A History of Concierge Medicine
Editor’s Note: This is by no means an all-inclusive, every single detail about all of the things that have occurred in this unique healthcare delivery space. It is a summary of many of the highlights however. When possible, we’ve tried to provide links to the stories, web sites, press releases, research, studies and organizations for you to learn more. We recognize a lot has happened in the past 20+ years. And, it’s virtually impossible to capture every moment in one document or on one page. It’s also important to note that within the past 5 to 10 years here in Concierge Medicine and Subscription-based healthcare delivery have been some the most eventful years in the space of Concierge Medicine which have helped cement the private-pay membership medicine model into our vocabulary. More news of Physician’s entering this space and educational headlines continue to circulate across the news wire. From The New York Times to The Wall Street Journal and everywhere in between, Concierge Medicine is now a a familiar term that Patients and Physicians alike are learning to understand why this is an important part of our healthcare ecosystem. Finally, as you may be aware, this document is routinely updated, may have imperfections, but we at Concierge Medicine Today, LLC., do our best to routinely edited, correct and keep this ‘Abridged History of Concierge Medicine’ updated each year as accurately as possible with links to the original sources if we can find them. Therefore, if we missed something or you think we should add something, please, let us know by emailing us directly at editor@ConciergeMedicineToday.com. Thank you!
Bringing History Back To Life. What the Patient-Physician Relationship Used to Be …
“When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’” said Michael Tetreault, editor in chief, Concierge Medicine Today (Source: Comstock’s Magazine; March 2014; Article: Convenient Care: How concierge medicine is changing the health care marketplace)
Abridged History Of Concierge Medicine And The DPC Healthcare Marketplace.
1996: Dr. Howard Maron and Scott Hall, FACP established MD2 (pronounced MD squared) located in Seattle, Bellevue, WA and Oregon. They charged an annual retainer fee of $13,200 and $20,000 per family.
1999: Medical Professionalism Project-consisting of members of the internal medicine community, including representatives of ACP and the American Board of Internal Medicine, set out to draft a charter that could serve as a framework for understanding professionalism.
1999: Institute of Medicine releases the now famous report of medical errors, Patient safety, and professional integrity that caused further probing in physician exam rooms.
2000: Virginia Mason Medical Center in Seattle, WA began operating concierge medical services within its facilities and used some of the profits from the 5 physician practice to subsidize other programs and indigent care services.
2000: MDVIP, founded by Dr. Robert Colton and Bernard Kaminetsky, in Boca Raton, FL. A brand of Concierge Medicine practice and management firm which has set-up more than 700 concierge medical practices with offices in almost every State across the U.S. Update: In April 2014, Procter & Gamble announced the sale of MDVIP to a private equity firm, Summit Partners.
2001: American Medical Association writes concierge physician guidelines: PRINCIPLES OF MEDICAL ETHICS.
2001: July 04, 2001 · Seattle Post Intelligencer Seattle Post Intelligencer In Retainer Medicine, the Doctor is Always In; The idea started five years ago when Dr. Howard Maron, former team doctor for the Seattle SuperSonics, started MD2 (pronounced “MD squared”) with his partner, Dr. Scott Hall …
2002: ACB Foundation , ABIM Foundation and the European Federation of Internal Medicine defines ethical principles and responsibilities contracts between Patient and physician, which is in a language that suggests both parties have equality, mutual interest and autonomy.
2002: Medicare addresses Concierge Medicine and retainer fees.
2002: Centers for Medicare and Medicaid, CMS, outlined its position on concierge care in a March 2002 memorandum. The memorandum states that physicians may enter into retainer agreements with their Patients as long as these agreements do not violate any Medicare requirements.
2002: Pinnacle Care establishes Patient care with a one-time membership fee for access to VIP service.
2002: The AMA counsel on medical services issued a report in June 2002 on Special Physician-Patient contracts. It concluded that retainer medicine was a very small phenomenon.
“When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’”
~Michael Tetreault, Editor in Chief, Concierge Medicine Today
2003: American Society of Concierge Physicians was founded by Dr. John Blanchard. The association later changed its name to SIMPD, Society for Innovative Practice Design.
2003: AMA issued guidelines for boutique practices in June 2003.
2003: Department of Health and Human Services rules the concierge medical practices are not illegal and the federal government the OIG, Office of the Inspector General, takes a decidedly hands off approach.
