Also known as retainer medicine, concierge medicine is a relationship with a patient and their primary care physician where the patient pays an annual fee known as a retainer. This may or not be in addition to other charges for services. In exchange for this retainer, doctors provide care and a commitment to limit patient loads to give them the proper time and availability needed. Gone are the days of hours waiting in a waiting room or an exam room for a doctor. This ensures they are a priority for their doctor. Ultimately, the level of service provided and the fee charged will vary with the structure and payment requirements of a concierge medicine practice. The origins of this medicine business model are often traced to MD International in 1996 in Seattle by Dr. Howard Maron. However, Dr. Maron himself did not invent the term we know as ‘concierge medicine.’ Today, the number of American doctors practicing this type of medicine is still relatively low.
Types of Business Models Associated with Concierge Medicine
Generally, there are three different types of concierge medicine business models. The first, Fee for Care (FFC) is an annual retainer model where the patient will pay a monthly, quarterly or annual retainer fee to the physician chosen. This retainer fee will cover most of the services provided in the office throughout the year. Lab work, x-rays, vaccinations and other services most likely will be excluded and charged separately on a cash basis.
Similar to the FFC model, the Fee for Extra Care (FFEC) model is when additional services are charged to Medicare or the patient’s insurance instead of cash. Some of the benefits are that they get same day access to the doctor of their choosing, immediate communication through phone and text messaging with the doctor, unlimited visits with no or little co-pay, little or no waiting, a focus on preventative care (perhaps the most valued part of this model for patients), a variety of consultation options, prescription refills and convenient appointment scheduling overall.
FFC or retainer plans may not be purchased with pre-tax dollars with one’s HSA or FSA accounts because this is not a fee that was incurred because of a service, it is a service being purchased. This is a type of insurance policy per say where fees are paid in advance of an expense.
Another concierge medicine model is one where physicians charge a quarterly,
monthly or annual retainer or “membership fee” for services that insurers or Medicare will not cover. Some of these things include (and are not limited to):
- Prolong visits
- Annual physicals
- Email access
- Phone consultations
- Comprehensive wellness plans
For all of the covered services, the provider will bill the insurer or Medicare for services and visits that are covered by the plans. This model allows the doctor to continue to see the non-retainer patients while providing their concierge ones a fee for special services. Many concierge practices are cash-only and do not accept insurance in any way. This helps the practice keep overhead and administrative costs very low, which allows them to provide affordable healthcare to their patients.
This type of physician cares for fewer patients than those in a conventional practice. This allows them to be able to provide more direct and personalized care to fewer patients. Annual fees will vary for this service depending on if an individual is enrolling or a family. The higher-price retainer price generally will include most covered services where the patient isn’t charged any additional fees for most services. Some of the biggest benefits of this type of healthcare is access to your doctor almost immediately and in-home visits (some concierge doctors have begun to offer this for younger and older patients alike).
One study showed that 2/3 of all concierge physicians were internal medicine specialists and the second popular doctor type was those in family practice. Pediatric and dental concierge practices are increasing too.
The American Medical Association is just beginning to track the number of practices like this because the concept is so new, so there is very little information or statistics available. Lower-cost concierge medical business models have been attempted before with a retainer fee that is dependent on one’s age.
Understanding Direct Primary Care
DPC or direct primary care is a term that is often linked to concierge medicine. While the two terms are similar, concierge medicine encompasses several business models with direct primary care being just one of them. Ultimately, DPC goes for a direct financial relationship with patients while providing both comprehensive and preventative services to patients of all ages.
This type of practice removes one of the financial barriers associated with assessing care when it is needed. This annual fee includes most or in some cases, all services from the physician chosen. This model doesn’t rely on insurance deductibles, co-insurance fees or co-pays in contrast to 1 on 1 MD services.
This mass-market version of concierge medicine is different because of its low price. The biggest difference between this and retainer medicine is that the DPC model takes a flat rate fee where other models charge an annual retainer fee.
Shortage of Physicians
The Association of American Medical Colleges reports that the United States will face a shortage of over 91,500 physicians by 2020. This is because the Affordable Care Act will expand coverage to over 30 million Americans in the next decade leading to a demand for service. The total number of official visits will grow exponentially in this time too. This means that concierge medicine will be an excellent choice for those seeking medical care that is focused on them and not a waiting room for hours for basic services.
This type of service is designed to fit both a patient’s lifestyle and unique medical needs. This type of practice focuses on serving each patient in a way that meets their schedules and their health needs. With an annual retainer fee, you receive:
Some advantages of concierge medicine are:
For physicians, this model allows them:
Ultimately, concierge medicine isn’t a one-size-fits-all model. However, it does have patients who want a more personal experience with their physician and for doctors who want less overhead. Patients appreciate having the chance to supplement their existing insurance coverage with a premium, subscription-based service that is convenient for their lifestyle and health needs.