Healthcare delivery comes in many forms. The traditional independent primary care physician model, in which physicians see a number of patients each day and then bills insurance companies for their services, is somewhat transforming. Over the past couple of decades, two new models have risen in popularity: concierge medicine and direct primary care (DPC). While there are some similarities in the two, there are also a number of differences.
Both the concierge and the DPC models have as their core a membership fee paid by the patient, or sometimes the patient’s employer. Concierge practices may also bill the patient’s insurance company for covered services, while the DPC practice usually relies solely on the membership fees to cover costs.
Membership fees provide direct access to physicians in both models. When the physician is not relying solely on insurance reimbursements to finance the practice, the number of patients seen each day can be reduced, so the physician has more time to spend with each patient. In the concierge model, the membership fees may be slightly higher and the patients may receive increased access to their physician’s services.
A study cited by the AAFP and conducted by the Concierge Medicine Research Collective found that “people age 50 and older make up an increasing share of patients at most concierge practices.” Typically, these concierge services are more concentrated in states such as California and Florida, which have higher populations of patients over age 50.
Those concierge practices seeing Medicare patients or that are billing insurance companies in addition to the membership fee are subject to the relevant rules and regulations. DPC models that do not bill insurance are not subject to Medicare or insurance regulations. The DPC model is identified in the Affordable Care Act as an acceptable non-insurance option, but the concierge model is not.
In both models, patients enjoy the individual attention and communication they receive from their physicians. Physicians are better able to focus on patient care with fewer worries about practice management issues. An independent physician considering a transition to either model will need to weigh all of the pros and cons for the practice and for the patient before moving forward.