2003: American College of Physicians writes doctors struggle to balance professionalism with the pressures of everyday practice.
2003: June 2003 the AMA Council on Ethical and Judicial Affairs outlines guidelines for “contracted medical services”. The AMA House of Delegates approves these guidelines.
2004: GAO, General Accountability Office writes 146 concierge physicians in the U.S.
2004: Harvard University study finds that 55% of the respondents are dissatisfied with their health care, and 40% of that 55% agreed that the quality of care had worsened in the previous five years.
2005: The AOA, American Osteopathic Association adopts not to recommend and an official policy on concierge care.
2006: MDVIP, a concierge physician practice management firm, reports that 130 physicians within their network treat up to 40,000 Patients worldwide.
2007: Concierge Medicine Today, a concierge medical news agency opens its doors to be an advocate for news pertaining to the Concierge Medicine, retainer-based, boutique, private medicine and direct care industry.
2007: The term “direct practice” was first used in legislation in Washington in 2007 that clarified these practices were not insurance companies under state law-but they do provide basic, preventive medical care.
2008: Boasting an estimated 35 concierge physician practices, Orange County, CA appeared to be a leading hub of Concierge Medicine.
2008: Concierge Physician of Orange County (CPOC) – a non-profit group of existing concierge physicians was founded.
2009: Concierge Medicine Today (CMT) announces the formation of The Concierge Medicine Research Collective, a analytics and advisory arm of CMT based in Atlanta, GA USA.
2009: Concierge Medicine Today reveals that concierge medical practices across the U.S. are thriving in a recession.
2009: Procter & Gamble Acquired MDVIP in 2009 – No less a respected corporation than Procter & Gamble (NYSE: PG) has staked out a major presence in Concierge Medicine. In 2007, P&G acquired a 48% stake in MDVIP, a Concierge Medicine company that was formed in 2000. Then, in December 2009, Procter & Gamble acquired 100% ownership in MDVIP for an undisclosed sum. This acquisition was reported by Dark Daily. (See “Boutique Medicine Venture Generates Marketing Intelligence for Procter & Gamble,” April 5, 2010.)
2010: SIMPD reorganizes, expands its vision, and rebrands itself the American Academy of Private Physicians (AAPP).
2010: Concierge Medicine Today reveals the affordability of concierge medical and private medicine practices across the U.S. stating that over 62% of the programs offered to Patients cost less than $135/mo.
2010: American Academy of Private Physicians (AAPP) forms first local chapter in Orange County, California called AAPP,OC (formerly CPOC)
2010: According to a 2010 American Academy of Family Physicians survey, three percent of respondents practice in a cash-only, direct care, concierge, boutique, or retainer medical practice.
2012: December 2012 – Study Proves Dramatic Reduction in Hospitalizations & $300 Million Savings for MDVIP’s Personalized Healthcare Model
2013: Three Year Analysis of Concierge and Direct Care Medicine Shows Encouraging Signs For Boosting Primary Care In U.S. Economy. Data collected from Concierge Medicine and DPC doctors show encouraging signs across the U.S. from December of 2009 to December of 2012.
2013: New Data on Concierge Medicine Physician and DPC (DPC) Clinician Salaries and Released by Concierge Medicine Today. Data also looks at career satisfaction among Concierge/DPC physicians.
2013: On August 2, 2013, the Dare Center, Seattle, WA, invited concierge physicians, hospital administrators and medical center executives from across the country to participate in a roundtable discussion. This inaugural event took place at the Washington Athletic Club in Seattle.
2013: Family Physicians, Patients Embrace DPC … AAFP Recognizes Benefits, Creates DPC Policy
Is it worth it?
Since concierge medicine is not insurance (it wouldn’t cover a trip to the hospital) many patients combine it with a high-deductible plan. Tetreault suggests that consumers think of health insurance more like auto insurance or fire insurance; it should be used for emergencies, not the day-to-day. You wouldn’t use car insurance to change your oil, rotate the tires or buy wiper blades. In the best-case scenario, the sum of the concierge fee ($150/month, for example) plus the bare-bones premiums for a high-deductible plan ($110-ish, theoretically) would pencil out to less than $328 per month, or what the Department of Health and Human Services cites as the “average” cost of health care.
