct Pay; in fact, depending on panel size, sometimes they never get back up to the level the did prior to the conversion. Still, though, incomes are good without all the billing costs and third party profit built into the old system. That fact that doctors can still make a reasonable income, see fewer patient, spend more time with them and do it more efficiently (less total cost for primary care component) is a good thing for society and our economy. It is one of the few areas in medicine that could actually bend the cost curve down. This is true about direct pay in general. Show me an area where third party payments have been eliminated and I will show you an area of medical care where prices have fallen relative to where there is third party dominance.

    Finally, as panel sizes normalize to sane levels under direct care models and doctors realize they can take better care of patients and still make a reasonable income, it will attract more primary care physicians to take up the slack.

  2. CMT reports that starting in January 2014 will kick-off the most significant month in the industry’s growth, a Tipping Point. While most news reports are focused on the problems with and the online health marketplaces launched in October 2013, a growing number of people have found another option.

    Call it “Boutique Care” or “Direct Primary Care (DPC)”, but it’s best known as concierge care. Generally, patients pay a monthly fee like a gym membership. And what do they get? A physical, 24/7 access to their doctor and often a number of other benefits. Initially such “highly cost medicine” came at a very high price, ranging upwards of $5,000 to $10,000 per patient per year. Today, over 62% of the fees touted by direct-pay or concierge medicine doctors cost patients less than $135 per month, according to Concierge Medicine Today’s research arm, The Concierge Medicine Research Collective.

    When most people sign up with a concierge doctor is in January through March of each year. September is also a popular month each year for concierge medicine and DPC enrollment too. Now offered by over 5,500 physicians throughout the U.S. and growing, finding a physician in your local area will be important.

    Priscilla in Ohio is searching for a more affordable, accessible healthcare option and tells Concierge Medicine Today (CMT) “Not often does one have the opportunity to have this kind of doctor that you feel is affordable and a real part of your life.”

    She’s not alone either. It’s open enrollment time, the autumn period when many with employer-sponsored health insurance decide which plan they will choose for the coming year.

    “I’m a self-pay patient,” says Eric in Millersport, OH. “Apparently, the modern health care business model no longer knows what to do with people like me. I’m a person, not a set of billing codes. I shouldn’t have to deal with 4 separate bills from one trip to the Doctor. I shouldn’t have to jump through hoops to find out what my lab work is going to cost just so that I can pay for it on the same day I get the work done. My medical care should be between me and my doctor. I see no reason why there need to be a half dozen corporate bureaucrats involved. I think you get the drift.”

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