FOR IMMEDIATE RELEASE | Media Contact: (770) 455-1650 | Editor@conciergemedicinetoday.com
ATLANTA, GA | JANUARY 7, 2015 – The Concierge Medicine Research Collective [The Collective – www.AskTheCollective.org], is an independent health care research and data depository of the Concierge Medicine and direct primary care industry’s trade publication, Concierge Medicine Today based in Atlanta, GA released a 10+ year summary of its analysis of the known tort cases in the field of Concierge Medicine and Private, Direct Practice healthcare marketplace in the form of a new Infographic. Several of the points are included below.
- The HHS’ Office of the Inspector General (OIG) published the results of three investigations from 2003-2013 related to the overcharging of Medicare patients.
- In a fourth case, according to several news reports in early 2015, a Florida jury awarded an $7 million judgement against a Florida doctor in a case that may have hinged on marketing practices as much as it did on medical malpractice.
- Details of the cases and a high-level comparison can be found in a educational Infographic provided by The Collective at www.AskTheCollective.org or www.ConciergeMedicineToday.com.
While several factors inside of practices may reduce the likelihood of medical malpractice suits, Concierge Physicians can still be sued by patients, albeit uncommon. In all likelihood, there are additional malpractice cases that could be directly related to an individual physicians record within the National Practitioner Data Bank (NPDB), a confidential information clearinghouse created by Congress to improve health care quality, protect the public, and reduce health care fraud. It contains information on medical malpractice payments and certain adverse actions related to health care practitioners, entities, providers, and suppliers. Federal law specifies the types of actions reported to the NPDB, who submits the reports, and who is allowed to query to obtain copies of the reports. Organizations must be authorized according to federal law to submit reports and/or query the NPDB. Organizations authorized to access these reports use them to make licensing, credentialing, privileging, or employment decisions. Individuals and organizations who are subjects of these reports have access to their own information. The reports are confidential and not available to the public.
As it pertains to the practice of Concierge Medicine, these are the previous cases that have been published by the OIG and the media related to these business models from 2003-2015. Sources close to Concierge Medicine Today note that because there is no official federal or state registry, it is hard to pin down exactly how many physicians have switched to Concierge or direct-pay practices. Today, it is estimated that as many as 12,000 physicians operate using private subscriptions practice models across the U.S. This estimate is based upon industry interviews with hundreds of doctors, thought leaders, marketplace consultants and investors looking to capitalize in the sector over a period of several years. That is still only a minute [mahy-noot, -nyoot, mi-] percentage of the roughly 904,500 actively practicing physicians in the United States today. The main growth in private provision of subscription medicine services has been in primary care and family medicine services. 
While growing, it is not for every doctor, and it has its critics. But, it also has its growing, healthy patients too!
While Concierge Medicine and its familial business model companion, Direct Primary Care share similarities, they sometimes vary widely in their insurance participation structure, Medicare participation, payment requirements, and form of operation. Additionally, they differ in the level of service provided, the fee charged and whether or not the practice participate in local and statewide insurance programs. Nationally, direct primary care practice is considerably newer than concierge practice — and there are considerably fewer reported direct primary care practice [although growing according to several reports] than concierge physicians. Many Direct Primary Care physicians surveyed report that they operate and reside in the Northeastern Region, Midwestern Region of the U.S., according to an examination of the marketplace data and polling trends conducted in December of 2015. 
In January of 2016, a online poll conducted by The Collective asked both Concierge Medicine and Direct Primary Care physicians if they participated in Medicare. Approximately 76.92% reported that they opted out of Medicare.  A similar poll was conducted in late 2015 which asked Concierge Doctors “Does Your Concierge Medicine Office Accept and/or Bill Insurance and/or Medicare?” Approximately 49% indicated ” No, Only Cash.” Thirty three percent responded “Yes, My Practice Accepts Medicare and Some Insurance (HMO/PPOs).” Eleven percent said “Yes to Medicare. No to all HMO/PPOs.” Finally, approximately six percent of Concierge Physicians sited that “Yes, My Practice Accepts Insurance but No Medicare.” 
Direct Primary Care is primary and preventative care, urgent care, chronic disease management and wellness support through a monthly care fee patients (or an employer) pay to cover the specific primary care preventative care services. A DPC health care provider charges a patient a set monthly fee for all primary care services provided in the office, regardless of the number of visits. Because the insurance “middle man” is removed from the equation, all the overhead associated with claims, coding, claim refiling, write-offs, billing staff, and claims-centric EMR systems disappears. Direct Primary Care medical practices bypass insurance and go for a more ‘direct’ financial relationship with patients and also provide comprehensive care and preventive services for an affordable fee. DPC is a ‘mass-market variant of concierge medicine, distinguished by its low prices.’ Simply stated, the biggest difference between ‘direct primary care’ and retainer based practices is that DPC takes a low, flat rate fee whereas concierge medicine models, (although plans may vary by practice) – usually charge an annual retainer fee and promise more ‘access’ to the doctor.
Both Concierge and Direct Primary Care practices can be a no insurance business model. Direct Primary Care however, across the U.S., is typically distinguished by its lower monthly membership fee, typically between $50 and $99 per month, according to reports by The Direct Primary Care Journal. Both business models would argue that they save patients money by reducing their need to go to specialists and hospitals because the relationship between physician-patient is improved by time, cost and ease of use. In the past two to three years, new data has been published by several organizations in the industry that support these claims.