~Comstock’s Magazine, April 1, 2014
2013: The DPC Trade Journal Launched. The DPC Journal works directly and indirectly with physicians, businesses and leaders, journalists and the media in the healthcare marketplace to help promote the distribution of news and information, policy initiatives and to reach out to physicians throughout the United States. DirectPrimaryCare.com.
2013: First National Gathering Focused On DPC (DPC) Held In St. Louis: October 11-12, 2013.
“This is the first national gathering of businesses and individuals interested in DPC,” says Dr. Erika Bliss, a Family Physician at Qliance Medical Group of WA and President/CEO of Qliance Medical Management Inc. “DPC is quickly becoming an important contributor to the transformation of our nation’s healthcare system. This conference will bring together key stakeholders to learn more about DPC and discuss its place in the future of medical care delivery.”
“The DPC National Summit will bring together physicians, business leaders, policymakers and others from across the country,” added Bliss. “DPC providers and supporters share the common goal of contributing meaningfully to the improvement of healthcare for all, and by building connections among like-minded people; we hope to accelerate progress toward that goal.”
Overall, Concierge Medicine and DPC are thriving in major metropolitan markets. Four states that have a huge lead in the amount of active concierge or private-pay physician’s in practice as well as consumers seeking their care are: Florida, California, Pennsylvania and Virginia. Each of these States have a significant number of people, most are over the age of 50, seeking out Concierge Doctors and cash-only options. Fortunately, a sizeable number of Concierge Doctors are available to serve them, which is not the case in the more rural parts of the country.
Of great benefit to consumers, prices are dropping significantly due to increasing competition among physicians entering the marketplace, retail medicine pricing, price transparency demand from Patients and uncertainty about the implications of the Affordable Care Act. The Affordable Care Act has also created quite a bit of uncertainty among both Patients and doctors. The shoe has most certainly dropped and now more doctors than ever are considering a career in Concierge Medicine, DPC and retail healthcare.
2014: New Association Formed, American College of Private Physicians (ACPP): Group to Focus on Credentialing Doctors, Advocacy to Employers, Unions, Government and the like to benefit industry nationwide.
2014: P&G sells concierge medicine unit: P&G CEO — ‘Since returning as CEO last year, A.G. Lafley has said P&G will exit ventures that won’t help it grow.’
2014: MD² commemorates 18 years of practicing highly personalized care; March 7, 2014
2014: MDVIP to be Acquired by Summit Partners — ‘MDVIP will continue to be run as a stand-alone company …’ [May 2, 2014]
2014: IRS asked to clarify HSA rules in letter: On June 17, 2014, Members of Congress wrote Commissioner of Internal Revenue John Koskinen asking for clarification on how the Internal Revenue Service (IRS) treats DPC Medical Homes with regard to Health Savings Accounts (HSAs). Senator Maria Cantwell (D-WA), who authored ACA Sec. 1301 (a) (3), allowing DPC practices to participate in health exchanges with Qualified Health Plans, took the lead on the letter and was joined by Senate Budget Committee Chairman Patty Murray (D-WA) and Rep. Jim McDermott, MD (D-WA), ranking member of the Ways and Means Subcommittee on Health. The three WA state lawmakers point out that The ACA rules on the Establishment of Exchanges and Qualified Health Plans Part I (CMS-9989-F) promulgated by HHS, clearly state that DPC is not health insurance, and that the law has its roots in a provision in WA state law (48.150RCW) defining DPC as a health benefit outside insurance. IRS Continues to give guidance that DPC plans are considered health plans under Sec. 223 (c) of the Internal Revenue Code (IRC), which prohibits HSA account holders with high deductible health plans from having a second “health plan.” DPC members have met with officials in the Department of the Treasury and continue to work with the administration and Congress to change the IRS definition so that DPC fees are qualified medical expenses under Sec. 213 (d) of the IRC and can be offered as a benefit complimenting Health Savings Accounts (HSAs) paired with high deductible health plans.
2014: Second National Gathering Focused On DPC (DPC) Held In Wash., DC. June 2014.
2014: DPC United, a new DPC Physician Association, launched by Dr. Samir Qamar of MedLion announces that it will provide resources for DPC physicians and consumers.
