Before You Take The Next Step To Pursue A Concierge Medical Practice Model For Your Practice, Please Consider The Following:
Consider what barriers must be overcome for primary care physicians to move from a fee-for-service practice to a retainer-based Concierge Medicine Practice Model or a direct-pay, cash-only Direct Primary Care (DPC) model?
LAST UPDATED: AUGUST 19, 2015 – In the new health law, retainer-based “medical home” models will be included in the new health insurance exchanges to begin in 2014 (even though they are non-insurance).
Organizations using this model such as Qliance in Seattle are demonstrating they can reduce costs by eliminating insurance overhead and reducing by 50% or more surgical, ER and specialist visits.
However, Before You Take The Next Step To Pursue A Concierge Medicine or Direct Pay Primary Care Practice Model For Your Local Area, We’ve Put Together the Following Four Criteria to Self-Evaluate Yourself and Your Practice Before You Take The Next Steps.
- YEARS IN PRACTICE. Experts within the concierge medicine industry suggest that physicians (of any specialty) should have a minimum of 6 years in private medical practice. However, 10 or more years is preferable.
- YOUR PATIENT PANEL & HOW MANY PATIENTS YOU TYPICALLY SEE PER DAY. According to The Concierge Medicine Research Collective, July 2011, physicians considering a successful move into a concierge medicine practice should have a patient panel of at least 1,800 patients that they’ve seen within the last 24 months. They also recommend that a minimum of 15 patients per day are seen across a 4-day period as the current number that your practice is routinely seeing prior to making a transition into concierge medicine.
- LEGAL ASPECTS to CONSIDER. According to Dr. Samir Qamar, CEO, MedLion, a Direct Primary Care practice with multiple locations across the U.S., he notes “Besides the usual business barriers, the most important factor to navigate is compliance with the law. Not structuring the practice properly can lead to drastic consequences if the model is perceived to be insurance.”“The next issue would be to consider how to either terminate or not renew third party contracts and how long each choice would take,” said Joy Twesigye, a Nurse Practitioner and Health Policy Analyst (www.hopestreetgroup.org). “It is a breach of contract under Medicare to charge Medicare beneficiaries for services covered by Medicare. The last and most important issue is regulatory. Each state has different statutes and a retainer-based/Concierge practice must be careful in contract wording to not have patients paying prior to care is provided (otherwise you may accidentally be construed as starting an insurance company). This is why most of these models use “membership fees” that are separate from charges for services rendered at time of visit. We lay out specifics on how to foster an environment in which innovative practice models, payment structures, and advances in technology can be tested, measured, and diffused more rapidly at: http://www.hopestreetgroup.org/d… The GAO report may be accessed here: http://www.gao.gov/new.items/d05929.pdf An example of an affordable concierge practice may be accessed here: http://www.nytimes.com/2011/02/01/health/01medical.html”
- MARRIED or UNMARRIED? Many physicians and their spouses work together in the same office. The Concierge Medicine Research Collective (April 2011), found in the practices surveyed and interviewed that changing your business model requires the joint agreement of both spouses, whether they work together or not. If your spouse is not in agreement with the change, a transition to a concierge medical practice is not recommended.
- SOCIO-ECONOMIC PROFILE of YOUR CURRENT PATIENTS. According to Concierge Medicine Today, Summer 2011, while over 63% of current concierge medical programs cost less than $135 per month, the socio-economic profile of patients in successful concierge medicine practices typically consists of middle class / affluent individuals and families.
- AGE RANGE of CURRENT PATIENTS. According to industry consultants, more than 50% of your current patient-base (last 24 months) should be 40+ in order to start, sustain and grow a successful concierge medicine practice in the future. (Source: Concierge Medicine Today, Spring 2011)
- Technology, Marketing and Collection Barriers. Natalie Hodge, a physician and thought leader in this sector says: “There are a number of barriers to implementing direct [or Concierge] practice. In short, they are technology barriers, and these are multiple, so one must have an integrated platform of health IT.”
Hodge adds “The second major barrier is marketing, customer discovery and validation of pricing.”“The Third is collections, as you will need some methodology to create streamlined money flow from patients into your bank account. The list of Health IT platforms that also enable streamlined direct practice collections is very short. The Fourth is legal, as physicians are making the transition from a variety of third party contracts. Direct collection of money from patients violates these contracts, in particular Medicare is a felony offense. More about Direct Practice conversion and new business model creation at www.personalmedicine.com,” notes Hodge.
- LOCATION. Joy Twesigye, a Nurse Practitioner and Health Policy Analyst (www.hopestreetgroup.org) says “the PCP must determine that their current location would support such a model and at what price point. According to a GAO report, annual patient membership fees in concierge practices ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500 to $1,999. Further analysis from Concierge Medicine Today and The Direct Primary Care Journal, trade publications and thought leaders in this healthcare sector note that …
In Concierge Medicine … most fees are billed annually and are between $125-$225 per month, per patient. These practices usually accept/participate in insurance as well as charge an annual retainer for services not covered by insurance or Medicare. Typically, the price justifies the level of care, convenience and services offered by the practice and is usually outlined in the patient-physician contract which a patient signs each year upon joining the practice. Typical services offered in a Concierge Medicine practice can be found at www.ConciergeMedicineToday.com.