Will ACA Be a Boon for Concierge Medicine?

By JENNIFER LUBELL amednews —April 15, 2013

Proponents of the model say rising patient demand will prompt more consumers to seek personalized care, but some conflicts with health reform rules might arise.

Mark Niedfeldt, MD, a family physician who practices concierge medicine in a Milwaukee suburb, is fairly certain he’ll gain new patients when the Affordable Care Act’s main coverage provisions go into effect in 2014.

Clients who recently joined the practice tell him, “I figure I should get in now because you’ll be full, and I wanted to make sure I had a concierge doctor,” said Dr. Niedfeldt, who runs a traditional retainer practice for individuals as well as a corporate option that offers eligible employees concierge-level primary care. He also sees sports medicine consults. Many of the new patients are business owners themselves, “so they know what’s coming,” he said.

Dr. Niedfeldt said the new patients are simply doing the math. An estimated 30 million additional patients will enter the insurance system starting in 2014, and based on the fact that many primary care doctors are nearing retirement age, consumers know there are going to be fewer physicians to treat them, he said. He has about 400 patients but is not quite at full capacity.

In concierge medicine, patients agree to pay an annual retainer fee in return for more personalized primary care services and better access to the practice. These physicians typically limit the number of patients they see to several hundred, and they don’t always accept insurance, although some continue to participate in Medicare or with commercial payers.

In Dr. Niedfeldt’s practice, individuals pay an annual retainer fee of about $1,800. But because he doesn’t offer more complex medical services, such as surgeries or cancer treatments, his clients may decide to carry high-deductible secondary coverage to pay for that care.

An increasing trend
Concierge medicine makes up a small but growing percentage of medical practices. The American Academy of Private Physicians, which represents concierge and direct care health professionals, estimates that there are more than 3,500 concierge physicians.

In surveying thousands of physicians for the nonprofit Physicians Foundation, Merritt Hawkins, a national consulting and search firm in Irving, Texas, recently reported that about 7% of respondents said they were planning to transition to concierge or cash-only practices in the next one to three years.

The model of care has its critics. Because the practices charge fees to maintain smaller patient bases, they have come under fire for their potential to limit access to care only to those who can afford them, possibly creating a two-tiered primary care system. The American Medical Association has taken a cautionary approach to the model, adopting policy that the practices “raise ethical concerns that warrant careful attention,” especially if they ever became widespread to the point of affecting access.

But the face of concierge medicine is changing along with the health system, said Mark Smith, president of Merritt Hawkins. It’s becoming more diverse, appealing to patients of different income levels and personal circumstances. “In the beginning, I think the marketing of these services were more to an elite group,” but over the years the model has evolved to a point that it varies widely in terms of what it costs patients and the types of people it attracts, he said.

On one end of the spectrum might be the corporate executive who pays $25,000 a year for a concierge doctor. At the other end might be the direct primary care practice, which charges a modest monthly fee in return for unlimited primary care services.

With so many practice models available, as well the market changes caused by health system reform, Smith predicts a growing interest in concierge medicine “and a larger number of physicians wanting to convert to the model. I think ACA is what’s going to take concierge care to the next level.”

Read the FULL STORY to find out what is the attraction to doctors and patients, and where some practices may come into conflict with the ACA.

CMJ- Private physicians are setting a new standard of care with direct pay and concierge medicine practices. Although additional fees are involved, the benefits to the right patients are innumerable. Many successful practices are now in the market which offer advanced levels of services at affordable rate to a large segment of the population. Information on concierge medicine and direct pay practices is growing and raising patient awareness that alternative methods for care are available. The internet is becoming a leading method for patients to explore concierge medicine and other alternative practices and to find a concierge doctor.

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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