2014: Michigan DPC Bill Introduced as Louisiana Passes Law: On September 9, 2014, Michigan State Senator Patrick Colbeck (R-Canton) introduced S.B. 1033, a bill to amend the MI state insurance code to clarify that a DPC agreement is not subject to state insurance regulation. DPCC has provided resourced to Sen. Colbeck, and we are watching developments in state legislatures around the country as they prepare for the coming sessions. This summer, Gov. Bobby Jindal (R-LA) signed similar legislation; Senate Bill No. 516, making Louisiana the latest state to create law to define DPC practices correctly outside the scope of insurance regulation. Stay tuned for further updates as the legislative sessions kick off in this coming January.
2014: DPCC member Iora health recently announced an exciting new partnership with Humana to treat Medicare Advantage patients in Washington and Arizona. According to the Iora release, “The partnership launches Iora’s unique health care model in Arizona and Washington where Iora Health will open four new primary care practices – two in Phoenix and two in Seattle – under the Iora Primary Care brand. The primary care practices are designed exclusively for Humana’s Medicare Advantage members and will provide members access to affordable, quality care.”
2014: New Study Conducted by Optum and MDVIP Finds Personalized Preventive Care Significantly Reduces Healthcare Expenditures Among Medicare Advantage Beneficiaries
2014: September 2014, American Academy of Private Physicians (AAPP) Course Corrects Physician Association, citing that the industry’s association is focusing on five key areas. Those include: legal compliance for doctors, innovative learning tracks at national meetings, physician networking, legislative and lobbying initiatives and staying up to date on new and emerging technologies…
Your ability to withstand the pressure and overcome the obstacles of uncertainty
and potential failure and see the other side before others do is what makes a successful concierge [direct-pay] physician
“There are no insurance codes for ‘cure,’” says Dr. Garrison Bliss of Qliance, based in Seattle, WA.
2014: In October 2014, at the AAFP Assembly, a DPC Track is added to the agenda in Washington, D.C. It was called the “Health is Primary” initiative, a key business model for success touted by the AAFP (American Academy of Family Physicians).
2014: MD² Expands, Granting Access to Two New World-Class Medical Institutions; November 2014
2014: Washington State OIC issued DPC Outlook in Washington State. The OIC report insinuated that DPC is losing ground in terms of patients and that our monthly fees have been climbing (presumably as we head toward concierge medicine pricing).
2014: In reply, The DPC Journal assimilated a DPC leadership response to the Washington State OIC Report publishing for legislators, payers, physicians and the like: ‘DPC Leadership Response To Washington State OIC Report: ‘Outlook for DPC is bright throughout U.S.’
2014: The DPC Journal releases its industry-wide definition of DPC, the 5-Minute Guide: What Makes DPC Different From Concierge Medicine. Also releases 2-Year analysis of DPC marketplace data.
2014: (November 4, 2014) Hospitals Take Cues From The Hospitality Industry | By Kaiser Health News
2015: Michigan State Sen. Pat Colbeck, R-Canton, believes the path to providing Michigan citizens with access to higher quality, lower cost health care has been cleared following Gov. Rick Snyder’s signature into law of Colbeck’ s SB 1033 (Public Act 522 of 2014). The new law in Michigan assures physicians who adopt a direct primary care service business model that the administrative burden associated with insurance regulations will not interfere with their treatment of patients. Physicians who offer direct primary care services provide specified services for a monthly subscription fee that usually vary between $50 and $125 per month.
States with DPC Laws: Source: DPCare.org; Current as of January 22, 2015: Washington – 48-150 RCW; Utah – UT 31A-4-106.5; Oregon – ORS 735.500; West Virginia- WV-16-2J-1; Arizona – S.B. 1404; Louisiana – S.B. 516; Michigan – S.B. 1033
2015: Specialdocs, a pioneer and leading Concierge Medicine consulting firm says ‘Cardiology, Endocrinology, Pulmonology, Pediatrics and OB GYN Practices Can Benefit from Conversion to Concierge Model.’
2015: The United Hospital Fund Releases A Report, Convenient Care: Retail Clinics and Urgent Care Centers In New York State.
This report is relevant to Concierge Care and the DPC healthcare space because: Although based on a small sample from a single group practice in Minnesota, the study found that patients who visited retail clinics had lower total costs than matched patients who visited the acute care clinic (Rohrer, Angstman, and Bartel 2009). A more recent study of adult primary care patients, also in Minnesota, found that the odds of return visits for treatment of sinusitis were the same whether patients received care at a retail clinic or in a regular office visit (Rohrer, Angstman, and Garrison 2012).