For example, in January of 2015, a review of two years’ worth of healthcare claims data on thousands of patients revealed, contrary to the prevailing media reports, that unlimited primary care drives down overall costs while improving patient outcomes and experience. The analysis by Qliance Medical Management Inc. – hailed by TIME magazine as “one of the most intriguing experiments in the medical industry” – reveals that the increasingly popular “direct primary care” model, with its emphasis on unrestricted access to primary care, makes healthcare 20 percent less expensive than traditional health insurance yet leaves patients feeling more satisfied with their care. 
Another such study released by MDVIP in September of 2014 was conducted by UnitedHealth Group division OptumInsight and appeared in the August 2014 issue of American Journal of Managed Care and is consistent with other published findings — finds that a of personalized, preventive primary care medicine model like MDVIP, can significantly reduce hospital visits and costs. Patients say it even improves their quality of life. The two-year study explored preventive healthcare’s ability to improve outcomes by creating a closer, personalized physician-patient relationship and focusing on disease prevention for Medicare Advantage. It’s long been known that patients of MDVIP (Value In Prevention) -affiliated physicians often enjoy improved care at greater savings to the healthcare system. This includes heightened attention to heart disease, diabetes, COPD, obesity and other chronic illnesses. When compared to their counterparts in traditional primary care practices, the 2,300 MDVIP patients studied enjoyed a host of tangible, life-changing and financial benefits. In the first year alone, there was a 20% reduction in emergency room visits for MDVIP members, as compared to non-members. The second year of the study saw a reduction of 24%. The study also found a 19% decrease in the number of inpatient admissions for MDVIP members over the course of two years, when compared to their counterparts in traditional primary care practices. 
“When they become concierge physicians their loss experience improves [by losses, meaning medical liability claims],” says a Senior Vice President of Corporate Strategy and Business Development at a prominent California malpractice firm. “When one becomes a concierge physician they [most likely] go from a high volume practice to a low volume practice [have fewer patients].” It’s also important to add that concierge doctors may have fewer claims because there is higher patient satisfaction.
“It is very likely that the reduction of malpractice premiums for both business models [Concierge Medicine and its mass-market variant, Direct Primary Care, distinguished by its low prices] will grow among carriers,” says Michael Tetreault, Editor of Concierge Medicine Today and its sister publication, The Direct Primary Care Journal. “Some of the larger carriers we’ve spoken with are just beginning to explore the space, its size and buying power. Other sources tell us that roughly half-a-dozen smaller carriers already offer many Concierge Medicine Physicians these discounts. We do believe that in the coming months and years as Direct Primary Care practices grow in both brand awareness and produce similar patient outcome data, more and more Direct Primary Care physicians will receive that same benefit, if they have not already started exploring these options with their carrier individually. Eventually, in the years to come, we do see that many of the subscription models branded by the media today and throughout the past decade will culminate into what is commonly called in other countries Private Medicine Practices.”
Concierge Medicine Today stresses that since the details of an individual’s personal situation are fact-dependent, readers and/or physicians should seek the services of a competent professional and/or attorney. Concierge doctors and direct primary care physicians need to be aware of how to mitigate patient and office staff risk and how to implement steps to avoid a lawsuit or legal action. Typically, failure to develop a Medicare compliant [business] model can lead to significant financial and legal ramifications. Solid compliance work by a competent attorney can avoid Medicare compliance exposure without necessitating opting out of Medicare.
Starting as early as 2007, some medical malpractice carriers have started offering discounts to Concierge Physicians. The Cooperative of American Physicians (CAP) reviewed their records of Concierge Doctors over the past 10 years and in late 2013, told Concierge Medicine Today in an exclusive interview that they found Concierge Physicians had fewer claims than regular physicians. They were providing some Concierge Physicians with up to a 45% discount off their premium. 
For a list of additional carriers who in the past have offered medical malpractice discounts for the operational Concierge Medicine physician office, please contact Concierge Medicine Today by email at email@example.com or visit the Malpractice Section at www.ConciergeMedicineToday.com.
About The Concierge Medicine Research Collective
The Concierge Medicine Research Collective is a research and data depository created by Concierge Medicine Today. The Concierge Medicine Research Collective is an independent health care research and data collection depository of the multimedia news and trade publication, Concierge Medicine Today based in Atlanta, GA. The Collective serves as an educational resource on all things concierge medicine and is geared towards those businesses, lobbyists, physician associations, health care advocacy groups and general consumers of healthcare who want to learn more about information available on the topic of concierge medicine. The Collective works in partnership with Universities, physicians, associations, businesses, individuals and even Graduate Medical Students to further advance the educational awareness and facts surrounding unanswered questions about concierge medicine care in the U.S. and Canada. For more information, visit: http://www.AskTheCollective.org.
About Concierge Medicine Today
Concierge Medicine Today (CMT), is the premier news and multi-media organization and the industry’s oldest national trade publication for the direct primary care and concierge medicine marketplace. Their web site is the online destination for business, consumers and physicians to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drive the conversation and generate the national buzz that concierge medicine and direct primary care is creating on a national and international level. For more information, visit: http://www.ConciergeMedicineToday.com.
- Qliance Savings Data – 2013-14; http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html
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