Is Concierge Medicine the answer to the primary care shortage?

Concierge medicine - boutique medicine - membership practice - retainer practice - personal medicine - direct care: no matter what you call it, the cash-pay practice is on the rise.

The Society for Innovative Medical Practice Design (SIMPD) has estimated there are over 5000 concierge practices in the US (up from 500 in 2005), and according to the CDC as far back as 2006, 11% of practices were cash-only (I assume this includes all specialties).

In the face of (1) a primary care physician shortage, (2) healthcare reform that is going to up the ante with numbers of insured patients needing doctors, (3) physician exhaustion and discouragement at the "primary care lifestyle" (seeing one patient every 8-10 minutes) and  (4) the focus on developing Medical Homes, I'm beginning to wonder if the concierge-style practice might be the answer!

Who wins with this model?

• the physician who is able to limit his or her practice to 600-800 families/individuals, provide care in a way that maintains the passion for doctoring, make an acceptable living and enjoy a reasonable lifestyle. Even though the numbers suggest that concierge physicians tend to make slightly less money than their counterparts in traditional practices, their quality of life appears to improve dramatically.
• the patient with a health savings account/high deductible insurance plan whose health is monitored closely and conveniently (?email consults ?phone consults - less risky when you know your patients well), who gets his or her questions answered thoroughly and whose out-of-pocket expenses my be reduced overall
• primary care as a specialty, as the options become much more attractive
• employers who help their employees invest in their health by making it possible for them to become patients of the Medical Home concierge practice
• those insurance companies that "get it" - that their next successful product isn't a plain vanilla health insurance policy. Instead it's designed to encouraged patients to engage in preventive care, absorb routine care costs themselves (with HSAs etc.), and opt instead for affordable coverage to pay for more costly and unexpected services

Of course, it behooves concierge medicine practitioners to use resources wisely, familiarizing themselves with evidence-based guidelines and avoiding the temptation to soak the rich with Presidential Physicals that include annual "everything is scanned and worked up" studies! And it will serve them well to pick up a few coaching skills -- the ones I wish I had truly had and used as a family doc in practice!

Is it the answer??

I'd love to hear your thoughts!

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Here are a few resources for those of you considering a cash or concierge-style practice:

1. Cash practice alternatives; considerations for physicians
2. Concierge Medicine: A Market Based Solution for the Primary Care Shortage?
3. The Difference Between Concierge Medicine & Direct Primary Care
4. Concierge Medicine Today
5. Concierge Medicine - by Dr Steven Knope
6. Legal Implications of Concierge Medical Practice for Health Plan Providers and Enrollees (take note; this is an evolving area)
7. Marketing your clinical practices: Ethically, effectively, economically by Neil Baum and Gretchen Henkel

PS: I forgot to mention the Entrepreneur magazine article ("A model for health-care reform: opting out") I came across today that sparked this post! When this topic gets heavy play in a lay publication like this, I get the sense it's a real topic of interest!

Comments

[Julie Munro]

Hi Philippa,

I so like the concierge medicine model for primary care. It just makes sense, doesn’t it? I think this is only the beginning of a change in how consumers access healthcare.

I believe the medical tourism “movement” is teaching a few lessons on consumer empowerment. Consumers are reaching out to access care away from home. This may be care that is hundreds or thousands of miles away but still in America, or hundreds or thousands of miles away in another country.

One thing we’re learning in medical tourism is the value of an “intermediary” between patient and hospital, even between patient and doctor. Ideally this is someone trained as a professional to work with the healthcare consumer, in the consumer’s best interests.

I have too many family members and friends who sat at their computers searching for solutions to their medical problems. I often wondered what happens to those people who are not college graduates, who work two jobs and don’t have the time for detailed google searches, who are older and don’t have the computer skills or support of relatives to help them find answers to treatment or care questions.

Who helps these people?

Given the wretched state of our healthcare system, we can’t ask doctors to take on this time-consuming extra workload. We can’t ask nurses either, though those who are not practicing nursing may be good candidates to be domestic “facilitators” if they still want to remain involved in care-giving.