Perhaps more telling, a larger study of spending patterns of CVS Caremark employees found a significantly lower total cost of care in the year following a first visit to a retail clinic compared to costs incurred by propensity score-matched individuals who received care in other settings. In total, retail clinic users spent $262 less than their counterparts, with savings stemming primarily from lower medical expenses at physicians’ offices ($77 savings) and reduced spending for hospital inpatient care ($121 savings). Retail clinic users also had 12 percent fewer emergency department visits than their counterparts (Sussman et al. 2013). The UHF saw nothing analogous on the impact of urgent care centers on total costs, but one study found that initial use of an urgent care center significantly reduced emergency department visits without increasing patient hospitalizations (Merritt, Naamon, and Morris 2000). Those results should be cautiously interpreted, however, given the study’s design limitations.
Conversely, in September 2014, the MDVIP model also was shown to have saved some $3.7 million in reduced medical utilization for the 2,300 MDVIP Medicare Advantage patients over two years. Savings were $86.68 per patient per month in year one, and $47.03 per patient per month in year two, compared with patients who did not join an MDVIP practice. 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.
2015: PinnacleCare, a leading health advisory firm, studied the impact of an expert second opinion on medical outcomes.
Researchers collected data on 1,000 cases over a three‐year period and found that almost 77 percent of medical interventions led to changes in diagnosis, treatment, and/or treating physician. PinnacleCare gathered data on patient outcomes from their interventions over a three‐year period. In a sampling of 1,000 cases with known outcomes from 2012‐2014, 41% resulted in transfer of care to a COE or expert provider with 34% resulting in a change in diagnosis, treatment, and/or course of care. A total of 18 patients were able to avoid unnecessary surgery as a result of a PinnacleCare intervention.
The data demonstrates the potential for health advisory services and second opinions to optimize outcomes and avoid needless expense. One of the persistent challenges in health care today is access to expert physicians. With consumer directed health care plans, the value of health advisory services becomes even more evident as consumers struggle with vetting appropriate providers and treatment options for their complex conditions while seeking timely access to the care that they need. PinnacleCare is committed to providing objective, concierge‐ level support with the expert resources and access needed to help consumers tackle these complex challenges.
2015: The DPC Journal to release its 2015 Annual Report and Market Trends Analyses In The First Quarter of 2015
2015: The DPC Journal releases physician insight gathered in a 2015 Industry Guidelines Proposal To Insurers and Legislators, Second Quarter 2015
2015: (December 2015) In 2015, fewer than half of the direct practices chose to report voluntary information. Some said they do not collect this information, and others simply did not respond to the supplementary questions. The bill requires the Office of the Insurance Commissioner (OIC) to report annually to the Legislature on direct health care practices. Under RCW 48.150.100(3), this includes but is not limited to “participation trends, complaints received, voluntary data reported by the direct practices and any necessary modifications to this chapter.”
2016: (October 2016) National trade publication, Concierge Medicine Today issues industry-wide “Position Statement” on Outdated Physician Referral Methods to Surgeons and Hospitals on Behalf of Patients.
2017: (January 2017) Las Vegas’ Turntable Health Closes | Jan. 2017 | ~Las Vegas Weekly | Leslie Ventura | Wed, Jan 11, 2017 (4:33 p.m.) Turntable Health, a membership-based primary care practice in Downtown Las Vegas, will close its doors on January 31. Touted as an affordable and comprehensive alternative to insurance-based healthcare, the Downtown Project-affiliated company notified its members in December that its services would no longer be available. The member-based model, in which patients pay a flat monthly rate of $80 to receive access to a “wellness ecosystem,” including same- or next-day visits; 24/7 physician contact by phone, email or video chat; health coaching; nutrition, yoga and group therapy classes; and an on-site demonstration kitchen. Read Full Story … Source: https://lasvegasweekly.com/intersection/2017/jan/11/turntable-healths-closure-leaves-downtown-patients/
2017: (May 2017) UnitedHealth shutting down Harken Health May 16, 2017 – Harken Health was never a major player in the insurance market, but its demise ends an experiment that company officials believed would reduce healthcare costs. The company lost nearly $70 million during the first six months of 2016 and never recovered. The closure will be disappointing for those promoting alternative care models as ways to improve outcomes while reducing costs and perhaps increasing patient’s satisfaction. In April 2016, then CEO Tom Vanderheyden told Healthcare Dive the company’s care teams would be “empowered with the time to listen and build authentic and trusting relationship with members.” ~HealthcareDIVE Insight | Les Masterson | May 16, 2017 Read More … http://www.healthcaredive.com/news/harken-health-closes-after-a-year-of-cuts-losses/442849/
2017: (May 2017) The DPC Journal has received multiple confirmations from various sources today [May 17, 2017] that reports from the Puget Sound Business (PBSJ) dated May 16, 2017 are confirmed … Qliance is closing their doors effective June 15, 2017. GeekWire reported today (May 17, 2017 @ 9:46 am) that … In an internal memo from Dr. Erika Bliss obtained by the PSBJ, she said the company was unable to find the funding to last them until they were able to find new contracts. The DPC Journal has confirmed this news as well.
