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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