Direct Primary Care, Direct Care and Concierge Medicine Defined
What is does Direct Care Group do and how is it different from concierge medicine? Or, more generally, what is direct care/direct primary care and how is it different from concierge medicine?
We receive this question frequently. Since
we are operating in a relatively new niche within a growing industry there are
many terms used to reference our business. A century or so ago, the automotive
industry was in a similar stage of development and their products carried many
different names. Automobile. Wagon. Cab. Motorcar. Jalopy. It's generally
understood that each of these terms is synonymous with "private, personal,
internal combustion transportation machine."
In the medical industry, references to
concierge medicine include: direct primary care, celebrity medicine, private
doctors, personalized medicine, private medicine, elitist-sounding phrases, or
direct care (as we prefer). Direct primary care
(or simply direct care) is just another term for concierge medicine.
A broad definition of concierge medicine
includes several key attributes. By any name, it is a format in which: doctors
see fewer patients; patient access to a doctor in person, by phone or email is
enhanced; an 'executive physical' is included; and patients are charged an
annual or monthly fee. Benefits to patients consist of a better relationship
with their doctor, more preventative medicine including wellness and nutrition,
and overall enhanced wellbeing as demonstrated by fewer trips to the hospital.
Physicians see an improved lifestyle, ability to focus on their craft, and
stability of income.
Within the current discussion and
nomenclature surrounding the product, there is little to no differentiation or
coherent brand identity. There is no standard for a "premium"
concierge offering nor is there a clear "entry level" version. In
fact, there is little product development or marketing outside of broad,
generic themes. As the industry grows, however, these types of distinctions
will become more and more apparent and dichotomies will evolve.
At present, the most easily identifiable
differentiator is price. Independent doctors charge from $1,000-$6,000 per year
per patient, MDVIP doctors charge $1,500-$2,000, and at the high end, MD
Squared charges about $50,000 per year per family. Features and benefits
generally trend with the expenditure to some degree. But... these practices are
indiscriminately referred to as concierge medicine, direct primary care, and
etc. regardless of price or offering.
Upon close inspection two major
distinctions emerge. Surprisingly (or not) they are rarely identified by how a
practice is referenced and neither is clearly explained or promoted.
First: Hybrid vs. Pure (Patient Conversion)
In most cases, a doctor will complete a
process whereby his patient base is solicited to join a new concierge
arrangement. In a pure practice, patients' options are to either continue on
with their current doctor in the new program with 24/7 access, same or next day
scheduling, longer appointments, wellness and nutrition, and more or to find a
new doctor. In the hybrid model, the doctor retains those patients which do not
wish to convert to the new format. While the ratio of hybrid to pure concierge
practices is unclear, the differences are not.
Consider a long, transoceanic flight with a
hybrid passenger cabin. Coach passengers are directed past roomy, premier
lounge chairs on their way to tight, upright seats. Imagine the same flight
attendants prioritizing between serving champagne flutes in first class and
stale peanuts in steerage. Hybrid concierge practices are the healthcare
embodiment of this system. In these practices, doctors are awkwardly juggling
two classes and a large number of patients. While concierge patients get a
special contact number, they cannot truly get the same quality of care as in a
pure model since their doctor is still seeing upwards of 1,000 patients.
In pure practices, a clear distinction is
made upon conversion that a doctor's practice is at once a concierge practice.
Each of her patients receives the same treatment and no uncomfortable jockeying
takes place at the office. Each patient has 24/7 access and the doctor does not
have to make the precarious - and ethically questionable - judgment call of the
urgency of a patient's condition versus their established payment arrangement.
Second: Insurance (Revenue Streams)
Not all concierge bills are built the same.
Some concierge doctors rely on private insurance and Medicare for a portion of
their revenue. By taking insurance, they may also be subjecting their patients
to co-pays and co-insurance. When reviewing an annual $1,800 fee, it may be
easy to overlook the additional per visit fees and find it a bargain compared
to a $3,000 sticker price.
Health insurance (as it exists today) in
concierge medicine complicates the relationship for patients and increases
financial and regulatory risk for doctors. As Washington changes the face of
healthcare delivery (including Medicare's inclusion of executive physicals as a
covered expense) the window for concierge doctors to find revenue outside of
direct patient billing is closing. This means one of two things: doctors out of
business or hefty rate hikes for those practices relying on insurance
reimbursement.
Like price point, hybrid/pure and insurance
factors create divergent experiences, yet practices across the spectrum are
collectively referred to as concierge medicine, private medicine, direct
primary care, etc.
Conclusion
In practice, we at Direct Care Group define
direct primary care (or direct care) as a concierge medicine experience where
each patient has the potential for the same direct relationship with their
health care providers. Patients have enhanced access, are given the time
necessary for quality treatment, and receive whole-lifestyle care of a primary
care physician and his team. Our doctors' all-inclusive fees are moderately
priced, their offices are pure concierge practices, and we do not require
insurance for visits.
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