2017: (August 2017) AAPP Board of Directors Votes to Suspend Operations and to evaluate AAPP’s value proposition for 2018 and beyond. They issued the following statements … Article/Story Written By Michael Tetreault, Editor
AUGUST 10, 2017 In a statement released to Concierge Medicine Today by Dr. Pamila Brar, current President of the American Academy of Private Physicians (AAPP) stated “Due to evolving marketplace conditions in the private medicine conference space, our AAPP board of directors voted to suspend operations in 2017 and to evaluate AAPP’s ongoing usefulness and value proposition for 2018 and beyond.”
Formerly known as the Society of Innovative Medical Practice Design (SIMPD) for many years, the AAPP’s presence, conferences and representatives served a limited, but engaged physician audience in unique ways. They focused on five key areas which included: legal compliance for doctors; innovative learning tracks at national meetings; physician networking; legislative and lobbying initiatives and staying up to date on new and emerging technologies. Although AAPP is suspending operations and evaluating the organization’s future, other physician organizations involved in private direct medicine seem to be experiencing strong membership growth.
Throughout an entire career however, physicians are faced with recurring questions related to medical associations: Which associations should I join? Which should I retain membership in? How do you decide which associations to pass on altogether? Simply type in the words ‘medical association’ and 29,200,000 plus results are found on Google alone.
A recent story in Forbes noted that ‘Nonprofits can be a great way for a community to mobilize around a cause, make an impact and deliver services to those in need.’
Following that, in November 2016, Becker’s Hospital Review cited relevant physician association challenges and wrote that nationally, 57.4 percent of physicians are part of a state medical society; 73.8 percent of physicians are members of a national specialty society; 31 percent of physicians are a current Member of the American Medical Association; and finally, 10.1. percent of physicians are a Member of the American Osteopathic Association. 
However, even with so many options today and increasing annual dues, the membership of the American College of Physicians nearly doubled between 1995 and 2009, reaching 130,000 members. The American College of Surgeons, with 77,000 members, has also seen tremendous growth in the past three decades. In June, the American Academy of Family Physicians announced that its membership had reached an all-time high of 100,300. 
So what makes these groups different from others?
Most doctors join medical societies and associations for what they can get, not for what they can contribute. Maybe this paradigm should be reversed, like many antiquated processes in today’s healthcare marketplace. Often the decision to join is influenced by a medical association’s position on hot-button political issues, such as healthcare reform. Many medical associations’ benefits are similar: access to discounts on medical devices; discounts on malpractice insurance; CME credit courses and webinars; hands-on help in choosing an EMR/EHR; participation at national or regional events and conferences; and advocacy for issues affecting members. It’s the last benefit where the difference in associations is generally revealed.
Optimism regarding Concierge Medicine, the delivery of Direct Primary Care and other private medicine business structures remains high among both consumers, executive healthcare professionals and physicians alike. In fact, a recent career satisfaction poll of the private physician community [e.g. Concierge Medicine, Direct Primary Care, Micro Clinic, etc.], reveals that nearly 90% of physicians in this niche community of healthcare professionals are highly satisfied with their career move into these entrepreneurial healthcare delivery business models There are models in which patients pay either an annual membership or monthly fee to be a part of the doctor’s practice.
