Summary: What are the latest trends with concierge medicine? What are the pros and cons associated from both a patient and physician perspective? How does the ACA play into concierge medicine?

How are healthcare trends affecting the future of healthcare? Is concierge medicine the answer? It is no secret that the physician shortage is growing in leaps and bounds, especially in terms of primary care. The creation of the Affordable Care Act has amplified the issue, adding more insured to the mix. The supply and demand ratio is completely unbalanced. As a result, both physicians and patients are looking for alternatives.

From a patient perspective, the average patient visit is approximately 15 minutes which is generally not enough time to properly be diagnosed and treated for a condition, especially if the condition is chronic. The conversation becomes focused primarily on an immediate illness or injury and little time to talk about any other concerns. When was the last time you tried to setup an appointment with your physician? Chances are the next available appointment may be several weeks or even months in the future.

From a physician perspective, there is frustration also with the very short window of time involved with each visit. It becomes a herd them in and herd them out mentality. The majority of physicians desire to have a relationship with their patients, to get to know them as a person, to properly diagnose and treat from head to toe. The emphasis is still currently on profitability obtained through volume. However, the focus is slowly evolving to a pay-for-value concept. The value concept should lend itself nicely to physicians spending more time with their patients. Physicians are also concerned with patient satisfaction scores which can be low when the patient can’t spend enough time with their physician to obtain the proper treatment, if they can even get an appointment. Don’t even get me started on the amount of paperwork and administrative time required to file insurance claims and follow up with denials, yet another area of frustration.

What options are available? One such option which is gaining in popularity is concierge medicine, sometimes referred to as direct medicine or boutique medicine. Originally this started as a model which catered to the wealthy. Well-to-do patients would pay a set amount per month or per year, sometimes as much as $25,000 per year, to have access to their physician, to be able to schedule appointments within 24 hours, and for cosmetic procedures, such as Botox, which are not generally covered by insurance. Additionally, some concierge medicine physicians will make house calls and / or actually accompany a patient, for example, to an appointment with a specialist.

Today, the costs of concierge medicine can be as low as $1,500 to $2,000 per year and can have advantages for both patients and physicians. It is important to note that these retainer fees are not all inclusive. You may have to pay additional for lab tests, diagnostic services, etc. From a healthcare spending perspective, there can be a cost savings. Physicians using this model can generally reduce their overhead, especially if they additionally opt not to accept insurance. There are fewer patients, less scheduling, and no billing. Consequently, generally less staff is needed so less money is spent on overhead. Billers and coders may be reduced or eliminated. Time doesn’t have to be spent on claim denial analysis, appeals, and the resubmission of claims. Additionally, and more importantly, physicians are able to spend more quality time with their patients, promoting better care – better treatment. Better treatment leads to better outcomes and may very well reduce hospital admissions/readmissions, which again is a cost savings to healthcare. Physicians are more satisfied with their work, feel as though they are really making a difference.

On the flip side for physicians, there are some drawbacks to concierge medicine. Generally, physicians make themselves available personally to their patients. There could be more of those 3:00 am calls. However, with the increased efficiency in scheduling and timeliness, most physicians using this model do not experience an increase in after hour calls. Additionally, this isn’t really a get rich now concept. Some physicians may even have a decrease in their overall revenue, but this can be counterbalanced with reduced stress and job satisfaction.

From a patient perspective, the ability to make an appointment and see your doctor within 24 hours may just be worth any additional costs. Spending time with your physician and getting to know him/her and to begin to trust your physician implicitly carries a lot of weight. The last time you went to the doctor, were you actually able to ask all of your questions and voice all of your concerns? Concierge medicine can include above and beyond actions from your physician. Perhaps you need to go see a specialist. Some concierge physicians will make the appointment and actually accompany you, to ease your anxiety and help you answer the questions you need to ask.

On the flip side for patients, the comfort insurance provides goes away. Additionally, some services may cost more with concierge medicine than they would have otherwise with insurance. Interestingly enough, some insurance companies also have concierge medicine in their plans, while others can be bundled with concierge and catastrophic policies. To find concierge medicine physicians in your area, you can do a Google search for “concierge medicine physicians “ or “direct medicine physicians” and include your city.

About BHM Healthcare Solutions – www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including healthcare transformation assistance, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.