By – C.J. Miles, MBAHCM, MSA
Research Analyst, AMAC Foundation
Concierge medicine, an alternative to traditional medical practices, is an umbrella term for medical practices with a direct financial relationship with patients. These practices are known by a variety of names including concierge healthcare, direct primary care (DPC), direct care, direct practice medicine, retainer-based, membership medicine, cash-only medicine, cash-only practice, boutique medicine, personalized healthcare, hybrid models, and contract carrying healthcare (Concierge Medicine Today [CMT], 2014a; McDonough, 2013; Tetreault, 2014).
Concierge medical practices typically charge a monthly or annual fee so that the patient receives additional access and personalized care. The range of access and amenities depends on the physician and the fee charged. For example, the patient may receive 24-hour physician availability by having the doctor’s phone number and email, as well as telephone consultations; executive-type physical examinations that last up to three hours long; expedited appointments, such as same-day or next-day appointments and no wait time at the office visit; longer appointments (as per CMT , more than 70% of concierge and DPC physicians have 30-60 minute patient visits); personal visits in the hospital and sometimes in-home visits; follow-up calls after a specialist referral and/or hospital stay; and customized treatment plans including lifestyle and preventive plans (Carnahan, 2007; CMT, 2014a; McDonough, 2013). The VIP concierge physicians are not the only ones out there, like some believe. However, the ones who are VIP offer additional amenities such as luxury robes, shower facilities, personal toiletries, and even cable television and Internet access (Carnahan, 2007).
There are two main types of concierge medical practices – retainer-based (what is commonly known as “concierge”) and direct primary care (DPC). Both of these do not have co-pays, deductibles, or co-insurance fees. Retainer-based concierge practices charge an annual retainer fee for enhanced services. Many of them are hybrid models, meaning that they also accept insurance (CMT, 2014a). “Over 80% of concierge physicians accept insurance in their practice, while the remaining have cash-only, menu-style healthcare practices” (CMT, 2014b, para. 24). DPCs, on the other hand, do not accept insurance so as to reduce overhead costs, which can be as much as 40% of each medical dollar spent. They charge a monthly recurring fee for a defined set of clinical services and avoid unnecessary referrals by referring patients to specialists that are willing to offer significant discounts. However, because of the defined set of services, concierge practices generally provide more services and access than DPCs (CMT, 2014a). Even though pricing structure and operations are a little different, “price transparency, access, affordable rates and the personal level of service provided to each patient is what they have in common” (Tetreault, 2014, para. 24)
Popularity and Growth of Concierge Medicine
Between 2005 and 2010, the growth of concierge physicians rose five-fold to more than 750 doctors (McDonough, 2013). In early 2013, it was estimated that there were between 5,000 and 5,500 concierge and DPC physicians in the United States (CMT, 2014a). In 2014, it has been estimated that the number of these physicians have grown to as much as 12,000+ in the United States. “This data is based upon an in-depth review and recent examination of the national marketplace as well as interviews with corporate industry leaders and marketplace decision makers” (CMT, 2014b, para. 23).
The four states with a very large lead in the number of concierge physicians in practices, as well as consumers seeking their care, are Florida, California, Pennsylvania, and Virginia. In these areas, the franchise concierge fees are increasing and the independent concierge doctor fees are decreasing due to competition (Tetreault, 2014). However, the number of patients seeking concierge medicine far outweigh the number of available physicians, especially in rural areas. According to CMT (2014b), states with high demand but very few concierge physicians include Hawaii, Idaho, Iowa, Mississippi, Maine, New Hampshire, South Dakota, North Dakota, Louisiana, and Alaska.
The most common specialty for these types of practices is obviously primary care with family medicine a close second. The next top two specialties are cardiology and pediatrics (CMT, 2014a). In 2011, specialists were growing in numbers in concierge medicine, which include general surgery, psychiatry, spine surgery, gynecology, dentistry, addiction medicine, dermatology, oncology, and the cardiology and pediatric specialties already mentioned. Specialists offer the same increased access and patient attention as the primary care concierge doctors and tend to have patients with chronic conditions. The main difference is that the primary care concierge physicians tend to have a patient load of 300-750, whereas the specialists tend to have a patient load of 150-300 (CMT, 2014b).
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