“I think that this is an exciting time for private direct medicine,” says attorney Jim Eischen, Esq. “With all sorts of stakeholders exploring private medicine solutions: this is no longer primarily a solo or small physician-owned medical practice space. Larger systems and providers, and even non-provider enterprises, are all exploring how to accomplish improved health outcomes with private consumer investment and expanded communication/connection. But there are challenges with how to integrate with the tax code, and with plan requirements.”
However, the trend lines in Direct Primary Care (DPC) for example, reveal that the independent, solo physician is regrouping and possibly consolidating in its service line offering after two DPC groups announced their closures earlier this year . When asked, ‘Will DPC Stay Small? Grow Big? Optimism? What’s in store for Direct Primary Care?’ more than 13% of physicians are hopeful HSA and FSA integration inside DPC will occur to help patients pay for their monthly memberships. Additionally, nearly 18% of respondents to the online poll stated ‘I hope DPC Doctors Can Work/Partner With More Businesses to Save HC Costs …’ and nine percent noted ‘I hope to see the creation of DPC networks for Employer Use (sim. to MCOs) come into the market.’ Self-insured employers are beginning to show interest in the ways in which these models can improve health outcomes and contain costs according to several industry insiders.
“There is no better strategy than a major issue campaign to increase the number of people in an association or professional society,” said Catherine Sykes, Publisher of Concierge Medicine Today, The Direct Primary Care Journal and Concierge Medicine Canada. “If properly managed, associations will use a new issue campaign as an opportunity to expand their sources of information and the number of people involved in that aspect of the work. Most organizations focus on building a membership network and often underestimate the need to build the value of their own organizations while struggling to win on public issues. As in the case of the corn farmer from Iowa, the thought is ‘if you build it, they will come.’”
When nearly sixty percent of physicians in 2017 cite that they took Less than 5 Business Education courses …, certainly associations and physician groups must adapt to the needs of its base. However, Concierge Medicine and its variants operating in the U.S. today work because so many people have made it work. Concierge Medicine and the like, work because a few visioneering physicians broke every standard delivery tradition they knew to embrace the mission of the Golden Rule: Treat others the way you would want to be treated.
“Since AAPP was originally designed to help support self-employed physicians seeking to convert to a private direct model, I think demand for live conferences focused on self-employed physicians limits the draw,” says Eischen. “More web-based education, along with live conferences structured to integrate the entire range of stakeholders, is the probable downstream solution for moving private direct medicine conferences/education forward.”
“Comprehensive Pharmacogenomics for example, is a powerful healthcare innovation,” adds Sykes. “Concierge Medicine is seen by many as providing the ideal delivery model for the future of precision medicine. Used under the guidance and application of a Concierge Physician, these innovative tests can have a predictive effect on patient treatment outcomes. Whole genome sequencing, genetic testing and comprehensive profiling with more than 50 well-established pharmacogenomics genes in a single, cost-effective test can provide medically actionable and clinically relevant data, allowing Concierge Physicians, to make a more informed and thoughtful treatment recommendation for the health and well-being of each patient. Concierge Medicine Today strongly supports use of this innovative testing.”
“Future growth of private direct medicine may not look like the past,” concludes Eischen. “As a more diverse array of stakeholders need to come together to balance how to better integrate private health and wellness services with the traditional diagnosis and treatment services of plan-reimbursed healthcare.”
 – http://www.beckershospitalreview.com/hospital-physician-relationships/112-statistics-on-physicians-under-45-years-old-practice-setting-finances-future-plans-more.html; 112 statistics on physicians under 45 years old — practice setting, finances, future plans & more Written by Laura Dyrda; November 02, 2016
2017: (August 10, 2017) In a statement released by The Direct Primary Care Journal, the trend lines in 2017 related to Direct Primary Care (DPC) for example, reveal that the independent, solo physician is regrouping and possibly consolidating in its service line offering after two DPC groups announced their closures earlier this year . When asked, ‘Will DPC Stay Small? Grow Big? Optimism? What’s in store for Direct Primary Care?’ more than 13% of physicians are hopeful HSA and FSA integration inside DPC will occur to help patients pay for their monthly memberships. Additionally, nearly 18% of respondents to the online poll stated ‘I hope DPC Doctors Can Work/Partner With More Businesses to Save HC Costs …’ and nine percent noted ‘I hope to see the creation of DPC networks for Employer Use (sim. to MCOs) come into the market.’ Self-insured employers are beginning to show interest in the ways in which these models can improve health outcomes and contain costs according to several industry insiders.
