Concierge Medicine Pros and Cons and a Little History

If you remember the time when physicians made house calls it was a period in American healthcare where the relationship between doctor and patient was both medical and economic. During the era of house-calls you received your services directly from your doctor and you paid for those services directly to your doctor. Along came the presidency of Lyndon B. Johnson and his “Great Society”. The Great Society This aspirational vision began the disconnect on payments for physician services t patient and doctor. In this new emerging aspirational society, everyone was going to have comparable healthcare and both the government and private insurance would be the payment intermediary between patient and doctor. The patients purchased health insurance or if they were senior citizens they purchased Medicare insurance to cover the costs of their healthcare needs. As this phenomenon emerged and expanded, a total disconnect occurred between the patient and the physician. The patient no longer understood the cost or the value of the service being received.

As we fast-forward decades from the Great Society to today, we have a new emerging unique relationship being developed between physicians who provide primary care services such as internists or family doctors and their patients. This new relationship is occurring within the more affluent socio-demographic who seek to have preferred status with their primary care doctor to ensure immediate access and physician availability. We are in a time of increasing physician scarcity and access to a doctor can be weeks or more away from the time the services are sought.  These physicians are experiencing a reduction in the reimbursements provided by the third-party payer (insurance companies) for the services they have historically provided. As a result, the physicians have begun to look for alternatives to seeing more patients and reducing the amount of time available to each patient. 

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The alternative that is emerging is that increasing numbers of well-trained primary care physicians are adopting a concierge medicine model. In this model, the physician caps the number of patients in his/her practice and receives an additional direct payment, in addition to the insurance reimbursement, from the patient. The norm for the average full-time primary care provider is to see between 1500-2200 patients annually. In concierge medicine, the number of patients seen by the physician is a sliding scale tied to the concierge payment made directly by the patient to the doctor. So what does concierge medicine cost? There are significant national groups that charge an additional patient payment, approximating $1800 annually, and the physician agrees to limit the number of patients in the practice to 600 patients. From this benchmark, there are practices that limit the number of patients to 50 patients annually and they are paid an additional $20,000 per year to have this very exclusive limited practice. Between these two extremes, there are a number of price points and patient numbered caps all along the continuum of concierge medicine.

In a unique way, you can think of concierge medicine as a throwback to the doctors who made house calls. The doctor provides much more hands-on direct access and the patient remunerates the doctor with an additional annual direct payment to have this accessibility. Do you really get good medical access with concierge medicine? The limiting factors that occur in this emerging concierge medicine model result from the fact that healthcare delivery has become much more complicated and specialized over the last five decades. Many of the illnesses that the traditional primary care doctor handled previously are now referred to specialist and subspecialists. In this scenario, the exclusive access that exists with the PCP dissolves when the patient moves on to the specialists. The specialists, not being tied to a patient cap, has a full waiting room and the patient is again thrown in with the masses seeking,Image result for notepad clip art this time, a specialized physician. Further, the PCP develops a referral pattern that may result in the specialists recommended not being uniquely qualified for the specific medical issue or event, but more, a result of familiarity or network connections. Further, the complications of the billing processes in medicine and the document known as Explanation of Benefits (EOB) still remain within the purview of the patient as most concierge physicians continued to bill their patient’s insurance company.   When you decide that you are in the market for a concierge doctor, you need to focus on the doctor’s skill sets, referral patterns, and ability to navigate with you through the complex healthcare system we have. Just purchasing access for primary care in the complex healthcare world may not satisfy the experience your parents and grandparents had with their doctor who made house calls.


There is a difference between concierge healthcare and concierge medicine. Which one are you really wondering about. 
Click the link below to get a whitepaper on the differences between concierge healthcare and concierge medicine. 

Filed Under: Insider, concierge medicine, concierge healthcare, why don't doctors do housecalls, changes in healthcare, lyndon by johnson, great society, pros and cons of concierge medicine

Healthpoints: Filling the Provider Void

In the recent past, the government was evaluating the concept of Medical Homes with Primary Care Physicians (PCPs) serving as the active navigator of their patient’s health care. This was an innovative theory; but in practice, it was highly unlikely to have a substantial impact on the delivery of care. At the same time as the government was proposing this solution to the conundrum of care availability, the reimbursements doctors were receiving for various services, procedures and tests were reduced. This reduction meant PCPs would have to see more patients to maintain a level of income commensurate with the sacrifices they have made in their lengthy education.


There was an interesting article on this week “NPs and PAs: Growing by Leaps and Bounds.”  The article indicated that while the number of physicians is increasing by over 1%, the numbers of Nurse Practitioners (NPs) and Physician Assistants (PAs) are growing even faster at a projected rate of 6.8% for NPs and 4.3% for PAs.  This influx of non-physician providers is another indication of the rapidly changing landscape within the American health system. This as another example of American ingenuity - to find solutions to complex problems while allowing an evolutionary process to occur.


NPs and PAs can spend more time with the patient. Their caseloads are designed for them to allow almost twice as much time with each patient as a physician would have. This leads to the patient having the ability to express their concerns more effectively as they feel less pressured during the visit. A recent study showed physicians tend to interrupt their patient every 3 seconds, while an NP would make a comment every 12 seconds. In the environment of an exam room, this level of attention is very helpful to creating a patient friendly atmosphere. In patient satisfaction studies, making the initial point of contact with an NP or PA is increasing patient satisfaction.


The increasing use of artificial intelligence as a diagnostic tool is also changing the way healthcare is delivered. Much like the automobile industry has changed. When you take your car in for service, it is astonishing how they plug-in a set of diagnostic tools and, with pinpoint accuracy, diagnose the problem. We are certainly headed the same direction in healthcare. With increasing miniaturization of technologies, phone applications are now possible. You can now take a two lead EKG with your phone and forward it instantly to a doctor.


Advances in diagnostic tools, combined with the increasing sophistication of NPs and Pas, are disrupting the old care delivery process in a positive way.


Good listening has always been the best diagnostic tool. Now patients will have more time to communicate their concerns. When you combine the time available to listen of the NPs and PAs with the technology breakthroughs that are continuing to emerge, patient satisfaction should continue to increase.


In no way does this change delivery or denigrate the fundamental role that physicians play in assuring that we are receiving the best healthcare possible. They remain the center of the delivery system around which all of these providers and new technologies revolve. This just allows more patients to be seen, and PCPs to be able to devote their time more effectively.


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Filed Under: healthcare quality, doctor shortages, patient satisfaction