Concierge Medicine: A Viable Business Model for (Some) Physicians of the Future?

Concierge medicine is a medical management structure that has been in existence since the 1990s. Essentially, a typical concierge medical practice limits its number of patients and provides highly personalized attention that includes comprehensive annual physicals, same-day appointments, preventive and wellness care, and fast, 24/7 response time. Concierge medicine has become popular among both physicians and patients/consumers who are frustrated by the limitations imposed by managed care organizations. From many physicians' perspectives, concierge medicine offers greater autonomy, the opportunity to return to a more manageable patient load, and the chance to improve their incomes that have declined because of increasingly lowered reimbursements for their services. From many patients'/consumers' perspectives, concierge medicine provides more immediate, convenient, and caring access to their primary care physicians and, regardless of their physician's annual retainer fee, the elimination of third-party insurance coverage costs and hassles. The major criticisms of the concierge medicine model come from some health care policy makers and experts, who believe that concierge medicine is elitist and its widespread implementation will increase the shortage of primary care physicians, which is already projected to become worse because of the Affordable Care Act's individual mandate, which requires everyone to have health insurance.Utilizing these topics as its framework, this article explains why concierge medicine's form of medical management is gaining ground, cites its advantages and disadvantages for stakeholders, and examines some of the issues that will affect its growth.

Physician Reimbursement: From Fee-for-Service to MACRA, MIPS and APMs.

To a significant degree, "healthcare reform" is a movement to change how both physicians and healthcare facilities are compensated, with value replacing volume as the key compensation metric. The goal of this movement has not yet been accomplished, but the process is accelerating. In this article, we track how the arc of physician compensation is bending, how the Medicare Access and CHIP Reauthorization Act will drive further changes to physician compensation models, and how these changes may affect physician practice patterns and physician staffing in the future.

Direct Primary Care: Practice Distribution and Cost Across the Nation.

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the "concierge" practice; and describe the model's pricing using data compiled from existing DPC practices across the United States. Lower price points and a broad distribution of DPC practices were confirmed, but data about quality are lacking.

Assessing the Patient Care Implications of "Concierge" and Other Direct Patient Contracting Practices: A Policy Position Paper From the American College of Physicians.

As physicians seek innovative practice models, one that is gaining ground is for practices to contract with patients to pay directly for some or all services-often called cash-only, retainer, boutique, concierge, or direct primary care or specialty care practices. Such descriptions do not reflect the variability found in practices. For the purposes of this paper, the American College of Physicians (ACP) defines a direct patient contracting practice (DPCP) as any practice that directly contracts with patients to pay out-of-pocket for some or all of the services provided by the practice, in lieu of or in addition to traditional insurance arrangements, and/or charges an administrative fee to patients, sometimes called a retainer or concierge fee, often in return for a promise of more personalized and accessible care. This definition encompasses the practice types previously described. The move to DPCPs is based on the premise that access and quality of care will be improved without third-party payers imposing themselves between the patient and the physician. Yet concerns have been raised that DPCPs may cause access issues for patients who cannot afford to pay directly for care. This ACP position paper, initiated and written by its Medical Practice and Quality Committee and approved by the Board of Regents on 25 July 2015, assesses the impact of DPCPs on access, cost, and quality; discusses principles from the ACP Ethics Manual, Sixth Edition, that should apply to all practice types; and makes recommendations to mitigate any adverse effect on underserved patients.