2018: (January 2018) CMT, PHYSICIAN POLL, 2018: Does your Concierge Medicine Practice bill Medicare?
2018: (May 2018) Analysis, How Private, Concierge and Direct Care Doctors Are Taking A Lead In Ending Fees For Missed Appointments, Immunization Record Copies and a Copy of Their Last Sports Physical Form
2018: (June 1, 2018) Press Release, RANKED: Top 20 Web Sites In Concierge Medicine Revealed by Concierge Medicine Today, LLC. — 2018-2019
2018: (June 25, 2018) Press Release, ACEP, PHYSICIAN GROUPS: PRICE TRANSPARENCY MUST INCLUDE HEALTH INSURERS
2018: (June 27, 2018) New Study, MDVIP: The Grades Are In; Most Americans Score an ‘F’ on Fat IQ Test
2018: (Oct. 26-28, 2018) Concierge Medicine Today hosted the 2018 Concierge Medicine Forum in Atlanta, GA USA
2019: (March 6, 2019) Dr. Garrison Bliss writes a blog story entitled The Origin of DPC:Transformation, Simple Ideas, and Trojan Horses; Moving into Subscription medicine — Two of my partners from my original practice eventually left to set up MD2, the first monthly fee practice in the US. At $1000 per member per month, MD2 was also the first ridiculously priced primary care practice, so it attracted comments in the press about concierge care and boutique primary care. When I looked at financing an optimized primary care system, I was attracted to the monthly fee concept. Primary care is a fixed-cost business, so a monthly fee could replace the fee-for-service insurance model, with its foolish incentives and toxic costs. I calculated the lowest monthly fee that could support a 600-800 patient panel at $30-50 per patient per month (depending upon age). It worked both as a care model a
nd business model, so Mitch Karton and I launched the new Seattle Medical Associates in 1997, filling our practices in just over a year. Roughly 3 years later, I moved on to supporting a national movement through a board position in the American Society of Concierge Physicians, started by Dr. John Blanchard, which later became the Society for Innovative Medical Practice Design, and eventually the American Academy of Private Physicians.
2019: (Oct. 24-26, 2019) Concierge Medicine Today hosts the industry’s annual conference, the 2019 Concierge Medicine Forum in Atlanta, GA USA
2020: OFFICIAL, POSITION STATEMENT | Concierge Medicine Industry Leadership Share Their Opinions On the Critical Protocols and Best Practices Related to Resourcing and Distribution of COVID-19 Vaccine; April/May 2020
2020: (Nov 2020) Concierge Medicine Today hosts the industry’s first virtual conference due to the pandemic, the 2020 Concierge Medicine Forum in Atlanta, GA USA
2021: Survey shows zero percent pandemic closure rate for membership-based medical practices; March 12, 2021; Dr. Dean McElwain; Dean McElwain is co-founder, president & CEO of Castle Connolly Private Health Partners.
2021: MDVIP Named to Fortune 2021 Best Workplaces in Healthcare & Biopharma™; March 2021
2021: SignatureMD Completes Merger with Cypress Membership Medicine; March 31, 2021
2021: (Oct. 21-23, 2021) Concierge Medicine Today hosts the industry’s annual conference, the 2021 Concierge Medicine Forum in Atlanta, GA USA
2022: Aspiring “Docpreneurs” find solutions to industry challenges thru Concierge Medicine Today’s Online & in-person opportunities, guiding you & your practice in enhancing the patient experience— Join the DocPreneur Leadership Academy; January 2022
Did We Miss Something? Do We Need To Add Something?
Editor’s Note: This is by no means an all-inclusive, every single detail about all of the things that have occurred in this unique healthcare delivery space. It is a summary of many of the highlights however. When possible, we’ve tried to provide links to the stories, web sites, press releases, research, studies and organizations for you to learn more. We recognize a lot has happened in the past 20+ years. And, it’s virtually impossible to capture every moment in one document or on one page. As you may be aware, this document is routinely updated by Concierge Medicine Today, LLC., and is routinely edited, corrected and updated. If we missed something or you think we should add something, please, let us know by emailing us directly at editor@ConciergeMedicineToday.com. Thank you!
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