Perhaps it’s time for a professional who is trained as a healthcare advisor and is engaged by the individual consumer or patient to work in the patient’s interest. This professional would be the patient’s advocate and representative. My bet is there would be less patient safety issues for those patients who retain such an advocate/representative.

When banks were deregulated, the financial services sector spawned the Certified Financial Planner. Why can’t we have a Certified Healthcare Planner or a Certified Medical Advisor?

[Susan Giurleo]

Hi Philippa,
Great ideas and much to think about.
As a psychologist I would love to work within a "medical home" model with primary care physicians to coordinate on cases that have a physical and mental health component. I know so many physicians have the desire, but not the time, to address mental health issues-even the minor ones of anxiety due to medical procedures, or depression related to pain, or psychosomatic ailments due to mental health issues
Also, the comment above regarding health care advocates is a wise. Many families hire educational advocates when their children have special needs and require complex educational interventions. Why not the same in health care?
It seems as the consumers costs for HC increase, new models and hybrids must emerge to maximize effectiveness and profit.
Thanks for advancing the discussion!

Susan

[Natalie Hodge]

Hi Philippa, You know how we feel about Direct Practice! The big questions here are technical and marketing. How does one implement practice, utilize emerging technologies to create value for your CUSTOMERS? How does one minimize one's risk in the process of transition? How does one maximize business ownership of the third party practice one has spent years building? How can you create value for a group of your existing customers? How can one monetize one's CONTENT within the context of medical practice? How can transparency of the medical record and participatory medicine improve value for consumers? Clearly the established HIT industry is spending 95% of their time iterating on the needs of the third party payors. The newest platforms are iterating on the needs of CUSTOMERS. Hope to chat again with you soon about some new developments at Personal Medicine.

The last question here is how does one eliminate 80% of one's overhead and run their entire practice off an Iphone, WITHOUT risking loss of their other bread and butter business?

That is what we have been working on...

and here is the Mission bit.ly/6XuuoS

Best,
Natalie
www.personalmedicineinternational.com

[Brandon]

I think it is a great solution for doctors that are looking to remove themselves from the grip of insurance companies and our backwards healthcare system. However, I don’t think it will be a solutions to our health care shortage.

I think that the concierge model is to healthcare the same way the Segway is to transportation.

When the Segway came out, people touted it as the next big thing in transportation; a solution to our congested roads and a potential liberation on our gas consumption, not to mention the ecological advantages an electric powered means of transportation affords.

Ten years later, the Segway has done little to change how we go about. It's too expensive and for the most part, impractical for the average consumer.

Sure, it serves a purpose for city tours, for cops to patrol cities, and zoo keepers to move about the zoo, but other than that, it realty doesn't have much use.

I think the concierge model has many similarities. Because the model is still pretty expensive for the average consumer, and can be impractical for specialties outside of internal med or family practice, it will only see life with a very small group of doctors and patients.

That is of course the model morphs into some sort of hybrid model in the future. But as it stands currently, I don't think it is the solution to our primary care shortage model. If anything, it will worsen the shortage problems because the concierge model limits the amount of patients a doc can manage.

If there is a shortage with the current number of docs, imagine if 50% of docs limit their practice to only 300 to 500 patients each.

@PediatricInc

[Akshay Kapur]

I like Brandon's analogy to the segway. Concierge medicine for the average consumer is still far away because the economics of limiting membership keeps costs high. Current self-pay patients are already connected to high-end specialists or family practitioners who've evolved into a concierge model without calling it that. The increased access is a must, providing follow-up after the initial 10 minutes the patient gets with their doc. Now that supply of patients will increase tremendously, increasing the patient panel and creating even more efficient workflows will be more a priority than limiting how many patients are seen.

I view concierge medicine as a signal. Both doctors and patients wanting more time to communicate . With the changing political environment, it may remain a signal until a more access-driven model comes along.